To Catch a Shapeshifter

BEFORE BIG TOBACCO WAS HIT with massive state-initiated lawsuits in the late 1990s, tobacco use among teens and young adults was so common that some high schools still maintained designated smoking areas for students. After the states won their lawsuits, the industry was forced to set up funding in perpetuity for programs to prevent smoking and to provide resources to help smokers quit. In 2013, 14 Tobacco Centers of Regulatory Science (TCORS) across the nation were established.

Texas TCORS on Youth and Young Adults, led by Cheryl L. Perry, of the University of Texas School of Public Health, is one such center. Comprised of three University of Texas sites—UT Austin, UT School of Public Health, and UT MD Anderson Cancer Center—the TCORS on Youth and Young Adults focuses its research on the impact of tobacco and tobacco marketing on the most vulnerable age groups for beginning tobacco use and becoming addicted: adolescents and young adults.

The center has found that while cigarette smoking has decreased among this age group, the use of alternative tobacco products is increasing at an alarming rate.

In short, the fight against nicotine and tobacco is far from over.

The Good Old Days Go Up in Smoke

The “good old days” is how Alexandra Loukas, the Barbie M. and Gary L. Coleman Professor in Education in the College of Education, refers to the early tobacco landscape.

Loukas, who studies health behavior in the Department of Kinesiology and Health Education (KHE), is the principal investigator for the Tobacco Marketing and Alternative Tobacco Use project, one of the center’s three research projects that focuses on young people’s nicotine and tobacco usage and the marketing aimed at them.

“Tobacco products used to come in a limited number of forms, like cigarettes, cigars, snuff, and chewing tobacco,” she says. In 2009, the Family Smoking Prevention and Tobacco Control Act became law and gave the Food and Drug Administration authority to regulate the manufacture, marketing, and distribution of cigarettes, roll-your-own, and smokeless tobacco products.

But while the government began more intensive regulation and focus on traditional tobacco, myriad alternative tobacco and electronic nicotine delivery systems—also called e-cigarettes— flooded the market.

Loukas says that tobacco companies were “unprepared when lots of mom-and-pop shops started selling e-cigarettes,” devices that often look like cigarettes but use a battery to heat a nicotine vapor. E-cigarettes are available in more than 7,000 flavors and are often marketed as alternatives to cigarettes, a way to slow or stop smoking, or for use in places like bars or restaurants, where smoking is banned.

And they aren’t less dangerous to health. Not only is regular nicotine use—even through an e-cigarette— associated with respiratory problems, cardiovascular disease, and various cancers, new evidence suggests nicotine interferes with adolescent and young adult brain development.

E-cigarettes have divided the public health community. “Many public health professionals believe that e-cigarettes may reverse declining trends in tobacco use by re-normalizing cigarettes and introducing kids to a supposed safe alternative.

“E-cigarettes have divided the public health community.”

“Others, however, believe e-cigarettes may help smokers quit their habit,” Loukas says.  They’re also concerned that the overregulation of e-cigarettes might put small companies out of business and cause the large tobacco companies, which have more resources and experience to fight regulation, to gain ground.

With no regulation of the industry and limited knowledge of the chemicals in the ubiquitous flavors, no one really knows how safe, or dangerous, e-cigarettes are.

And according to research, from November 2012 to June 2013, e-cigarette companies spent $39 million marketing these products, which have a particular appeal to young people.

An Intro to Nicotine Addiction for the Young

Many Millennials, people 18 to 34 years old, grew up viewing cigarette smoking as a disgusting and dangerous habit. That’s due in part to “the media promotions such as the Truth campaign, which decreased tobacco use among young people by showing how the tobacco industry has manipulated and targeted youth and young adults,” says KHE Associate Professor Keryn Pasch, a coinvestigator for the project.

Despite smoking’s decline in recent years, tobacco use is still the leading cause of preventable disease and death in the United States.

Eighty-five percent of those who become addicted to nicotine try it before age 18, and 99 percent who become addicted do so by age 26, according to research.

The college years are the ones in which young people transition from regular use to addiction. That’s why the rise in college students’ use of alternative nicotine products is disturbing. “Youth are drawn to e-cigarettes,” says Loukas, “because they view them as a safer alternative.”

And according to the research, e-cigarettes might serve as an introduction to the array of nicotine products, with 11.5 percent of students using multiple tobacco products, like hookah, which is also growing in popularity among college students.

What’s Being Done

The $20 million dollar grant that funded the Texas TCORS is helping UT researchers track changes in college students’ tobacco use and examine the role of tobacco marketing.

The center is in its third year collecting data from students at 24 two-and four-year colleges in Texas. Funding by the Texas Department of State Health Services to Loukas and her colleagues contributes to the development and implementation of college-based programs to prevent tobacco use. These prevention programs are being implemented in an additional 21 two- and four-year colleges in Texas.

Pasch leads work that examines the various ways tobacco is marketed to students. She and her students assess outlets that sell tobacco products around each campus. They document and describe what tobacco products stores sell, which bars students attend, and how much tobacco students might encounter in their environment.

According to Pasch, the FDA is building an arsenal of data to pass regulations to regulate marketing, and “in order to get policy change we have to add evidence to the stockpile,” she says.

Her team is helping gather that evidence, and in May, the Obama Administration announced it will begin regulating e-cigarettes, hookahs, and premium cigars like regular cigarettes— barring those under 18 from purchasing the products, adding warning labels and preventing them from being given away as samples.

In addition to evidence-gathering to facilitate policy change, Pasch, who also studies the effects of food marketing on K-12 students, explains that “we need to consider the environment. We focus on individual choices and behavior, but people don’t realize how much of their world is influenced by marketing in their environment. Our research is looking for links between the students’ environment and what they use.”

Lara Latimer, lecturer and project coordinator in KHE, provides college student groups with resources, such as ways to assess and strengthen tobacco policies on their campus, a web-based curriculum, and coordinated anti-tobacco marketing campaign materials and messages to help them combat the problem.

The peer-to-peer communication about the risks of the various kinds of tobacco use and the dangers of hookah and e-cigarette use, in particular, is key to helping students make better choices.

In the end, says Loukas, the message that young people need to understand is simple: “No matter the product, a smoker is a smoker is a smoker, and all of these products have a negative impact on health.”