Why the Vaping Business Is Going Up in Smoke

by Diana Drake

If you’re craving JUUL mango pods, you may be out of luck. This week, the U.S. Food and Drug Administration (FDA) launched an attack on the rising underage use of tobacco products – which it considers to be an epidemic – and imposed sharp sales restrictions on flavored electronic cigarettes. The FDA also announced plans to ban menthol cigarettes and flavored cigars. In anticipation of this regulatory ruling, JUUL Labs, the San Francisco company that makes JUUL e-cigarettes, said on Tuesday that it would suspend sales of most of its flavored e-cigarette pods in retail stores and would stop its social media promotions.

Government action comes on the heels of some ominous statistics. The 2018 National Youth Tobacco Survey, by the FDA and the Centers for Disease Control and Prevention, found that vaping had increased 78% among high school students since last year and almost 48% among middle schoolers; 3.6 million youngsters reported vaping at least once in the previous 30 days.

The FDA, a federal agency charged with protecting the public health related to food, medicine and other things we ingest, responded quickly to the widespread vaping trend, which is thought to be spurred in part by the appeal of flavored e-cigarettes. “Our aim is to make sure no kid can access a fruity flavor product in a convenience store,” said FDA Commissioner Scott Gottlieb, who predicted the new restrictions would “eliminate those sales.” He added that any stores that want to sell fruit-flavored e-cigarette products “need to age-restrict completely or have a separate room that is age-verified. A curtain or a partition won’t cut it.”

For Gottlieb, a father of three young children, preventing nicotine addiction among teens is a personal mission. As he pointed out in an FDA statement released this week, almost all adult smokers started smoking when they were kids. Nearly 90% started smoking before the age of 18, and 95% by age 21. Only about 1% of cigarette smokers begin at age 26 or older. “Any policy accommodation to advance the innovations that could present an alternative to smoking – particularly as it relates to e-cigarettes – cannot, and will not, come at the expense of addicting a generation of children to nicotine through these same delivery vehicles,” he proclaimed. “This simply will not happen. I will take whatever steps I must to prevent this.” In other words, even if vaping is a less toxic option than smoking the real thing (possibly a good alternative for real cigarette smokers who want to quit), if it is creating a whole new problem of teen nicotine addiction, Gottlieb won’t support it.

“The JUUL product has a really high nicotine delivery through the nicotine salt technology developed at JUUL Labs. This can get kids addicted very quickly.” — Kurt Ribisl

We turned to the experts for some perspective on the business side of the e-cigarette story. This week, Scott Halpern, professor of medicine, epidemiology and medical ethics and health policy at the University of Pennsylvania Perelman School of Medicine in Philadelphia, P.a., and Kurt Ribisl, a professor in the Department of Health Behavior at Gillings School of Global Public Health, UNC Chapel Hill in North Carolina, joined the Knowledge@Wharton Radio Show, which airs on Sirius XM, to discuss the changes in the vaping industry. Here are some key takeaways from their visit:

A question of public health. The FDA is exercising its regulatory power for a reason. “They’re very concerned about the potential negative effects on the health of our youth,” said Halpern. “From an overall public health standpoint, it’s important to recognize that there are three big considerations: Do e-cigarettes harm the youth directly or by getting them to start using combustible [regular] cigarettes? Two: do they help adults who are current users of combustible cigarettes quit completely and not enter the dual-use paradigm [where they smoke both regular and e-cigarettes], and three: what are the toxic effects of these cigarettes themselves? The overall preponderance of evidence is not particularly favorable to there being a public-health benefit to e-cigarettes… In terms of the toxic effects on the lungs and the other parts of the body, we’re just beginning to realize the potential and it’s hard to know the long-term health consequences because this is a relatively new product on the market, but there are many reasons for concern.”

Addiction is real. The belief that e-cigarettes are like smoking harmless water vapor is a complete myth. “JUUL is the 800-pound gorilla in the room. It has a dramatic marketshare,” said Ribisl. “The JUUL product has a really high nicotine delivery through the nicotine salt technology developed at JUUL Labs. This can get kids addicted very quickly. It has mango and other appealing flavors, and this is one of the major reasons that people are alarmed right now. A few months ago, I was out in California visiting some researchers there. One of the people had just visited schools and the janitor was complaining because so many kids had been using these products who hadn’t used nicotine before. It made them nauseous and they threw up in the hallway. The janitor had so many cleanups, partly due to the introduction of these products.”

Tobacco companies want to make money. “The retail location or the online vendor may be where the kid gets the product, but if you look at the appeal or why the kid wants to buy, a lot of that is at the manufacturer level,” noted Ribisl. “They’re manufacturing amazing flavors that are very appealing to children. There are over 7,000 flavors that have been documented by a retail study at the University of California, San Diego. It’s a very appealing product to kids.”

“There is a deliberate attempt to create as many potential users of these products as possible,” added Halpern. “The industries are likely to take a number of mixed approaches to the evolving news coming from the FDA. What’s clear is that they are interested in their financial bottom line, which is exactly what we want most companies to be focused on. But when it’s companies that are producing a product that has adverse health consequences, I think that’s an agenda that needs to be constrained and regulated [by agencies like the FDA].”

Yes, bring on the regulators. The real fear is that teen vapers will become smokers of highly addictive and harmful combustible cigarettes. “E-cigarettes can be a gateway [to smoking real cigarettes],” said Ribisl. “We haven’t done enough regulation and reigned in the e-cigarette manufacturers. [That’s changing], and it’s about time.”

Overall tobacco use is on the decline. A recent Centers for Disease Control report showed that overall smoking in the U.S. has declined to 14%, down from 42% in the 1960s. Some studies suggest that e-cigarettes have played a role in that and others suggest that e-cigarettes really undermine successful quitting. Either way, challenges remain. “Even at the 14% level, smoking is still by far the leading preventable cause of death in the U.S. and one of the leading causes of death worldwide,” said Halpern. “Also, that is still a high prevalence, particularly when you consider the disparities. That 14% is an overestimate among college-educated people, but it’s a dramatic underestimate among many disadvantaged and disenfranchised populations in our country. The rates are over 40% in many minority populations. That’s where we need to turn our efforts, trying to reduce those disparities with access to interventions that can help people to stop.”

Are we headed toward a tobacco-free world? Philip Morris International, one of the most high-profile tobacco companies that sells popular brands like Marlboro, has said it hopes to end its sales of cigarettes. “Countries like Australia and New Zealand have been talking about something called an end game, where cigarette smoking and tobacco use collapses,” noted Halpern. “They’ve been getting closer and closer to realizing this to the point where 3-5% of people are using the products, a really small amount. Hopefully, [the U.S. will] get to this place in the near future and won’t let e-cigarettes derail this. As the FDA takes action and begins to ban almost all flavors, cracks down on illegal sales to minors, and pulls menthol out, I think we’ll finally see the FDA making a real serious difference in tobacco use in this country.”

Related Links

Conversation Starters

Why is the FDA making e-cigarette use by teens a priority? How does this article help you to better understand the relationship between regulators and private companies?

How do you feel about the new restrictions on flavored e-cigarettes and access to online products? Do you think it’s a good thing or a bad thing? What is the vaping scene like in your school?

Scott Halpern points out that while cigarette smoking in the U.S. has dropped to 14%, “that 14% is an overestimate among college-educated people, but it’s a dramatic underestimate among many disadvantaged and disenfranchised populations in our country.” What does he mean by this statement? How does this disparity make you feel and what solutions do you suggest to help improve it?

3 comments on “Why the Vaping Business Is Going Up in Smoke

  1. As a student at a large public high school, I’ve seen many of my friends and classmates fall victim to an e-cigarette addiction. Firsthand, I’ve watched as students with seemingly bright futures have ruined their lives through the use of nicotine and other addictive substances. This close connection to the issue of underage nicotine usage has led me to wonder more about the causes and implications of youth addiction to e-cigarettes.

    A lot of people like to immediately blame the students for their addictions. It’s easy to say that, when so much information can be easily accessed online, youth should know what they’re getting into and should fully expect the consequences when they come. I don’t deny that teenagers need to be more conscious about the choices they make, but modern society just gives them too many chances to go down a bad path.

    In my native area, Silicon Valley, this problem is amplified even further by factors such as the sheer availability of resources. Unlike in most other parts of the world, many teenagers from Silicon Valley have the financial means to fully support their nicotine cravings. Combined with a densely populated area and plenty of distributors, it’s not hard for teenagers here to get their hands on e-cigarettes.

    Essentially, no matter how discouraged they are from doing so, teenagers will always explore the options available to them. The prefrontal cortex, the area of the brain where judgment takes place, simply isn’t fully developed in teenagers, resulting in them making some questionable choices. It’s on the shoulders of our entire society, along with regulators, to protect the best interests of our youth.

    This early legislation is a great step in the right direction. By eliminating the flavors which grab the attention of so many youth, along with making it harder to purchase the devices, I believe the onboarding of new users will certainly slow down. However, I question how much these measures will help the existing userbase. With millions of teenagers having reported that they vaped in the previous 30 days, slowing the acquisition of new customers will not be enough. Along with preventing new people from becoming addicted, we need to help current users get the help they need before they succumb to a life-altering addiction.

    Ideally, we’d follow a path similar to Australia or New Zealand, slowly decreasing the number of users until we could ban all sales altogether. Getting to this position certainly would not happen overnight, but it’s feasible with the right plan. Getting those who are addicted to seek the help they need and breaking the stigma that vaping in high school is “cool” would certainly help get us on a path to a tobacco-free future.

    Teenage nicotine addiction is an epidemic that needs to be handled, and we’re certainly taking some good steps to do so. While we need teenagers to remain cautious and smart, it’s up to all of us to make sure that the problem doesn’t get even worse. Changing society’s overall view on nicotine consumption could be one of the key factors in combating this epidemic, and all of us can help by raising awareness and offering guidance to those affected by it. Teenage addiction to e-cigarettes is a vast, complex problem, but with the right mindset and actions, it’s one we can tackle.

  2. If you think vaping is cool, then you are wrong. 99% of all vaping products contain nicotine
    Nicotine can damage the parts of the brain that control attention, learning, mood, and impulse control
    Nicotine can possibly also lead to future drug addiction
    Ingredients such as aerosol is safer to be eaten rather than inhaled because the stomach can process more things than lungs can
    Many vaping companies use yummy flavors to intrig kids
    Between 2009-2016 there were 195 vaping/e-cig related accidents
    JUUL pods contain as much nicotine as a pack of cigarettes
    From 2017-2018 the vaping percentage increased 78% in high school students
    The FDA just passed a law that you have to be 21 to purchase tobacco products

  3. The answer is simple: Ban NIC SALTS… very specifically that. Anything with more than 6mg of nicotine and in the salt form. If you ban that, disposables lose their kick, if not leave the market entirely. The kids can’t get mods and freebase (non-nicotine) juice as easily due to cost and the fact that you generally have to go to specialty stores for it where they are more stringent on IDing anyone who looks young. Now, that said, you will never stope youth nic use completely. Most of them will go back to cigarettes and switch to low-nic vapes when they are old enough.

    Adults who use salt nic will jsut have to get over the fact that they can’t have their headbuzz anymore without going back to cigarettes. They’ll switch to low-nic vaping eventually when they wanna quit, once they realize that it actually makes more sense than conventional wisdom would seem to suggest.

    The SEPCIFIC issue is Nicotine SALTS. There’s a difference between how freebase nic and salt nic works. Salt nic is immediately absorbed and goes to the bloodstream straightaway. It is more addictive and typically comes in far higher levels than what is in cigarettes (which is about 20mg. Disposable vapes are 50mg for comparison). Freebase nicotine is harsher at high amounts, which is why most stores in my area carry only a maximum of 6g with most people who use subohm mods only using 3mg… far lower than cigarettes. Freebase is also more bioavailable and more gradually absorbed, allowing for longer satisfaction and an easier time weaning off of it when you’re ready to quit.

    Flavour bans aren’t the answer, since kids actually care more about the ability to get away with vaping more than what it tastes like. They could be flavourless and they’ll still prefer them because there’s no smell or other evidence. Freebase and subohm mods are harder to conceal and leave a cloud behind, so the kids can’t get away with them as easily.

    You have your answer. Ban any nicotine juice greater than 6mg and any nicotine in the salt form, specifically. Problem solved.

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