Why do teens still smoke? On addiction, advertising, and the rise of e-cigarettes

U.S. teen smoking rates have dipped below 10 percent, but public health advocates worry that progress may soon level off, as other surveys suggest teens think light smoking is safe, and e-cigarette use is on the rise.

“The real public impact is preventing teens from smoking— that remains the key, and one of the things that the furor over e-cigarettes can do is distract you from that debate,” Amy Fairchild, professor of sociomedical sciences at Columbia University, told FoxNews.com.

Why teens smoke at all is a question that public health advocates have been scratching their heads over since the 1960s— when a U.S. Surgeon General’s report exposed the health risks of smoking— and even more so since the 1970s, when the federal government set strict marketing rules that made it tougher for tobacco companies to target minors.

According to a 2014 survey of 40,000 to 50,000 students in eighth, 10th and 12th grade, 8 percent of teens at 400 secondary schools in the United States reported smoking cigarettes in the month prior to answering the questionnaire. The findings, from the University of Michigan’s Monitoring the Future study, presented the lowest teen smoking rates since the study was first conducted in 1975.

But a separate survey of almost 25,000 teens in grades six through 12 suggests that many teens think light smoking is safe. The findings, from the 2012 National Youth Tobacco Survey and published December in the journal Pediatrics, found that only 64 percent of the teens surveyed knew having a few cigarettes a day is very harmful.  And only 33 percent of the study participants knew that intermittent smoking on some days, but not every day, was unhealthy.

“Kids accept and know that heavy smoking is really, really bad for you, but what they’re not so aware of is that light and intermittent smoking is also really bad for you,” Robin Koval, CEO of anti-smoking nonprofit Legacy, who wasn’t involved in either study, told FoxNews.com. “They think it’ll be easy for them to quit later on, but once your brain gets that taste of nicotine, it actually won’t.”

According to the National Institutes of Health (NIH), smoking is the leading cause of preventable death in the U.S. Tobacco smoke contains 250 known harmful chemicals, 69 of which can cause cancer. The Centers for Disease Control and Prevention (CDC) estimates that 443,000 people die prematurely from smoking or secondhand smoke, and that another 8.6 million live with a serious illness caused by smoking.

A biological vulnerability

With easy access to statistics such as these on the Web and social media— not to mention a recent health movement that hails CrossFit and green juice as trendy— answering the question of why teens still smoke is made even tougher.

Biology is partially to blame, said Christian S. Warren, a history professor at Brooklyn College who focuses on human habits, cultural history, and the history of medicine.

“Brain science is showing us about the levels of sophistication that adolescents have about measuring and assessing risk and long-term consequences— these are parts of the brain that don’t develop until the 20s,” Warren told FoxNews.com.

Studies show that nicotine, which stimulates feelings of pleasure, chemically alters the adolescent brain. Koval said these changes make the organ more susceptible to nicotine as teenagers grow older.

Few people start smoking after age 25, according to the American Cancer Society. A 2012 U.S. Surgeon General’s Report showed that 99 percent of adult smokers first smoked by age 26, and about nine out of 10 adult smokers had their first cigarette by age 18.

Teens have always been an ideal target for cigarette makers due to these developmental vulnerabilities that compel them to smoke and get them hooked, Warren said.

That was true in the 1980s, when R.J. Reynolds launched its now-infamous “Joe Camel” marketing campaign, Warren said. The ads took the form of wall posters and graphics on T-shirts to sidestep federal rules that prohibited marketing cigarettes directly to teens. In them, a cartoon camel donned a leather jacket and black sunglasses in ads while smoking a Camel cigarette.

Joe Camel appealed to teens who sought to rebel, and his themed garb was “ubiquitous,” Warren said.

Dissecting pop culture and unveiling tobacco companies’ marketing tactics is at the heart of Koval’s group, Legacy. Legacy has run the well-known “Truth” campaign for the past decade and a half. Their newest ads feature electronic music with flashing images of celebrities like Rihanna and Orlando Bloom with cigarettes hanging out of their mouths and text overlay: “UNPAID TOBACCO SPOKESPERSON.”

“We have a tobacco industry that is spending $9 billion a year marketing their products—we don’t need to give them a dime more,” Koval said.

Kurt Ribisl, a health behavior professor at the University of North Carolina at Chapel Hill (UNC), pointed out that social media makes regulating advertising to teens more challenging.

“One of the things that’s hard to discern with social media is, ‘Who is a fan of a product versus a tobacco company [advertising itself]?’” Ribisl, who sits on the Tobacco Products Scientific Advisory Committee, which advises the FDA on tobacco-related matters, told FoxNews.com.

The rise of e-cigarettes

“There are no regulations for e-cigarettes on social media,” Ribisl said. He and a team of researchers at UNC are studying how e-cigarettes are promoted on Twitter, and their results will be published within the coming months.

Ribisl noted that while cigarette advertising has been banned, e-cigarette commercials appear on TV and he’s unaware of any restrictions on the product.

E-cigarettes are electronic, battery-powered devices that contain vaporized nicotine but not tobacco. Users inhale the vapor and release a plume of smoke, an act that is meant to simulate smoking a traditional cigarette. U.S. tobacco companies didn’t create them. E-cigarettes use stems from China, where the industry has reportedly peaked.

“The advertising is certainly working very hard to make [e-cigarette smoking] glamorous and sexy, and the numbers that we’re seeing certainly suggest that for a lot of young people, it’s a new, trendy, cool thing to try,” Koval said.

Warren said that while e-cigarettes are not as easy to use as traditional cigarettes— a factor that played a major part in their popularity in the 1920s— their novel nature make them appealing to certain demographics.

“My sense is they have a stigma to them,” he said, “but I think that as long as we have nicotine addicts, I think we’re at a fairly good risk that these devices are going to overcome that stigma because they’re delivering the drug that needs to be delivered.”

Some organizations, including the American Heart Association, have formally stated that e-cigarettes may provide a low-risk nicotine replacement therapy for smokers trying to kick the habit. If that’s the case, e-cigarettes would fall into the same category as the nicotine patch or gum.

The Food and Drug Administration’s (FDA) Center for Tobacco Products is in the process of reviewing nearly 135,000 comments on proposed regulation for e-cigarettes in the U.S., which was submitted in April, according to Legacy. Before the FDA can approve legislation, it must review these comments— many of which tobacco companies have submitted.

But, for now, a lack of research confirming the precise health risks of e-cigarettes, as well as a lack of manufacturing regulation, concerns many public health experts.

That 16 million children can legally purchase e-cigarettes concerns many experts.

“If it was just a question of adults, I think this would be less controversial,” said Fairchild, the Columbia University professor. Fairchild co-authored a paper published Thursday in the journal Science that presents both sides of the e-cigarette argument: the case for strict regulation based on lack of research, and another more lax, innocent-until-proven-guilty approach to regulating the devices.

In an interview with FoxNews.com, Fairchild said that e-cigarettes may be able to help teens quit smoking, but that decision would need to be made only after more conclusive evidence that proves they are an effective stop-smoking tool is gathered.

In December, scientists in Britain and New Zealand published a Cochrane Review of e-cigarettes in an effort to figure out whether the devices could be used as a harm-reduction alternative to tobacco cigarettes. A Cochrane Review is meant to whittle down existing research only to the strongest, most legitimate studies. Of the nearly 600 papers examined, only 13 were up to the Cochrane standard. Only two were randomized, controlled trials, which is the strongest measure.

“Certainly, there has to be a ban [for teens],” Fairchild said. “You’re not going to find anybody— not even e-cigarette companies— that disagrees.”

Regulating teens’ access to e-cigarettes

According to the Monitoring the Future study, 2014 was the first year that more teenagers reported using e-cigarettes than cigarettes. Of those surveyed, 9 percent of eighth graders reported using an e-cigarette in the past 30 days, compared to 4 percent who reported using a tobacco cigarette. Respectively, those numbers were 16 and 7 percent for 10th graders, and 17 and 14 percent for 12th graders.

“The lax regulations that are in place at the local, state and federal level make it so that e-cigarettes are cheap, readily available and come in flavors that are appealing to youth,” said Ribisl, the tobacco marketing expert at UNC. “It’s really no surprise that we’re going to see a big uptick with this product.”

E-cigarette starter kits can run from $40 to $100, while 30-millimeter cartridges sell for $15 to $20, estimates show. A year’s worth of e-cigarette nicotine cartridges is about $600, compared with $1,000 annually for a half-pack a day of regular cigarettes.

While every U.S. state has imposed a tax on traditional cigarettes, only two states— Minnesota and North Carolina— tax e-cigarettes.

“Raising taxes is probably the gold standard for tobacco control policy,” Ribisl said. “It’s the thing that reduces tobacco smoking more than any other policy lever that can be pulled.”

According to the CDC, 10 states currently allow minors to buy e-cigarettes. Those states are Maine, Massachusetts, Michigan, Montana, Nevada, New Mexico, North Dakota, Oregon, Pennsylvania and Texas.

In one of the most comprehensive papers on e-cigarettes, published in August in the journal Circulation, researchers at the University of Louisville argue for a tax plan based on differentials. Such a plan would include a higher tax on e-cigarettes for youth and combustible products— those that require the burning of tobacco leaf and are seen as the most dangerous type of smoking product— being taxed at the highest rate.

“E-cigarettes are less dangerous, but they’re still harmful,” Ribisl said. “The approach to regulation, I think, seems reasonable to reflect that.”

Derek Yach, a former professor of global health at Yale University, and former executive director for noncommunicable diseases and mental health at the World Health Organization (WHO), agreed.

“We don’t want to send a signal that e-cigarettes are worse than cigarettes,” Yach told FoxNews.com.

Yach, the executive director of research organization The Vitality Institute— which is owned by the same company funding research at the University of Pennsylvania on e-cigarettes as a stop-smoking tool— predicts that e-cigarettes can likely be used as a harm-reduction alternative to traditional cigarettes.  

“That doesn’t mean there’s zero risk or that there’s some contaminant here and there,” he noted, “but we’re talking about a product (tobacco cigarettes) that kills almost half a million Americans, and anything that can intervene to cut that needs to be supported.”

For now, the most urgent message that parents and governing bodies need to relay to teens is that “tobacco products are not a good idea,” Yach said. “Many of the people calling for tighter control of e-cigarettes have failed to call for tougher control on the known killer product: cigarettes— especially when it comes to youth access.”