Transcript for CDC Telebriefing: New Vital Signs Report - Why is youth e-cigarette advertising harmful for youth?

OPERATOR: Welcome and thank you for standing by.  At this time all participants are in a listen only mode.  At that time please to ask a question over the phone lines press star 1 over the phone and record your name at the prompt.  This call is being recorded, if you have any objections disconnect at this time.  I would like to turn it over to Kathy Harben.

KATHY HARBEN: Thank you all for joining us today for the series of a new CDC Vital Signs, this one on the exposure to e-cigarette advertising among middle and high school students.  We’re joined today by the director of CDC, Dr. Tom Frieden, as well as Dr. Brian King, K-I-N-G, deputy director for research translation in CDC's office on smoking and health.  I’d like to turn the call over now to Dr. Frieden. 

DR. FRIEDEN: Good afternoon, everyone. Thank you for joining the call. This is Tom Frieden.  CDC works 24/7 to protect health, safety and security. One of the things that we do is to identify health threats and work to address them. This Vital Signs report contains important information on youth and their exposure to e-cigarette advertising. Let me give you the bottom line.  In 2014 more than 18 million middle and high school students saw e-cigarettes ads in retail stores, on the internet, on TV or movies or in newspapers or magazines. This is important because research shows that advertising for conventional tobacco products, such as cigarettes, is causally related to youth tobacco use and e-cigarettes ads use many of the same themes that conventional cigarette ads used for decades to get a generation of American kids hooked on tobacco. Therefore, exposure to these e-cigarette ads may contribute to youth e-cigarette use.  It’s important to clarify at the outset we're talking about e-cigarette use in kids and e-cigarette advertising that kids see.  For adults who use e-cigarettes and quit using conventional cigarettes completely and forever they would be a benefit, but any potential benefit for adults is negated if the adult continues to smoke regular conventional or combustible cigarettes even just a few a day and there is never a benefit for use of e-cigarettes or any form of tobacco product or nicotine in kids. We’re concerned about youth e-cigarette use, especially because e-cigarettes contain nicotine. We want parents to know that use of nicotine in any form is dangerous. There is one definite danger and two likely dangers. The definite danger is that nicotine is highly addictive, that means it will lead to cravings and a physiological need to obtain more nicotine. It is an addictive substance and we want every child in America to reach adulthood not addicted to nicotine or any other addictive substance.

Second, use of e-cigarettes may harm brain development. There is increasing scientific evidence that suggests that the changes it makes to how the brain works may be long lasting or even permanent. And third, use of e-cigarettes in kids appears increasingly likely to result in an increased risk of using regular cigarettes.  If a kid gets -- uses e-cigarettes and gets addicted to nicotine, the likelihood that they then go on to smoke regular cigarettes later in life may well be higher than it would have been otherwise. Today’s Vital Signs report uses data from the national youth tobacco survey which was collected in 2014. We asked kids, students, if they see ads for e-cigarettes on the internet, in retail stores such as supermarkets and gas stations, on TV or in movies and in newspapers or magazines and we found that more than two-thirds, about seven out of every ten middle and high school kids had seen these ads in at least one of these sources. This is important because tobacco advertising entices youths to use tobacco.  Really the e-cigarette advertising we're seeing is like old time wild west, no rules, no regulations and heavy spending advertising the products.  In fact, advertising spending by e-cigarette companies increased dramatically between 2011 and 2014. 

E-cigarette ads use many of the same themes used to sell cigarette and other tobacco products; independence, rebellion, sex.  During the time spending increased there has been an increase in e-cigarette use by youth.  I would draw your attention to the figure that you see in the Vital Signs that we've distributed that shows a pretty tight correlation between the dollars spent on e-cigarette advertising and recent cigarette use by youth. In fact, in 2014 e-cigarettes became the most used tobacco product among youth surpassing conventional cigarette use with use increasing in high school students astonishingly, nearly tenfold between 2011 and 2014. From 1.5 percent to 13.4 percent. Whatever people think about e-cigarettes for adults, I hope we can all agree that kids should not use e-cigarettes or any form of tobacco or nicotine. We want parents, healthcare workers, public health practitioners and policy makers around the country to know that kids are vulnerable to e-cigarette ads and they're seeing them in their communities and daily activities as they go about their life.  We can work together to reduce exposures.

States and communities can fund tobacco prevention programs at the CDC recommended levels to prevent youth use of all tobacco products. Presently states spend less than 2percent of the revenue they get from tobacco taxes and settlement payments on tobacco prevention and control. Less than two pennies out of every dollar that they receive. States and communities can also work to limit where and how tobacco products, including e-cigarettes, are sold to reduce e-cigarette use as well as ad exposure. This could include requiring that cigarettes are only sold in certain ways such as through face-to-face transactions and limiting sales to facilities that don't have youth present. There are a number of efforts under way in the federal government as well including research and surveillance, our own support for state tobacco control efforts, the food and drug administration's development of new regulations. And outside of government parents and other influencers of youth and healthcare workers also have important roles to play. They can talk to kids about e-cigarette use.

Too many people don't realize that e-cigarettes are tobacco products and they contain nicotine. They are addictive. They are not harmless. We need to counsel people about the dangers of nicotine and we can also play an active role in deciding which websites and media kids view and discuss content with them. There is clearly a lot of work to do on this important issue, it affects the health of our kids and the next generation.  If you look at what's happened in recent generations there has been since the mid '80s a steady decrease in tobacco use among kids. This increase in e-cigarette use risks undermining the progress that we made in the '90s and over the past 10 to 15 years reducing youth smoking.  Before we start taking questions I’d ask Brian King of our Office of Smoking and Health to give additional details about today's report. 

BRIAN KING:  Thank you, Dr. Frieden.  The Vital Signs reports we are releasing today is based on data from the 2014 national youth tobacco survey, which is an annual survey that included over 22,000 students in grades 6 through 12 in 2014. We found the retail stores were the largest source of e-cigarette ad exposure, more than half of all middle and high school students or about 14 million students saw e-cigarette ads in retail stores. Nearly two in five middle and high school students or more than 10 million students saw e-cigarette ads online and more than one-fifth of all middle and high school students or more than 4 million saw e-cigarette ads in all four of the sources we assessed in this survey. We also analyzed the data according to sex, grade and race/ethnicity of the students.  By sex, exposure to e-cigarette ads on the internet and newspapers and magazines was higher among females than males, and by race/ethnicity it was higher among Non-Hispanic white students than Non-Hispanic Black students.  By grade exposure to e-cigarette ads generally increased as grade level increased for all sources.

A question you may be asking is do we know e-cigarette ad exposure causes youth to use e-cigarettes. The answer is today's report doesn't specifically examine the exposure through the advertisement and use, however, we have three reasons for concern. We have decades of evidence that advertising causes youth to try smoking and to continue smoking. We also know from years of research that the more tobacco ads kids see the more likely they are to use tobacco. Second, the situation is compounded by the fact that e-cigarette online vendors are using social network services to heavily market their products and many online vendor websites are very easy for youth to enter and make purchases. An example of this was found in a recent study that found that more than 60 percent of e-cigarette websites only require users to click a pop-up or dialogue box to verify age while one-third had absolutely no age verification process. Third and finally, this unfettered marketing of e-cigarettes coupled with the rising use of these products among youth has the potential to compromise decades of progress we've made in preventing and reducing the social acceptability of tobacco use among the nation’s youth. 18 million of our youth are being exposed to e-cigarette ads and everyone has a role to play to reduce youth exposure to advertising and youth use of e-cigarettes. 

KATHY HARBEN: Thank you very much, Dr. King and Dr. Frieden.  Operator, we are now ready for questions. 

OPERATOR: We will now begin the question-and-answer session. To ask any questions over the phone lines please press star 1 on your phone, unmute your phone and record your name at the prompt. To withdraw your question press star 2. One moment, please, for incoming questions. 

OPERATOR: Our first question comes from Sheila Kaplan with Stat. 

SHEILA KAPLAN: Thank you. I’d like to know, Dr. Frieden, how -- whether you think that the role that FDA has been working on will include measures that will address these issues? 

DR FRIEDEN: Regulations are really up to the Food and Drug Administration. What we're doing here is providing information on what's happening in this country and what's happening is widespread marketing of e-cigarettes that kids are seeing. More than two-thirds of kids in middle and high school are seeing e-cigarettes, that's 18 million kids, and that's the concern that we're flagging here. 

SHEILA KAPLAN: Have you spoken to OMB about this? 

DR. FRIEDEN: We certainly share our findings throughout the U.S. Government as we share them with the public and the media. 

SHEILA KAPLAN: Thank you very much. 

OPERATOR: Our next question comes from Dan Childs with ABC News. Your line is open. 

DAN CHILDS: Thank you very much for taking my question.  You know, sort of extending on what you were just talking about, the strategy for dealing with e-cigs has been largely reactive and I know that this is more of a regulation issue, but as a large health body how might -- how do you see this experience leading to more effective regulation of nicotine on the front end to essentially, I guess, curb this sort of new venue of nicotine use before it starts? 

DAN CHILDS: Well, I think we have to start with understanding, and the understanding is that e-cigarettes are tobacco products, they contain nicotine, nicotine is addictive and kids should not be on addictive substances. It’s fairly straightforward. What we're seeing is a very widespread marketing and correlated with that marketing the number of kids seeing e-cigarettes and using e-cigarettes. 

DAN CHILDS: Thank you. 

OPERATOR: Our next question comes from Andrew Siddons with "Congressional Quarterly." Your line is open. 

ANDREW SIDDONS: Thank you. I know you can't speak for the FDA, but is there anything for the government to do like they have with conventional combustible cigarettes to ban e-cigarette advertisements from television and radio at least like has been, you know, law for 40 years? 

DR. FRIEDEN: It's really up to the regulatory agencies to decide what are the most feasible and effective strategies to regulate tobacco product marketing. 

ANDREW SIDDONS: Thank you. 

OPERATOROUR: Next question comes from Mike Stobbe with "Associated Press."  Your line is open. 

MIKE STOBBE: HI.  Thank you for taking the question. Dr. Frieden, you refer to a dramatic increase in the amount that was spent on e-cigarette advertising from 2011 to 2014. What figures are you referring to? What were those numbers? 

DR. FRIEDEN: Actually, I was referring to the increase in e-cigarette use by high school kids which went from a little over 1 percent to 13 percent. 1.5 percent in 2011 to 13.4 percent in 2014. It's worth noting that the advertising figures for e-cigarette use also increased more than tenfold from 6.4 million in 2011 to 115 million in 2014, however, even those figures greatly understate the amount of e-cigarette advertising there is because there's so much that's viral, on the internet or placement in stores that's otherwise difficult to monetize and capture. 

MIKE STOBBE: Okay. Where did you get those figures, 6.4 million and 115 million? 

DR. FRIEDEN: That is from Brian King who will discuss them now. 

BRIAN KING: Yes.  So the figures come from varying different sources. The first was the earlier figures for 2011 and 2012 were from an article published in the American Journal of Preventive Medicine and then the more recent estimates for 2013- 2014 were from a report published by the Truth Initiative, which released a study on e-cigarette advertising expenditures that they obtained from their sources that monitor industry influences. 

MIKE STOBBE: Thank you. 

OPERATOR: Once again, if there are any questions over the phone lines please stress star 1 on your touch tone phone, unmute your phone and record your name at the prompt. 

DR. FRIEDEN: Okay. I want to thank everyone for joining us today and also thank the team here who worked on this very important report and emphasize the bottom line here.  Kids should not be using e-cigarettes and yet two-thirds of kids in this country are seeing e-cigarette ads, e-cigarette use is increases rapidly just as exposure to advertising is increasing rapidly.  More than 18 million youth see e-cigarette ads and many of those ads use themes from cigarette ads that appeal to youth.  We risk two decades of progress reducing youth smoking in this country. We’ve seen substantial declines since the early 1990s and those declines are at risk if more and more kids become addicted to nicotine. So thank you all very much for joining us. 

KATHY HARBEN: Thank you, Dr. Frieden and Dr.  King, for joining us today, as well as reporters on the line. If you have follow-up questions please call the CDC press office at 404-639-3286 or you can e-mail media@cdc.gov. We will also post a transcript later in afternoon on the CDC newsroom website. Thank you for joining us. This concludes our call today.  

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES