Tobacco and Vaping
Vaping and tobacco are defined as the use of tobacco products such as electronic cigarettes, smokeless tobacco or other tobacco products, in addition to regular cigarettes.
Since the milestone of the first Surgeon General’s Report in 1964, when the negative health effects of smoking cigarettes were acknowledged, the United States adult smoking rate has declined from 43 percent in 1965 to 16.8 percent in 2014 (1). However, almost half a million Americans still die annually from tobacco use. This makes tobacco use the single, largest preventable cause of death and disease in the United States (2). According to the Centers for Disease Control and Prevention (CDC), tobacco use can cause “cancer, heart disease, stroke, diabetes and lung diseases such as emphysema, bronchitis and COPD.” More than 16 million Americans are currently affected by these diseases due to their tobacco use (3). In addition, since the 1964 Surgeon General’s Report, approximately 2.5 million non-tobacco users have died from health problems due to exposure to secondhand smoke — adding to the substantial toll that tobacco use takes on children and adults in the United States (2).
Various tobacco control policy interventions have led to substantial decreases in overall tobacco use rates over the last few decades (4). These interventions include the broadcast media ban on cigarette advertising in 1971, requirements for warning labels on cigarette packs and advertisements, increases of federal tobacco taxes and public awareness campaigns around the health impacts of tobacco use. Until recently, there has been a great deal of success in reducing the overall tobacco use rates in both adults and youth. However, these gains have not been equitably distributed. Some groups, like those whose household incomes are near or below the federal poverty line, continue to suffer the unbalanced burden of the health, social and economic costs of tobacco use and exposure.
The state of tobacco use has changed dramatically with the introduction of electronic cigarettes and vaping as new forms of nicotine delivery in recent years. These emerging trends in tobacco use have proven to be alarming. This is shown particularly among the youth, where in 2014, electronic cigarettes became the most commonly used tobacco product among middle and high school students in the United States, surpassing combustible cigarette use (5). According to the most recent Surgeon General’s Report, use of electronic cigarettes by high school students in the United States during 2011-2015, surged to epidemic levels with a reported 900 percent increase (6).
The use of vaping devices was introduced as a ‘safe’ alternative to other forms of tobacco use, and it has taken time for the science to show that this is not true. In the interim, use of vaping devices has been normalized, challenging critical policy achievements made to reduce smoking in indoor and outdoor public places, such as parks and playgrounds. With pro-vaping groups opposing the restriction of vaping devices in public places, youth and other vulnerable populations can perceive use of these devices as acceptable, normal and safe. Studies have shown that the unregulated devices can deliver cancer causing chemicals and toxic heavy metals to the user, and leave residue on surfaces, potentially exposing children and pets to these substances (7,8,9). While the long-term effects of vaping devices are not yet known, these early studies and the increase use among youth and adults is a cause for concern.
Health Disparities and Inequities
Many factors influence the onset of tobacco use in adults and children. The most common factors are age, education and socioeconomic status. There are also significant disproportions in tobacco use geographically. These inconsistencies arise from differences among states in smoke-free protections, pricing, funding for tobacco prevention education and outreach efforts, as well as the effective targeting of certain groups by tobacco companies (10). Underserved populations most at-risk to tobacco related health disparities include individuals with HIV/AIDS, LGBTQ community, individuals experiencing homelessness and low socioeconomic status individuals (11). Preventing tobacco use at an early age and assisting current users access cessations tools and resources, can improve the health and quality of life for all residents in our community. It has been estimated that tobacco control policies have saved the lives of at least 8 million Americans (12).
Percent of adults who currently smoke cigarettes (2014-2017)
Source: CDPHE BRFSS Small Area Estimates (2014-2017)
Implications and Data for Jefferson County
The rise in e-cigarette and vaping use by youth and young adults is a major concern for Jefferson County. Another concern is the existence of a persistent gap in how certain groups are successful at quitting tobacco. There’s a discrepancy in rates of successful quitting between adult populations and youth and young adults who are also affected by health disparities. More needs to be done to reduce access to, and the use of, electronic smoking devices among youth and young adult populations. According to the Healthy Kids Colorado Survey (2015), current use of electronic smoking devices among youth exceeds 25 percent, while those who have ever-used is approximately 46 percent (13). With the emergence of new vaping devices — such as the device named “Juuls,” which uses a more highly concentrated form of nicotine known as nicotine salts for increased bioavailability — the risk of lifelong nicotine dependence, and the associated conditions, is increased for youth. Populations that are underserved and disproportionately affected by tobacco use, especially individuals with low-income, will likely continue to use tobacco at much higher rates. They will also likely experience the poorest quit rates unless more can be done to reduce youth and adult tobacco use as well as reach and serve these groups with effective, culturally responsive interventions.
Community Health Needs Assessment Focus Group Findings
No concerns were reported by focus group participants.
Community Health Needs Assessment Key Informant Interview Findings
No concerns were reported by key informants.
Adult Tobacco Use
Cigarette use among adults has been declining, and overall Jefferson County's rate of adults using cigarette's is lower than Colorado and the United States overall. However, we are still not meeting the Healthy People 2020 goal of only 12 percent of adults smoking cigarettes.
Among Jefferson County residents those who have less than a high school degree are significantly more likely to smoke than those who have had some college or have have graduated college. Similarly, those whose income is less than $25,000 are significantly more likely to smoke then those with an income over $50,000.
Note: In 2011, the BRFSS methodology changed to include calls to cell phones. Changes between 2010 and 2011 should be interpreted with caution.
"5.2 percent of Colorado adults and 4.7 percent of U.S. adults are current e-cigarette users."
— CDC BRFSS (2016)
Policy changes have been shown to be one of the most effective solutions to reducing cigarette smoking. The graph below shows key changes to Colorado and federal policies regarding cigarette taxes and smoking policies.
Trends in Colorado adult (18+) current smokers and changes in tobacco policy over time (1995-2016)
Note: In 2011, the BRFSS methodology changed to include calls to cell phones. Changes between 2010 and 2011 should be interpreted with caution.
Youth Tobacco Use
The percent of high school students currently smoking cigarettes (use in the past 30 days) had declined in both the U.S. and in Colorado. The percent of high school smokers in Colorado has surpassed both the Healthy People 2020 goal of 16 percent and the Colorado Winnable Battle Goal of 10 percent, with only 8.6 percent of Colorado high school students reporting that they were current smokers in 2015.
*Smoked at least one cigarette in the past 30 days
While the percent of high school students that are using cigarettes has been steadily declining, in the last few years we have seen a large increase of students using e-cigarettes/vapor products. Between just 2013 and 2015 there was a 206 percent increase in students who had ever tried an e-cigarette/vapor product. Comparatively, those that smoked cigarettes declined by almost 20 percent.
Percent of Colorado high school students in 2015 engaging in specific tobacco related behaviors and the percent increase or decrease in those percents since 2013.
*Used at least one product: cigarettes, cigars, chewing tobacco, e-cigarettes
Among high school students, current use of tobacco products varies by grade, age, race/ethnicity, gender and sexuality. As youth get older, they are more likely to use tobacco products. In Colorado, White Non-Hispanics, Hispanics, and those students of multiple race are more likely to use tobacco products. Similarly, male students and those that identify as gay, lesbian or bisexual, are more likely than female or heterosexual students, respectively, to use tobacco products.
*Smoked or used any of the mentioned products in the past 30 days.
Community Resources within Jefferson County
Jefferson County Public Schools-Youth BE Team - Through a partnership with Jefferson County Public Schools, JCPH Youth BE Team supports the implementation of school-based tobacco prevention and cessation services for youth.
Colorado Quitline -Residents of Jefferson County can also access cessation support through the Amendment 35-funded, Colorado Quitline (which offers phone and internet-based cessation counseling and assistive medications entirely free of charge), and support groups and classes through Jefferson Center for Mental Health.
Baby and Me Tobacco Free - Pregnant and postpartum women who are served by WIC, Lutheran Medical Center, and JCPH’s Prenatal Plus and Nurse Family Partnership programs are offered cessation support through services such as Baby and Me Tobacco-Free.
Jefferson County Public Health (JCPH) has been funded through the Amendment 35 Tobacco, Education, Prevention and Cessation Grant Program for more than fifteen years and has had notable success with several tobacco control strategies, particularly with best practice policy implementation. Tobacco-Free Jeffco Alliance, and a number of local tobacco prevention coalitions and partner organizations have worked together with JCPH to influence local laws proven to reduce youth and adult tobacco use. These laws/ordinances include making the outdoor spaces of parks and recreation areas smoke and vapor-free, increasing the age for sales of tobacco products to 21, and requiring tobacco retailers to have licenses.
1. Centers for Disease Control and Prevention. (2016, March 30). Trends in Current Cigarette Smoking Among High School Students and Adults, United States, 1965-2014. Retrieved from: https://www.cdc.gov/tobacco/data_statistics/tables/trends/cig_smoking/index.htm
2. U.S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Retrieved from: https://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf
3. Centers for Disease Control and Prevention. (2018, February 20). Smoking & Tobacco Use: Fast Facts. Retrieved from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#toll
4. Warner, Kenneth (2014). Tobacco Control Policies and Their Impacts. Annals of the American Thoracic Society. Vol 11, No 2, pp 227–230. Retrieved from: https://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201307-244PS
5. Healthy People 2020. (2018). Tobacco Use. Retrieved from: https://www.healthypeople.gov/2020/topics-objectives/topic/tobacco-use
6. US Public Health Service. (2016). E-cigarette use among youth and young adults. Retrieved from: https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf
7. Thornburg, J.; Malloy, Q.; Cho, S.; Studabaker, W.; Lee, Y.O., Exhaled electronic cigarette emissions: what’s your secondhand exposure?. RTI Press Research Brief: 1-4, March 2015. Retrieved from: https://www.rti.org/rti-press-publication/exhaled-electronic-cigarette-emissions
8. Rubinstein, M., Delucchi, K., Benowitz, N., Ramo, D. (2018). Adolescent exposure to toxic volatile organic chemicals from e-cigarettes. Pediatrics, 141(4). Retrieved from: http://pediatrics.aappublications.org/content/pediatrics/early/2018/03/01/peds.2017-3557.full.pdf
9. Allen, J., Flanigan, S., LeBlanc, M., Vallarino, J., MacNaughton, P., Stewart, J., Christiani, D. (2016). Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes. Environ Health Perspective, 124(6):733-9. doi: 10.1289/ehp.1510185.
10. Centers for Disease Control and Prevention. (2018, May 4). Tobacco Industry Marketing. Retrieved from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/index.htm
11. Kolawole, O., Lorraine R., Pebbles F. (2015). Interventions to Reduce Tobacco-Related Health Disparities. Nicotine & Tobacco Research, 17(8):887–891. https://doi.org/10.1093/ntr/ntv096
12. Centers for Disease Control and Prevention. (2018). Retrieved from: http://www.countyhealthrankings.org/explore-health-rankings/what-and-why-we-rank/health-factors/health-behaviors/tobacco-use
13. Healthy Kids Colorado Survey. (2015). Tobacco Use Among Youth in Colorado. Retrieved from: https://www.colorado.gov/pacific/sites/default/files/PF_Youth_HKCS_Tobacco-Infographic-Digital.pdf
CDPHE BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey, Small Area Estimates: http://www.cohealthmaps.dphe.state.co.us/cdphe_community_level_estimates/
Colorado BRFSS: Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance Survey: http://www.chd.dphe.state.co.us/cohid/
CDC BRFSS: Behavioral Risk Factor Surveillance Survey: https://www.cdc.gov/brfss/data_tools.htm
HKCS: Healthy Kids Colorado Survey: https://www.colorado.gov/pacific/cdphe/hkcs
YRBS: Youth Risk Behavior Surveillance System: https://www.cdc.gov/healthyyouth/data/yrbs/results.htm
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Published on July 17, 2018
Updated April 23, 2019