The Youth Nicotine Epidemic 1

Running Head: THE YOUTH NICOTINE EPIDEMIC

The Youth E-Cigarette Nicotine Epidemic

Jessica Li

Glen Allen High School

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Introduction

Electronic nicotine delivery systems (ENDS) have been in the rise across America and

the world (Recognition, use and perceptions of JUUL among youth and young adults, 2018).

These products, also referred to as E-cigarettes or JUULs, is relatively new, and rapidly gaining

popularity (Chen, 2017). Usually in an e-cigarette, the device heats a liquid, which produces an

aerosol or a mix of small particles in the air (Quick facts on the risks of e-cigarettes for kids,

teens, and young adults, 2018). While e-cigarettes are considered to be a safer option than

combustible cigarettes, long term effects are still unknown. With the youth constructing a

majority of the e-cigarette audience, it is important to assess the many factors that contribute to

the youth nicotine epidemic. Analysis of the political inactivity in response to the rise of

e-cigarette usage can create a better understanding of the impacts the usage and prevalence of

e-cigarettes will have on the youth and their future.

The Progressing Prevalence of Youth E-cigarette Use

Over the past decade, electronic cigarette usage has dramatically gained popularity,

which has been evident through growing profits and completed research. In only five years, the

vaping revenue in the U.S. grew from $416 million in 2010 to $3.2 billion in 2015 (Arnold,

2018). Since then, the e-cigarette market has exponentially grown due to the introduction of the

JUUL in 2015. The FDA Commissioner, Gottlieb has stated that about two-thirds of JUUL users

are ‘new users of nicotine’” (LaVito, 2019). As of 2018, the number of middle and high school

who regularly use an e-cigarette increased from 2.1 million in 2017 to 3.6 million in just one

year (Youth and tobacco use, 2019). About one in four teens as young as 12 have tried

e-cigarettes (Arnold, 2018). Also, there is no significant disparity regarding e-cigarette usage
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based on age, which research shows that about 22.6% of high school boys use electronic

cigarettes while 18.8% of girls (Youth and tobacco use, 2019).

Today, JUUL owns over three-quarters of the e-cigarette market, and profits are expected

to continue to rise (LaVito, 2019). Not only has there been a rise in e-cigarette usage amongst

teens, but the proportion of high school smokers who smoke Marlboro cigarettes has increased

by 27% between 2012 and 2016 (LaVito, 2019). In a recent conducted study in Connecticut, 808

students from three high schools were studied between 2013 and 2015, which was prior to the

release of the JUUL. From 2013 to 2015, the amount of students who used a vape pen increased

by 5.6% and the amount of students who smoke cigarettes nearly doubled (Chen, 2017). The

associate research scientist at Yale School of Medicine who lead the study, Krysten Bold

discusses the potentially significant correlation between e-cigarettes leading to e-cigarettes.

[People] who used e-cigarettes were 7 times more likely to smoke

cigarettes by the second survey, and almost 4 times more likely by

the third survey (Chen, 2017).

Youth Ignorance Towards Vaping

A recent study conducted through the truth initiative has revealed that the younger the

teen, the more likely they are to engage in “juuling.” The study discovered that 15 to 17 year olds

are 16 times more likely to be current JUUL users compared to the age group of 25 to 34 (Shank,

2018b). With JUUL usage rising at alarming rates, surveys have found that about 63% of JUUL

users were not aware that the product always contains nicotine (Shank, 2018a). A significant

factor that led e-cigarettes to gain popularity is through its convenience and the ability to hide the
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devices easily. E-cigarette do not attract unwanted attention and there is a very minimal amount

of smell (Chen, 2017).

With JUUL consuming about three-quarters of the e-cigarette market share, youth know

very little regarding its implication because of deceptive marketing. Since its creation, JUULs

have been marketed as a “satisfying alternative to cigarettes” (Shank, 2018a). Furthermore, early

advertisements claimed that it was a “safe” alternative, thus promoting the false belief that

e-cigarettes are beneficial to one’s health (Arnold, 2018).

Research conducted by Dr. Robert Jackler, who is a physician and professor at Stanford

University that specifically studies tobacco advertising revealed that JUUL has deleted a large

amount of their early advertisements sometime before September 2018. However, the 2,500

tweets and 400 Facebook and Instagram posts, and other ads from JUUL’s website was saved by

Dr. Jackler and his team. Analyzing the advertisement has clearly been appealing to a youth

audience through the usage of attractive young models socializing with a “club-like” feel. JUUL

even had launch parties for their product that included bands and free tastings, which typically

attract a younger population (Chaykowski, 2018). Dr. Jackler has discussed the deceiving reality

of JUUl advertisement.

Juul says their goal is to save the lives of a billion smokers; You

have to ask yourself, ‘Is the company’s behavior aligned with that

goal?’ I would have to say, sadly, no.

In 2018 alone, a minimum of four lawsuits were filed against JUUL arguing that users were

victims of the company’s “deceptively marketed” product as safe, which specifically targeted

underaged youth and nonsmokers (Chaykowski, 2018). Not only is the marketing deceptive, but
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Dr. Jackler and his time discovered that even if they had put their date of birth as underaged on

the website, they still were added to JUUL’s email list and received marketing and discounts off

its starter kit (Chaykowski, 2018).

Overall, e-cigarettes have the prenotion that they are “good” and “harmless,” however,

many individuals are confusing the definition of “good” vs. “better.” Many do not realize that

young adults who use e-cigarettes are four times more likely to begin smoking cigarettes within

18 months compared to their peers who do not (Arnold, 2018).

Government Response to Growing Youth Nicotine Epidemic

WIth JUUL sales increasing by 300% in 2018 to their new $12.8 billion deal with Altria,

the government has placed in a position where policies and actions need to be taken to resolve

the rising youth nicotine epidemic (5,11). With Altria also have a long history of deceptive,

youth marketing and Marlboro still being the most popular cigarette brand amongst children in

America, change and solutions are in great need (LaVito, 2019).

The FDA, who was placed in charge of tobacco products 13 years ago, has taken several

small responses to the increase in teen e-cigarette usage. One action the FDA has taken is

announcing their attempt to reduce the addictiveness and appeal of these products by creating

product standards, but there still has been no concrete proposal to do so (Shank, 2018a). In

addition, the FDA abruptly decided, with no justification, to delay full regulatory compliance

until 2022, which is 4 years later than the originally established deadline (3). In response, seven

public health and medical groups, and several individual pediatricians filed a lawsuit against the

FDA (Wexler et. al., 2018). The lawsuit argued that the delay:

will hinder the development of the science needed to understand,

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and to educate the public about which products actually do promote

smoking cessation (Wexler et. al., 2018).

Ultimately, the FDA concluded that these products will remain on the market indefinitely while

they review, and there was no deadline for the completion of the review (Wexler et. al., 2018).

What FDA did force JUUL to do is to stop marketing towards a more youthful audience,

and one change initiated was the retitling the names of the flavors (ex. Cool Mint is now just

Mint) (Chaykowski, 2018). Also, FDA hopes to ban menthol cigarettes, flavored cigars, and

restrict sales of fruit-flavored nicotine vaping cartridges. However, the Forbes article also

mentions that:

In 2009, before Juul was founded, the FDA banned all cigarettes

with “characterizing flavors” other than menthol, which halted

kid-friendly cigarette flavors like chocolate, grape and strawberry.

The ban did not apply to e-cigarettes (Chaykowski, 2018).

As a result, it is evident that the government has taken incredibly minute steps to addressing this

pressing issues. Dr. Suchitra Krishnan-Sarin, a psychiatrist at Yale University and the senior

author on the Pediatrics study, believes that the FDA’s minimal efforts is influenced by “the

potential for e-cigarettes to help get adult smokers off tobacco is one reason why the FDA has

been slow to act on e-cigarettes “(Chen, 2017).

While the executive branch has done very minimal in addressing the youth nicotine

epidemic, almost a dozen Democratic senators have taken action against JUUL and began an

investigation into the company. A scathing letter was written to JUUL in order to begin an

investigation, which was set in motion due to JUUL’s recent deal with Altria. The investigation
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will determine if JUUL is violating regulations or commitments that it made with the FDA (11).

In the letter, the senators ask a series of questions to JUUL to expose and/or gain a better

understanding of the new deal between the two giant smoking product company. This action

taken by the senators suggests that greater legislative involvement may occur in years to come.

Health Effects of Youth E-Cigarette Usage

E-cigarettes contains and produces safer chemicals than cigarettes, but e-cigarettes can

still be harmful, especially for a developing teen. E-cigarette often contain high levels of

nicotine. In one JUUL pod, the amount of nicotine is equivalent to a pack of 20 regular cigarettes

(Youth and tobacco use, 2019). Nicotine is extremely addictive, and it can potentially harm an

adolescent’s brain development (Quick facts on the risks of e-cigarettes for kids, teens, and

young adults, 2018). It has been found to affect the part of the brain associated with attention,

learnin, mood,and impulse control (Youth and tobacco use, 2019). However, once addicted, the

risk of smoking cigarettes increase exponentially and the teen is more likely to become addicted

to other drugs (Quick facts on the risks of e-cigarettes for kids, teens, and young adults, 2018).

Recently, there was a new study done that found a significant amount of men and women

who vape have a 71% higher risk of stroke.,​ ​59% higher risk of heart attack or angina. And a

40% higher risk of heart disease (Thompson, 2019). Also, the aerosol found in many e-cigarettes

have been found with varying levels of metals and other chemicals that are harmful to the body.

Ultrafine Particles can be inhaled deeply into the lungs by using an e-cigarete, and diacetyl is a

flavoring chemical found in e-cigarettes has been linked to serious lung disease (Arnold, 2018).

There was a study than that analyzed 58 adults who vape, and the metals that are present when

using an e-cigarette. Researchers found nickel, chromium, lead, and arsenic in almost all of the
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adult e-cigarette users (Arnold, 2018). A majority of the health effects of using an e-cigarette are

unknown, and will remain mostly unknown for many years to come. As Joanna Cohen, a PhD,

MHSc, Bloomberg Professor of Disease Prevention and IGTC director, stated, “They are likely

safer than continuing to smoke combustible cigarettes, but without the long-term studies, we just

don’t know” (Arnold, 2018).

Conclusion

The rise in e-cigarette usage is increasing at alarming rates, and without proper research,

the long term effects will remain mostly unknown. With the current rates of e-cigarette usage

amongst teens, it is expected that there will continue to be an increase in teen vapers at least until

2022. While the government has tried to slow down or halt the rise, without proper research, not

much can be completed. Without the proper education regarding e-cigarettes, teens will continue

to be ignorant to the potentially fatal effects of long term use of an e-cigarette. Because being the

only generation that will develop through their teen years, current teens are susceptible to

lifelong addiction to nicotine, and potentially become addicted to other drugs.

References

Arnold, C. (2018). E-cigarettes, Juuls and heat-not-burn devices: The science and regulation of

vaping. ​Hopkins Bloomberg Public Health Magazine.​ Retrieved from https://magazine.j

hsph.edu/2018/e-cigarettes-juuls-and-heat-not-burn-devices-science-and-regulation-vapin

g.

Chaykowski, K. (2018, November 16). The disturbing focus of Juul’s early marketing

campaigns. ​Forbes.​ Retrieved from https://www.forbes.com/sites/kathleenchaykowski

/2018/11/16/the-disturbing-focus-of-juuls-early-marketing-campaigns/#5cf9ebea14f9.
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Chen, A. (2017, December 4). Teenagers embrace Juul, saying its discreet enough to vape in

class. ​NPR. ​Retrieved from https://www.npr.org/sections/health-shots/2017/12/04/56827

3801/teenagers-embrace-juul-saying-its-discreet-enough-to-vape-in-class.

LaVito, A. (2019, April 8). Nearly a dozen Democratic senators to investigate Juul’s marketing

practices, deal with Altria. ​CNBC.​ Retrieved from https://www.cnbc.com/2019/04/08/juul

s-marketing-deal-with-altria-come-under-senators-scrutiny.html.

Quick facts on the risks of e-cigarettes for kids, teens, and young adults. (2018, December 3).

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Recognition, use and perceptions of JUUL among youth and young adults. (2018).​ Truth

Initiative.​ Retrieved from https://truthinitiative.org/sites/default/files/Recognition-use-and

-perceptions-of-JUUL-among-youth-and-young-adults.pdf.

Shank, S. (2018, April 18). JUUL e-cigarettes gain popularity among youth, but awareness

of nicotine presence remains low. ​Truth Initiative.​ Retrieved from https://truthinitiative.o

rg/news/juul-e-cigarettes-gain-popularity-among-youth.

Shank, S. (2018, October 30). New study reveals teens 16 times more likely to use JUUL than

older age groups. ​Truth Initiative.​ Retrieved from https://truthinitiative.org/sites/defaul

t/files/Study-Reveals-Teens-16-Times-More-Likely-to-Use-JUUL-than-Older-Age-Grou

ps.pdf.

Thompson, Dennis. (2019, January 30). Vaping tied to rise in stroke, heart attack risk.​ U.S.

News.​ Retrieved from https://www.usnews.com/news/health-news/articles/2019-01-30/va

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Ping-tied-to-rise-in-stroke-heart-attack-risk.

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March 27). Health groups file suit to expedite FDA review of e-cigarettes, cigars. ​Truth

Initiative.​ Retrieved from https://truthinitiative.org/sites/default/files/Health-Groups-File

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Youth and tobacco use. (2019, February 5). ​Centers for Disease Control and Prevention.

Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobac

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