Lung Association says Georgia has flunked tobacco exam again

If the American Lung Association's grades counted, Georgia would have been held back every year, metaphorically speaking, the state would be a 20-year-old first grader for lung health. Youth e-cigarette use could only be adding to the state's problems in the future, Georgia pediatricians said.

"This report card yet again is one that you would stuff in the bottom of our backpack and hide from your parents," said Lance Boucher assistant vice president for state public policy for the lung association.

In their 20th year of the Lung Association handing out grades in its annual State of Tobacco Report, Georgia once again came away with four Fs and a D.

The United States as a whole has made progress over those last two decades, increasing the number of statewide comprehensive smoke-free laws from two to 28 states. States have also increased tobacco taxes from an average of 62 cents a pack to $1.91, he said. Unfortunately, Georgia has not done either, Boucher said. In fact, at 37 cents a pack, Georgia has the second-lowest tobacco tax and has not increased it substantially since 2003.

More:Group: Georgia failing to address smoking amid pandemic

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"Unfortunately, Georgia is still down at the bottom and has not made that progress," he said. "There’s definitely lots of bright spots in the gains that have been made nationwide. But we have some work to do in Georgia to get our tobacco control policies up to par. We can protect those who addicted to tobacco and protect the next generation from becoming addicted to nicotine."

Middle- and high-school use of e-cigarettes is a particular concern, Boucher said. The National Youth Tobacco Survey for 2021 found 1.72 million high school students or 11.3%, and 320,000 middle school students or 2.8%, were current e-cigarette users. While those numbers were lower than previous years, the survey was also conducted differently, with many respondents answering from home as opposed to school, so the Centers for Disease Control and Prevention discouraged comparing rates to previous years. Of those kids vaping, 8 in 10 said they used flavored products and more than 27% of high school students and 8.3% in middle school were daily users.

Having large numbers of kids vaping is concerning, said Dr. Alice Little Caldwell, associate professor of pediatrics at Augusta University and the E-Cigarette Champion for the Georgia chapter of the American Academy of Pediatrics.

"Almost all of these e-cigarettes contain nicotine and we know that nicotine is highly addictive," she said. "So what you’re doing is setting up kids up to have a lifelong addiction."

The companies know this and know that many cigarette smokers got hooked before the age of 21, Caldwell said.

"You’ve got this very vulnerable market," she said, and social media and platforms like Tik Tok are filled with videos that make it look cool. That can add to the peer pressure kids feel to try it, said Dr. April Hartman, medical director for ambulatory pediatric services at AU Health System.

"They’re trying to fit in, they are trying to look cool, all of these things that go along with this image of someone who vapes," she said. "Then they start vaping and then they get hooked."

Georgia Department of Education is now requiring schools to educate teachers about vaping and e-cigarette use and Caldwell was part of a webinar about it in November with educators and parents. The devices and the practice can be easier to hide, she said.

"There’s not as much telltale evidence," such as the heavy odor of cigarette smoke, Caldwell said. "You don’t get that with vaping. It’s very sneaky." Teachers also are getting better at spotting the devices, which can be hard to recognize if you don't know what to look for, Hartman said. 

Kids are also attracted to the many e-cigarette flavorings, which are often sweet and reminiscent of candy, Caldwell  said. There may be some potential relief coming on that front. The Food and Drug Administration, which has to give premarket approval for vaping products, has denied some of the flavored products already. The agency also said last year it would issue rules by this April removing menthol cigarettes, which have had a historically disproportionate impact on some groups, such as Black American, the lung association noted in its report.