Surgeon General Advisory on E-cigarette Use

E-cigarettes are popular with young people.  The Surgeon General issued an advisory on e-cigarette use among youth.  He made the bold statement that e-cigarette use among youth is an epidemic.

A key concern in the advisory is the large increase in use among high school students.  Current e-cigarette use increased 78 percent in the past year, from 11.5 percent in 2017 to 20.8 percent in 2018.  Another concern is nicotine exposure during adolescence.  Nicotine exposure during adolescence  can impact learning, memory, and attention.  It affects brain development, which continues to age 25.  It can increase risk for future addiction to other drugs.  In addition to nicotine, heavy metals, volatile organic compounds, and ultra fine particles have been found in e-cigarettes.

The Surgeon General also writes that many e-cigarette flavors are considered appealing to young people and that chemicals in these flavors have additional health risks.

For the full report:

Women and Alcohol, an Equal Rights Tragedy

An unusual decline in life expectancy occurred from 2013-2014 among American women.  Life expectancy at birth for white, non-Hispanic females in the United States declined slightly from 81.2 to 81.1 years [1].  American women in mid-life are experiencing unprecedented numbers of suicide and diseases related to smoking and heavy drinking.  As Western social norms shift away from “traditional” gender roles, women are reporting greater frequency of binge drinking and larger numbers of drinks consumed in a single sitting [2].  The CDC reported in 2016 that the percentage of women aged 18 and over who had four or more drinks in 1 day at least once in the past year was 18.9 percent [1]. Conclusions from a Journal of American Medical Association (JAMA) article stated that there were substantial increases in alcohol use, high-risk drinking, and DSM-IV alcohol use disorder among women [3].

In the late 1920s the tobacco industry expertly marketed cigarettes as a women’s liberation issue, touting smoking as a woman’s right.  Then lung cancer deaths eclipsed breast cancer deaths in women.  Now we are witnessing alcohol becoming an equal rights tragedy.  Alcohol ads targeted to women feature both mothers and business women using wine to cope with stress.  After consuming the same amount of alcohol, women tend to have higher blood-alcohol content (BAC) than men.  This is in part due to women’s lower body mass and women do not produce as much alcohol dehydrogenase (ADH) as men and are therefore unable to process as much alcohol before it enters the bloodstream.  The Dietary Guidelines for Americans recommend no more than one drink a day for women and no more than two drinks a day for men.  What is a drink?  In the United States, a standard drink is one that contains about 14 grams of pure alcohol.  Recommended amounts are 12 ounces of beer with 5 percent alcohol content, 5 ounces of wine with 12 percent alcohol content or 1.5 ounces of distilled spirits with 40 percent alcohol content.  The health effects of alcohol abuse are serious and can include alcoholic liver disease, brain damage, increased risk of breast, head and neck cancers, and heart disease.  As a healthcare provider, remind your female patients that when it comes to alcohol, they cannot go toe-to-toe with men.  The increased prevalence of alcohol consumption among women is killing them.

  1. Centers for Disease Control and Prevention (CDC) – National Center for Health Statistics. Life expectancy at birth, at 65, and 75 years of age by sex, race and Hispanic origin Health, United States 2016.
  2. Delker, E., Brown, Q., Hasin, D.S. (2016). Alcohol Consumption in Demographic Subpopulations.  Alcohol Research Current Reviews; 38(1): 7-15.
  3. Grant, B.F., Chou, S.P., Saha, T.D., et al (2017). Prevalence of 12-Month Alcohol Use, High-risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013.  JAMA Psychiatry; 74(9):  911-923.