CDC: Makers of e-cigarettes, little cigars target kids

Liz Szabo | USA TODAY

New types of cigarettes and tobacco threaten to addict a new generation of kids, in spite of the country's overall progress against smoking, said Tom Frieden, director of the Centers for Disease Control and Prevention.

"I really worry about our kids," Frieden said in an exclusive interview with USA TODAY. "If the next generation gets hooked, you're talking about a lifetime struggle with addiction."

About 16% of high school students smoke, along with 19% of adults — rates that have fallen slightly or leveled off in recent years. New products threaten to undermine those gains, however, Frieden said.

Nearly one in 12 high school seniors now smoke "little cigars," which are nearly identical in size, shape and color to traditional cigarettes, but are regulated much more loosely, according to the CDC.

And nearly 7% of students in grades 6 through 12 tried an e-cigarette in 2012, more than twice the rate in 2011, according to a September CDC report. E-cigarettes are battery-powered devices that deliver nicotine, but produce water vapor, instead of smoke. Studies show that vapor contains potentially hazardous chemicals, including ingredients used in anti-freeze and chemicals that cause cancer in animals.

Both electronic cigarettes and flavored little cigars fall through loopholes in federal regulations, allowing their manufacturers to target children and teens, Frieden said. Because little cigars are marginally larger than cigarettes, they fall into a lower tax category, allowing them to be sold for as little as 7 cents each. A pack of cigarettes costs at least $5 in some states and more than $11 in New York.

And while consumers can buy cigarettes only in packs of 20 or more, kids can buy as few as one or two little cigars at a time, making them far easier for kids to afford, Frieden said.

Although the FDA banned flavored tobacco cigarettes, there are no such restrictions on cigars or e-cigarettes, which are sold in "Gummi Bear" flavors and "Fruit Loops."

Keeping tabs on new, unregulated products from the tobacco industry, which manufactures most e-cigarettes, is akin to playing "whack-a-mole," Frieden said.

Although the Food and Drug Administration has said that it intends to regulate e-cigarettes as it does regular cigarettes, it has not yet released new rules.

Manufacturers of e-cigarettes have trumpeted their health value, arguing that they could help smokers give up tobacco, much as nicotine-replacement products do.

"There is no bigger killer than conventional tobacco," said Ray Story, founder and CEO of the Tobacco Vapor Electronic Cigarette Association. "This particular product is clearly less harmful."

But Frieden said he's concerned that e-cigarettes could actually addict more young people to nicotine, by attracting non-smokers, who might later shift over to regular tobacco. Nearly one in 10 teens who have tried e-cigarettes have never smoked conventional ones.

E-cigarette makers often advertise in venues that are popular with teens, such as shopping malls, sporting events and on TV during the Super Bowl.

Three members of Congress, including Rep. Henry Waxman, D-Calif., this week wrote to FDA Commissioner Margaret Hamburg asking her to quickly release e-cigarette regulations. Their letter notes that the makers of e-cigarettes have adopted some of the same marketing techniques used by tobacco companies for decades, such as hiring celebrities to make them look glamorous. Some ads feature monkeys and other cartoon characters.

Story said he also welcomes regulation from the FDA that would outlaw marketing to children and other gimmicks by "rogue players" in the industry.

Frieden described tobacco — which kills more than 440,000 Americans a year — as the USA's top health challenge. "It just is unparalleled as a cause of suffering and death in this country," Frieden said. "If there's one thing we'd like to end, it's the tobacco epidemic. ... It really is in a class unto itself in terms of the harms done to our health."

Frieden said other health threats include antibiotic resistant bacteria; new strains of the flu, such as the H7N9 outbreak in China; food-borne illnesses; and low acceptance rates of HPV vaccine, which can prevent infection with viruses that cause cancers of the cervix and other organs. He also singled out prescription painkiller abuse as an epidemic and one of the "few problems in society that are getting worse."

Last month's government shutdown made it harder for the CDC to tackle any of these problems, Frieden said. The two-week shutdown, when nearly 10,000 CDC staff were furloughed, was one of the most frightening times since the 2009 outbreak of H1N1 pandemic flu, he said. While his staff could still respond to emergencies, they weren't able to actively look for them. "The most anxiety-provoking thing was what we weren't finding," Frieden said.