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Fifty Years After First Surgeon General Report on Smoking, E-Cigarettes Pose Latest Threat to Public Health

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This week marks the 50th anniversary of the first Surgeon General's report on smoking and health -- an occasion for recognizing both how far we've come and how far we have yet to go in fighting to end tobacco-related disease and death. Since 1964, significant domestic policy reforms have helped to lower tobacco use in this country, especially for young people. Within one year of publication of that report, Congress passed the Cigarette Labeling and Advertising Act of 1965 -- the first-ever federal law in the United States to require health warnings on cigarette packaging. As the result of the concerns raised regarding secondhand smoke in the 1972 report , Connecticut became the first state to pass a law to apply smoking restrictions in restaurants. Perhaps the most significant advancement in federal public policy related to responding to the threat of tobacco came from the Family Smoking Prevention and Tobacco Control Act. The Tobacco Control Act has eliminated the ability of cigarette manufacturers to advertise to children, to make unsubstantiated health claims about their products, and to downplay the life-threatening risks of cigarettes through inadequate warnings.

However, the promise of the Tobacco Control Act has remained largely unfulfilled while novel tobacco products threaten to provide new gateways to nicotine addiction and tobacco use for youth in America. Effective regulation of cigarettes has led to fewer young people starting to smoke cigarettes, but the widely unregulated market for other tobacco products with flavors that appeal to children like vanilla, grape, and bubblegum, has led to an increase in popularity of other products like cigars, hookah, and smokeless tobacco.

The new threats do not stop with tobacco-based products. New technologies and new marketing strategies have created a burgeoning market for e-cigarettes. The Centers for Disease Control and Prevention recently found alarming rates of e-cigarette use among middle and high school students. The growing popularity and health concerns associated with e-cigarettes have led to some major cities, such as Chicago, considering laws that would regulate e-cigarettes similar to how the city currently regulates conventional cigarettes. This proposal was met with opposition from those who dismiss e-cigarettes as products that present little or no risk. They claim e-cigarettes are a great way for smokers to quit smoking without exposing innocent bystanders to hazardous vapor.

What they don't tell you is the impact that e-cigarettes are having on people who have never smoked before. Between 2010 and 2011, the number of U.S. adults who have tried e-cigarettes doubled. From 2011 to 2012, the percentage of high school students who have ever used e-cigarettes more than doubled from 4.7 percent to 10 percent. More than 20 percent of the middle school students who reported using e-cigarettes said they had never tried traditional cigarettes. Despite the increase in popularity, the truth of the matter is that we don't really know what's in these products and what long-term impact they will have on people -- young and old -- who pick up the habit and potentially become addicted.

A 2009 analysis by the Food and Drug Administration (FDA) found significant quality control issues with e-cigarettes. They discovered carcinogens and toxic chemicals in some, a variation in the dose of nicotine per inhalation in others, and the presence of nicotine in products that were claiming to be nicotine-free. This analysis raises valid concerns about the health risks of e-cigarettes for users and bystanders who inhale the vapor. Despite this obvious cause for concern, until the FDA begins regulating these products, e-cigarette companies won't be held responsible for what's in their product, the claims they make and the impact it is having on non-smokers.

If these companies want to market their products as a safe alternative to smoking, they should be subject to rigorous FDA scrutiny. Oversight and regulation are the only way to know the true nature of these products and the only way to ensure that today's youth are not subject to the same deceptive practices that were supposedly relics from the past.