Erika Sward on Tobacco Use in Youth

In this podcast, Erika Sward, from the American Lung Association, discusses recently released data from the Centers for Disease Control and Prevention that show a decline in tobacco use among middle- and high-school students, as well as discusses the implications of this data on the United States' smoking epidemic.

Additional resources:

  1. As nation grapples with pandemic, we must also address tobacco use. News release. American Lung Association; December 17, 2020. Accessed January 12, 2021. 
  2. Gentzke AS, Wang TW, Jamal A, et al. Tobacco product use among middle and high school students — United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50):1881-1888.

Erika Sward is the assistant vice president of National Advocacy for the American Lung Association. 

Published in partnership with the American Lung Association in New Jersey



Leigh Precopio: Hello, everyone. Welcome to another installment of Podcasts360, your go‑to resource for medical news and clinical updates. I'm your moderator, Leigh Precopio, with Consultant360 Specialty Network.

Recently released data shows that 23.6%in middle and high school students use tobacco products, even though tobacco use overall has declined among adolescents. Here with us today to speak about this data is Erika Sward, who's the assistant vice president of National Advocacy for the American Lung Association.

Thank you for taking the time to speak with me today, Erica. Let's get started. The latest report on tobacco use among middle school and high school students was published by the CDC. What do the results of that analysis show?

Erika Sward: The results show that our nation has a lot of work to do to reduce the use of tobacco products among youth. While there has been an overall decline in youth tobacco use from 2019 to 2020, we're still very concerned that 1 in 4 high school students is continuing to use at least 1 tobacco product.

The data also show us that kids follow the flavors. We recognize that as long as flavored products are allowed to remain on the market, kids are going to shift patterns of use and begin to use the flavored products that are out there. And this is really no surprise. Old tobacco industry documents show one cigarette maker talking about the importance of using flavors to attract kids. That is unfortunately a tried‑and‑true recipe for the tobacco industry to addict kids. And we're not seeing that with e‑cigarettes, but we're also seeing it with flavored cigars, with hookah, and also, of course, with menthol cigarettes. That's why the American Lung Association has called on the Food and Drug Administration to eliminate all flavored tobacco products that are currently available on the market.

Leigh Precopio: What do the national trends show regarding tobacco use among youths? How has tobacco use been trending over the past few years?

Erika Sward: Tobacco use over the last 3 to 4 years is dramatically up. We did see a slight decline in youth use overall from last year to this year. One thing that we don't know is what the impact of the pandemic will be on tobacco use among kids.

One question is, is it down because kids are at home more and they don't have access to school as much, and they're just around fewer people? Is it up because there's more unsupervised time? These are all questions that it's going to take a couple of years to sort out the answers, unfortunately. But in the meantime, we know what we need to do. We know what our leaders need to do. The Lung Association has called on the Biden administration to eliminate the sale of all flavored tobacco products. That is a real huge important way to go.

We know that if we can get rid of flavored products, that's going to help turn the spigot off of youth users. Then, of course, what we need to do is to help current users including kids get the help they need to quit. If we were to set on a path to eliminate the sale of all flavored products including menthol cigarettes and flavored cigars, we would certainly put those numbers trending in the right direction and further reduce tobacco use among everyone.

Leigh Precopio: How has the pandemic influenced tobacco use among youths?

Erika Sward: The long and short of it is that we don't know yet how the pandemic will influence youth use of tobacco products. There are some short‑term studies that have come out that the FDA runs overall that again point to flavored use. But we ultimately will not know until we have the National Youth Tobacco survey fielded in 2021, where we'd be able to understand where youth is in general. The National Youth tobacco study from 2020 and the Monitoring the Future study from 2020 that have both been released in full in December of 2020 were fielded before the pandemic. And so we're going to have to see what the data show us about youth use during the pandemic.

Leigh Precopio: How can healthcare providers use this data to better care for your patients who use tobacco products?

Erika Sward: The American Lung Association has a whole series of materials available on our website at aimed at helping parents, but that can be equally transferred and used by family physicians and pediatricians and others to look at and understand that youth using e‑cigarettes and vaping, there are different cues for that than there are for youth smoking and using cigars. You don't usually have the same smoky smell on clothing, so you have to look for other cues as well. The Lung Association encourages parents to talk with their kids about this or healthcare providers to discuss this with kids especially.

We launched a new public ad campaign in 2020 called Get Your Head Out of the Cloud. It's aimed at parents of kids who are between 10 and 14 so that they can talk with their kids in a way that is successful and that can help educate kids that e‑cigarette and vaping use is not safe. It's very harmful.

In addition to causing lung health problems, nicotine exposure also alters brain development among youth. We know how important it is for parents who may not suspect their 10 or 11‑year‑old could be at risk for going and using tobacco product to start to have those discussions. That's also very important for health care providers to realize the types of products that are on the market now and how easy it is for those to be used in a way that parents and providers may not recognize.

Today's tobacco products don't always look like cigarettes. They also look like flash drives. They may be the size of a small cell phone in the back pocket. There are a whole of ways that the tobacco industry is trained to make these as stealthy and as pro‑technology as possible. It's one other way for parents to need to make sure that they're talking to their kids about this.

Leigh Precopio: What programs or projects are currently available to help reduce the use of tobacco among youths in the United States?

Erika Sward: Perhaps the single most important thing that can be done to reduce youth tobacco use is to pass proven policies that will cut down on tobacco product use. First and foremost is raising the price of these products through tobacco taxes.

The Lung association strongly supports equalizing taxes so that there's not a financial incentive to pick up a cheaper tobacco product, but that the tobacco tax on all of them comes out at the same rate, so that they cannot be available for a kid who's got a couple of bucks in her or his pocket.

We also recognize the importance of making these products less attractive to kids. That comes down to the flavors. That comes down to the marketing. We know that, unfortunately, the industry has very much used social media influencers and others to try to make their tobacco products very appealing. The Lung Association has called for that to be cracked down on. We've also called for the elimination of all flavored tobacco products on the market, which would also go a long way there.

Making tobacco cessation or quitting smoking that much easier for adults by making sure they have access to all of the proven quit smoking products is important. We also have to do more to figure out how kids can effectively quit. Right now, there's no pharmaceutical product on the market to reduce youth use of tobacco products.

Some other ways that have proven to be quite successful are mass marketing campaigns. The Centers for Disease Control and Prevention has one aimed at adult smokers to encourage them to get the help they need to quit smoking. It's called the Tips From Former Smokers campaign.

The Food and Drug Administration also runs a youth prevention campaign called the Real Cost campaign. That not only has focused on cigarette use, but also smokeless and most recently e‑cigarette use. All of those campaigns come together to help provide a very important tool in the tool belt for parents and our public health officials to further reduce tobacco use.

In January of 2021, the American Lung Association will release our Annual State of Tobacco Control report. That'll be on Wednesday, January 27. We grade all 50 states, the District of Columbia and the federal government on whether or not they've passed an implemented proven policy that will reduce tobacco use. We do look at tobacco taxes and whether or not states are investing in youth prevention programs and the whole like. That is something that we look to each year to find out what states will do well and are putting the resources and the laws behind reducing youth tobacco use and adult use, or if they are falling short. That's an important policy report on whether or not everything is being done that can be done to reduce tobacco use in the state.

The bottom line is that as we are in the midst of this COVID‑19 pandemic, we cannot lose sight of the fact that we also have a tobacco epidemic in the United States. We lose 480,000 souls a year on tobacco use, almost half a million people, because they became addicted to tobacco products at a young age and we didn't do enough to prevent that. We haven't done enough to help them quit before they developed a tobacco‑caused disease.

The American Lung Association recognizes the importance of making sure that as we look and battle COVID‑19, which has disproportionately impacted people who are current smokers and former smokers, that we must also at the same time work to reduce tobacco use and put into place these proven policies that we know will do that so that we do not lose another generation of Americans to tobacco products unnecessarily.

Leigh Precopio: Thank you so much for taking the time to speak with me today.

Erika Sward: It was my pleasure. Thanks so much for reaching out. I enjoyed our discussion today.