“I think if I couldn’t ‘vape’ I might go back to smoking.” That and a puff of ‘vape juice’ was my friend’s response when I asked her what her stance was on the recent e-cigarette debates. *Kiara, who was previously a devoted cigarette smoker, has gone from 12 milligrams of nicotine, down to 3 milligrams, and hopes to gradually stop vaping entirely. While vaping may be an appealing harm reduction or smoking cessation tool for Kiara, it’s an immensely unknown product. One study found e-cigarettes to be significantly more effective than nicotine replacement therapy (such as the nicotine gum) as a smoking cessation tool. Eighteen percent of the participants vaping quit smoking compared to the 10 percent of those using nicotine replacement therapy. Notably, 80 percent of the successful e-cigarette participants were still reliant on vaping a year later, contrasted to 9 percent of the other group’s reliance on their product. This suggests that knowledge of potential harm is imperative to approximately 30.4 percent using e-cigarettes as a smoking alternative ability to make a well-informed decision.
As of September 19, 2019, the U.S. Centers for Disease Control and Prevention is investigating 380 cases of lung disease, and six deaths, purportedly caused by vaping. The CDC has not yet identified the precise cause, such as specific device, or liquid. While extremely unfortunate, for those using e-cigarettes to stop smoking cigarettes, this number isn’t as frightening as the 480,000 yearly U.S deaths caused by smoking. So, simply from a harm reduction tool perspective and given the absence of longitudinal data, vaping appears to be very much a lesser of two evils. The best choice? Perhaps not. But an effective harm reduction tool? Given the information we have now, it would seem so.
Perhaps the real fear then is surrounding the constantly increasing number of teens vaping. Approximately 1 in 5 high school students and 1 in 20 middle school students reported vaping in the past 30 days in 2018. After seeing a decline in recent years, the CDC found that in 2018, nearly 2 of every 25 high school students, and 1 in 50 middle school students reported having smoked a cigarette in the past 30 days. That is 20.8 percent of high school students reporting e-cigarette use, related to the 8.1 percent reporting cigarette use. There are those who reason that one cannot definitively say that the teenagers who are vaping wouldn’t have otherwise smoked or are using it to stop smoking. Research says otherwise. There have been numerous studies that looked for a link between personality and predispositions to smoking. One study found that teenagers who were not close to their parents and had a more rebellious personality were more likely to smoke. However, attempts to find the same link between vaping and rebelliousness have come up short, and in fact, many of these no-risk taker/low risk of smoking teens began smoking after vaping for a time.
In a 2015 interview with the founders of Juul, a popular e-cigarette company, Ari Atkins, Juul Research and Development Engineer, said “We don’t think a lot about addiction here because we’re not trying to design a cessation product at all… anything about health is not on our mind.” The appeal to teenagers is three-fold, appealing flavors and the absence of the offensive scent, accessibility for all ages, and the marketing tactics, that can all be said to be targeting teenagers and related to lacking federal oversight.
Kiara took personal offense to the heightened stigma of vaping. She described the taste and smell as a pivotal part of her being able to stop smoking, “I understand [that if flavors are banned] it would taste like nicotine, so like cigarettes. I don’t know what I would do, as a huge part of vaping is it releases the social stigma of smelling like cigarettes, and why make the taste undesirable to me as a consumer?” The problem is, the flavor and smell component are a big appeal to teenagers as well and send the message of lacking harm and being young and fun. I don’t see the taste as being imperative to the appeal for adult smokers, but I do understand the smell component. Perhaps there is a way to keep the taste unflavored, but make the smell perfumed.
Kiara isn’t looking to make vaping a free for all and keep the current climate. She noted that she is all about regulation. In 2016, a professor at the University of California took offense to the apparent age requirements, one aspect of the lacking regulatory requisites, as accessibility seemed too easy for the presumed regulations. To test this, he had several teenagers- ages 16 and 17- try and purchase e-liquid from 120 U.S online vape shops. They used their real names, their debit cards, but faked their birthdate to make them appear above 21 years old. However, if they were asked to verify their ages, they gave their real driver’s licenses. A related study was done in North Carolina, a state that prohibits the sale of e-cigs to minors and requires verification of age. The study found that of the 98 attempted online e-cigarette purchases, 75 were delivered. A few of the online stores stated that verification of age would be required upon delivery, but they did not follow through. Granted, there have been some improvements since 2016, but the regulations on vape product sales to minors need to be far more restrictive, with real consequence.
The North Carolina study above also noted that while these stores claimed not to sell to minors, and not to seek out minors as consumers, some of the orders arrived with candy and little toys. This is clever marketing that sends a very strong subliminal message of playfulness and matches Ari Atkin’s sentiments. Since the popularization of vaping, there have been many advertisements and marketing tactics that seem to target teenagers and suggest harmlessness. In response to a 2014 Blu (a popular e-cigarette company) ad in Sports Illustrated critics said, “Using sex to sell cigarettes is nothing new… and e-cigarettes are pushing the envelope because they’re unregulated.” Blu (a company who has since removed theirs), and other companies used gimmicky cartoons, and advertisements, making more accountability necessary here as well.
So, with improved flavor, age, and overall marketing regulations we may be able to decrease the number of new teenage users, and truly make this about harm reduction and cessation than it previously was. But, how do we account for the many teenagers already addicted? Banning attractive flavors may help prevent further engagement and addiction, but retroactively will it do enough to the teenagers already drawn in, perhaps this should be a matter of focus as well?