Youth Vaping in 2020 | Part 02: Lost in the Fog
Hi folks – welcome to the second chapter of my three-part series on vaping in 2020. If you missed it, click here to see a brief history of the rise of vaping in the United States, and the heavy fingerprints of targeted marketing tactics directed towards youth (e.g., social media influencers, flavored products) that led to our current situation: the CDC reports that as of 2019, 1 in 3 high schoolers has vaped in the last month (“current users”), and 1 in 2 has vaped at some point in their life. These are staggeringly high use rates, and you’d think that they would elicit a strong response from federal and state officials.
Unfortunately, that has not been the case. What went wrong? Let’s explore.
Dueling Epidemics
Despite youth vaping rates escalating for years, vaping didn’t receive much attention in the media until late 2019, when hundreds of young people began falling ill with an unidentified respiratory illness linked to vaping. Eventually dubbed “E-cigarette or vaping product use-associated lung injury” (EVALI), it received the national spotlight, buoyed in part by concern for the huge population of youth who used the devices. As the EVALI outbreak continued for months without a verified cause, vaping and the vaping industry were placed under heavy public and political scrutiny, with calls finally emerging to protect children by enacting a “flavor ban.”
The idea of this ban is that if 93% of kids who vape use flavors, we could significantly cut down on the total number of youth vapers if those flavors disappeared. Now, you could make the case that EVALI was not directly related to flavors (it largely related to an additive, vitamin E acetate), and that EVALI also primary centered around THC products, rather than nicotine. And you would be right! What we had were two concurrent vaping epidemics: one related to youth use that had long-term health implications, and another related to hospitalization and death in the short-term. So although, technically speaking, the flavor ban was a misfire as it related to EVALI, it was hitting another extremely important target related to vaping and public health.
Money Talks
Unsurprisingly, the vaping industry didn’t take this threat to their profits laying down, and launched an aggressive, multifaceted lobbying campaign. They approached their opposition to a flavor ban from the following angles:
01 / Economic
This was a primary argument – citing the 166,000 jobs and roughly $24.5B currently in the vaping industry. They attested that taking away flavors would eliminate jobs, and ultimately hurt the economy. The money vs. public health harms debate is often central to drug policy decisions (e.g., legalizing marijuana).
02 / Hammer vs. Scalpel
The vaping industry made the claim that doing a broad “flavor ban” was too broad, and that a more precise policy would be more effective (we’ve seen, of course, that this is not the case).
03 / Government Overreach
This argument centers on the basic philosophical perspective that the government (or at least, the federal government) should be regulating less, not more (a libertarian viewpoint).
04 / Harm Reduction
Vaping proponents claimed that if we enacted a flavor ban, we would be pushing current vape users back to smoking, which would ultimately be more harmful to those individuals. And although this concept makes sense on some levels, it falls apart when examined in context. First and foremost, a recent study found that only 3% of adults who vape are doing it to stop smoking—most of them are both vaping AND smoking (i.e., adult smokers). And, incidentally, if you both vape and smoke you’re actually at a greater health risk than if you were either doing one or the other.
Additionally – even for that tiny 3% of adult vapers who are actually using vaping to quit smoking, vaping is not an FDA-approved method for smoking cessation. We have several other options readily available that have better institutional and research support: nicotine replacement gums and patches (e.g., Nicorette), Chantix, Wellbutrin, cognitive-behavioral therapy, and even hypnosis.
Lastly, even if a flavor ban was enacted, it would exempt tobacco flavors, and likely menthol, as well (to mimic cigarettes). So if someone really just wanted to move away from smoking to vaping, they’d still have the options that most closely mirror their current smoking experience.
So in sum, it’s not like a smoker’s only two options are using Blueberry Mango Ice vape pens or going back to chain-smoking Marlboros. There are bunches of other (and better) options.
05 / Political Consequences
The last angle the vaping industry used was a political cudgel: they made very clear that if the administration angered voters who vape, they may pay a very significant cost. The industry presented the graph below to administration officials, showing that the number of vapers in battleground states is larger than the win margin in the 2016 election. In addition, they supported the #IvapeIvote movement, further underscoring the potential political blowback of impinging on the vaping industry.
When you put it all together, the result worked: although a “flavor ban” was passed, it was watered down to the point that it didn’t accomplish its ultimate goal: keeping kids away from vaping. It fell short because of its exclusions: the final policy did ban flavors from pod-based vape devices like JUUL, but continued to allow them in disposable devices (such as STIG and Puff Bar), as well as in liquids (called “vape juice”) for tank-based systems.
An Uncertain Future
So that leads us to the present - where are we now? I’m happy to report that, despite lawsuits from the Vaping Trade Association that pushed the deadline back, as of September 9th the FDA has finally been able to enforce the Premarket Tobacco Product Application (PMTA), a law that all nicotine companies (including vape companies) need to have their products reviewed for safety by the FDA before they are allowed to take them to market in the United States (there’s a solid explanation of this process on Vaping 360, but be aware that it’s written in a very pro-vape fashion). This has led to shutdowns of many of the giants in the post-JUUL vaping world, including STIG, Puff Bar, and Vape Wild, all of whom were selling their products without proper FDA authorization.
But, of course, in the absence of a true flavor ban we’re continuing to see online vendors emerge, such as this one, this one, this one, this one, and this one. And I’m fairly confident that until we see a true policy change, even if these websites are closed others will emerge to take their place.
Which takes us to our final chapter in this vaping series: what’s next? How do we truly curb youth vaping, on a federal, state, and local level? And how can we all play a part?
Stay tuned! Until then – be well, and stay safe out there.
If you need individual help, more information is available on my website related to working with me for addiction counseling over telehealth – in addition to my concierge therapy practice, I also have a small in-network practice with Equipoise Teletherapy in Chicago. I also provide non-clinical parent coaching services upon request. For any other questions, please feel free to reach out to me directly!