Mission: A Tobacco-Free World

Q&A with Pamela Ling, director of UCSF’s Center for Tobacco Control Research and Education

By Janet Wells | Magazine.UCSF.edu

Pamela Ling, MD

Youth smoking rates in the U.S. were at all-time lows when flavored e-cigarettes hit the market 15 years ago, sparking an epidemic of novel nicotine products. Also called vape pens, these devices heat up liquid that contains nicotine and other chemicals, creating an aerosol that’s inhaled. Pamela Ling, MD ’96, MPH, applies her research-driven social media and marketing expertise to beat the tobacco industry at its own game – and avoid similar pitfalls with cannabis.

In the 1950s, 45% of the U.S. adult population smoked. By 2020, that figure was down to 12.5%. Is tobacco still a public health crisis?

Tobacco remains the leading preventable cause of disability and death in this country, responsible for 1 in 5 deaths – 480,000 people a year.

It’s great news that smoking rates are continuing to come down. But e-cigarettes are slowing progress. Vaping is harmful and has taken over the youth market. In California, five times more young people vape than smoke cigarettes.

The U.S. Food and Drug Administration (FDA) only started regulating cigarettes and smokeless tobacco in 2009. It was another seven years before they began regulating e-cigarettes. During this time, the industry was selling fast and furiously, even coining the term “vape” to get away from negative associations with cigarettes.

Right now, young people’s use of tobacco products is a driving concern. A lot of youths who were not addicted to cigarettes started vaping – largely due to unfettered availability and marketing. In 2021, 2% of high school students nationally smoked cigarettes, but more than 11% vaped.

Juul Labs recently agreed to pay $440 million to settle an investigation by nearly three dozen states into its sales tactics to youths. Will that have an impact?   

The settlement put some limits on advertising, but it only applies to Juul, which has already lost a huge percentage of the market share after bowing to pressure to drop fruit flavors. Juul look-alike brands immediately took over that niche.

So how do we get kids to stop vaping, or even better to never start?

Early in my career, I got interested in tobacco and marketing to learn how the industry convinced young people to do something that kills them. I use those strategies to improve smoking prevention and cessation by making the advice relevant and accessible to the people we’re trying to reach. For example, to address teenage vaping, we adapted the look and messaging of a smoking-cessation group-support program UCSF developed on Facebook and put it on Instagram because teenagers are not on Facebook anymore.

There’s been a lot of talk about vaping’s potential benefits – like Juul’s claim that it helps people quit smoking cigarettes. Is there science behind that?

The evidence is still in its infancy. For smoking cessation, a few studies found e-cigarettes were as effective as other nicotine replacements in controlled situations. But the reality is that most people who vape also continue smoking cigarettes, and most revert back. If someone wants to quit smoking by vaping, we have to try to mimic the situation you get in a randomized trial with close supervision and structured plans to quit. Switching on your own, going to the corner store to buy your vape products, not having any counseling support – that depresses quitting.

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