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Seven in 10 middle and high school students were exposed to e-cig ads in 2014

That's 18.3 million students

Dan Kitwood/Getty Images

The unrestricted marketing of e-cigarettes could reverse decades of progress in preventing the use of tobacco products among youth, the CDC says.

In 2014, 18.3 million middle and high school students were exposed to ads for e-cigs, according to an agency report published today. Given that e-cigarettes are battery-powered devices that vaporize liquid nicotine — a chemical that can promote addiction and has been linked to brain development issues when used at a young age — that’s a big concern for US health officials. Already, e-cigs have become the most commonly used tobacco product among youth, surpassing even conventional cigarettes.

13.4 percent of high schoolers have used e-cigs

The high rate of e-cig use among youth is, in part, a result of the US’s almost non-existent e-cigarette regulations. Currently, the only e-cigs that are regulated by the US Food and Drug Administration are ones that are marketed for therapeutic purposes. That could soon change, however; the FDA has drafted new regulations that would ban the sales of nicotine-vapor dispensers to minors, and sent its final rule over to the White House for review in October.

But the country’s current regulations, or lack thereof, have already had an effect. Between 2011 and 2014, spending on e-cigarette advertising rose to an estimated $115 million, from $6.4 million. Concurrently, e-cigarette use among US high schoolers rose to 13.4 percent from 1.5 percent in 2011, and to 3.9 percent from 0.6 percent for US middle schoolers. That’s why the CDC has been studying the reach of e-cig advertisements among American youth. Almost all tobacco use begins before the age of 18, the CDC says. That kind of information might help states and communities pass stronger laws that can curb teen use of e-cigs, or fund tobacco prevention and control programs for youth.

"The e-cigarette advertisements that we're seeing is like the old-time Wild West," CDC director Tom Frieden said in a press conference today. "We want parents to know that use of nicotine in any form is dangerous."

E-cigarette advertisements are "like the old-time Wild West."

Today’s report shows that seven in 10 US students were exposed to e-cig ads in at least one media format in 2014. Ads in retail stores were most common, but 40 percent of youth saw ads online and 37 percent of youth saw them in TV and movies. As a result, 4 million students saw e-cigarettes promoted in four format categories in 2014: in TV and movies; in magazines and in newspapers; online; and in retail stores. When the CDC compared these results to those for conventional cigarettes, they found retail store exposure to e-cigarette advertising is still lower than levels of exposure to other tobacco product advertising. Every other source of exposure was basically the same as conventional cigarettes, however; kids are seeing a lot of ads for e-cigs.

The CDC’s report also points out that many e-cigarette ads employ the same old tropes — independence, rebellion, and sex — that the tobacco industry uses. This is important because research shows that advertising for conventional tobacco products are causally related to youth tobacco use, Frieden said. This also means that, in some ways, health officials are fighting a familiar fight. That said, today’s health officials have to contend with an already booming online market that makes it very easy for youth to purchase e-cigs. And the FDA’s new rule probably won’t be much help with that because the White House’s Office of Management and Budget altered the FDA’s proposal in June, weakening the language that could have been used to prevent the online sale of e-cigs.

So, today’s report contains a number of other proposals besides banning online sales that the agency thinks will help communities and states deal with the increasing use of e-cigs among youth. For example, the CDC suggests that age verification should be required for online sales as well as for deliveries of e-cigs bought online. The agency also suggests limiting tobacco product sales to facilities that never admit youth, and restricting how close stores can be to schools — strategies that, although valid, don’t seem all that feasible at this point.

"I hope we can all agree that kids should not use e-cigarettes."

Still, the report may fuel communities' desire to fund tobacco prevention programs. Last year, states only spent 1.9 percent of combined tobacco revenues — $25.6 billion — on such programs, or less than 15 percent of the CDC's recommended level of funding for all states combined. "Too many people don't realize that e-cigarettes contain tobacco products and they're addictive — they are not harmless," Frieden said. "Whatever people think of e-cigarettes for adults, I hope we can all agree that kids should not use e-cigarettes."

Given that the FDA's final rule has already been sent to the White House, it's unclear what kind of impact this report might have on the US's proposed e-cig regulations. But Frieden did hint that the Office of Management and Budget was given a copy the report. "We certainly share our findings through the US government, as we share our findings with the public and the media," he said.