Thanks in large part to aggressive marketing and appealing flavors, smoking e-cigarettes or vaping has rapidly escalated from a fad to an issue that many experts are considering a public health epidemic—particularly for teens and pre-teens. While e-cigarettes have been available since 2007, new manufacturers, offerings and marketing tactics have brought them into the lives of countless young people. According to the FDA, 21% of high school students have used an e-cigarette in the last year. These are just some of the products’ estimated 3.6 million underage users. This skyrocketing increase in adoption and addiction has left regulators playing catch-up while medical professionals point out how little is known about both the effects of these products on young people’s health and how best to help them quit. However, the FDA’s recent focus on the Juul brand has spawned a local and national regulatory response that has some lawmakers contemplating outright bans with the potential to change the entire industry.
E-cigarettes that vaporize liquid rather than burn tobacco in order to deliver nicotine have been on the market since at least 2007, but the introduction of flavors has made them increasingly appealing to young new users. Until recently, Juul Labs, which manufactures one of the most popular e-cigarettes among young vapers, sold liquids in mango, fruit, crème and cucumber flavors, among others. These flavors make the vapor much smoother and easier to inhale than traditional cigarettes, while masking the fact that they often deliver a higher dose of nicotine.
While many e-cigarette manufacturers like Juul initially focused on their products’ utility for helping adult smokers smoke less or even quit, the introduction of flavors made them irresistible to potential young users. According to the FDA, from 2018 to 2019, use of e-cigarettes increased 78% among high school students and 48% among middle school students. This spike in use comes after approximately 1.5 million young people started vaping between 2017 and 2018. In a 2018 federal survey, one in five high school students reporting vaping in the last month. Despite manufacturers’ claims that they were focused on adult users, aggressive marketing campaigns and heavy use of social media channels to promote these products also played a key role in reaching young potential new customers.
The rapid spike in vaping among teens has helped to illuminate serious gaps in our knowledge about nicotine addiction and treatment in young users. The high levels of nicotine found in e-cigarettes often mean that young vapers can find themselves addicted very quickly, and when they do try to stop using, wrestling with withdrawal symptoms like anxiety, irritability, trouble concentrating and loss of appetite. The problem is compounded by the lack of knowledge we have about treating addiction in young people and the fact that anti-smoking tools like nicotine patches are not approved for use in young patients. While we know that nicotine can impact the memory, attention and learning of young smokers, very little is known about how vapor from e-cigarettes actually impacts their lungs. In fact, the awareness gap is so large that many pediatricians are not only unprepared to address nicotine addiction in their young patients, some don’t even recognize the e-cigarette devices when parents bring them into their children’s appointments.
Medical professionals aren’t the only ones with limited knowledge about the potential dangers of vaping—kids themselves often don’t know exactly how dangerous their habit can be. A survey conducted by the Truth Initiative, for example, showed that two thirds of U.S. teenagers aren’t even aware that the Juul e-cigarette contains nicotine. This lack of knowledge, coupled with the misguided perception that vaping is either far less harmful that traditional smoking or in fact not harmful at all are key reasons why more and more young people are picking up a habit they might find very difficult to kick.
The FDA is at the forefront of a relatively recent regulatory response that has seen state legislative bodies crafting regulations which could dramatically impact the industry. At the end of 2018, the FDA took steps to restrict the sale of flavored vaping or e-cigarette products. While they have not completely banned the sale of these products as some anti-vaping advocacy groups are demanding, the administration has focused on Juul and other manufacturers in an investigation into how these companies may have targeted younger users on social media and other platforms. Further regulatory action may come as more is learned about the various chemicals used in the production of vaping liquids. Some speculate that an outright ban of e-cigarettes and vaping products could be on the table if the risk to public health continues to increase and if the FDA concludes that companies are actively trying to encourage underage smoking.
States like California are also proposing legislation intended to protect their young residents. Two proposed bills in the California state senate would make the sale of flavored tobacco and e-cigarette products illegal and would increase labeling requirements. According to the CDC, flavored products make up about one-fifth of all e-cigarette sales in most states. Responding to pressure from advocacy groups, parents and media reports, Juul Labs announced in late 2018 that they would limit sales of their flavored products to their website, removing them from retail shelves. Certain flavors are still available in stores, however, leading many to believe the company has not gone far enough.
As physicians, parents, regulatory bodies and the general public learn more about vaping and e-cigarette products in the wake of their massive surge in popularity, it seems increasingly likely that new regulations will eventually play a prominent role in how these items are marketed and purchased. It’s an interesting example of how both regulation and health knowledge can sometimes lag behind a fast-growing trend. The remainder of this year is sure to bring many updates to this story as lawmakers and activists work try to protect and inform children and parents, while manufacturers focus on preserving their businesses and providing adult smokers with options and potential tools to help them stop smoking.
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