As electronic nicotine delivery devices (ENDS) or e-cigarettes continue to increase in popularity, so do new and evolving health concerns. From the devastating deaths and illnesses as represented by the 2019 national outbreak of the lung injury called E-cigarette Vaping Associated Lung Illness (EVALI), the use of these devices has become a public health emergency amongst youth and adolescents. For example, the number of middle and high school students using e-cigs rose from 3.6 million in 2018 to 5.3 million in 2019.

Since February 2020, over 2,800 patients have been hospitalized or died due to EVALI according to the Centers for Disease Control and Prevention. The number of deaths and illnesses have declined since then due to more research, law enforcement restrictions such as increasing the age of purchase to 21 years old, removal of harmful chemicals like Vitamin E Acetate from the market and overall prevention and cessation efforts led by state and local health departments. However, rural areas are still disproportionately affected as stated in NACCHO’s Tobacco Control Efforts in Rural America: Perspectives from Local Health Departments, where nearly all (93%) of rural local health departments surveyed indicated that e-cigarettes were a threat in their communities due to lack of resources, funding, and staffing. As such, NACCHO recognizes that local health departments (LHDs) play a key role in reducing these tobacco related threats by educating community members and youth regarding risks associated with the use of and exposure to e-cigarettes. LHDs can reinforce proven cessation methods like counseling and nicotine replacement therapy. NACCHO Stories from the Field are also helpful for LHDs who would like to hear personal accounts of successes and challenges within comprehensive tobacco control programs. Two recent stories are here from Gaston County, NC and Florence County Health Department in Florence, Wisconsin that focus on rural and youth vaping issues and policy changes.

Because ENDS have limited regulation and can be excluded from typical tobacco laws, NACCHO recommended in our Local Tobacco and Vaping Control Regulations Policy Statement that the Food and Drug Administration (FDA) provide full disclosure of all chemicals included in new tobacco products. NACCHO believes that broadening the defining language to include cigarettes, nicotine delivery products, tobacco products, smokeless tobacco, and e-cigarettes in all new smoke-free legislation for indoor and outdoor environments would greatly impact all communities including rural.

With COVID-19 becoming a contributing factor in more lung issues, certain states are considering banning vaping products to reduce the health risks. Phoenix, AZ for example is considering removing e-cigarettes, menthol cigarettes, and flavored smokeless tobacco. As Coronavirus attacks the respiratory system and affects the immune system, smoking enhances the harmful effects of the disease. Therefore, CDC suggests that vaping or e-cigarette use amongst youth and adults should discontinue during this outbreak and in the future.

In connection with youth tobacco engagement with a focus on cessation and prevention, the CDC’s Office on Smoking and Health in partnership with the Center for Public Health Systems Science at Washington University in St. Louis published a new and appropriately timed Best Practices User Guide: Youth Engagement in Tobacco Prevention and Control. This User Guide provides actionable strategies, workplans, advice, and support on how to connect with youth in communities as this generation heavily impacts tobacco initiation, prevention, and cessation. Youth have a powerful voice and the public is listening now more than ever as peers are able to rally for a cause and create social and environmental change together. This guide highlights ways to assist youth and adolescents in becoming knowledgeable about emerging issues such as lung illnesses and vaping, creating social media messaging, prevention programs in schools, peer support groups, smoke-free rules, influence Tobacco 21 laws, contributing to flavor bans, educating peers and adults about risks of vaping and smoking, and empowering youth to provoke real change. With real-life case studies, the guidebook provides examples of programs that other communities can easily replicate. Multiple user guides exist, and they help put research into action with realistic guidance for local health departments and communities for tobacco and vaping cessation.

For more information and for the full reports, click here to visit the CDC website.