Close up on a man exhaling vapor from an electronic cigarette

After hundreds of cases of sudden pulmonary illness across the country — seven of them fatal — President Donald Trump has endorsed the Food and Drug Administration’s plans to pull many electronic cigarette products from the market.

The move comes after more than 450 people, many of them young and otherwise healthy, were hospitalized after using e-cigarettes or “vapes,” electronic devices that deliver nicotine to the user by vaporizing forms of liquid tobacco. The cases are being investigated by the Centers for Disease Control and Prevention as a “multi-state outbreak.” 

The surge of illness has also brought attention to what the FDA, CDC and now the President have acknowledged as a public health crisis — the surging popularity of vaping devices among the country’s youth, and the growing supply of unregulated vaping liquids. So, the FDA ban would target the products that appeal to children and teens most; those with mint, menthol and fruity flavors.

Vaping’s Rise Among Teens

Roxanne Elliott, policy director for FirstHealth Community Health Services, says nearly 20 percent of North Carolina high schoolers reported using e-cigarettes in 2018. Substances used by vaping devices are not only flavored but perfumed, which helps shed the negative association toward cigarettes held by much of today’s generation.

“This is the tobacco industry’s answer to a product that doesn’t have a safe association with it,” she said. “And the industry has been aggressive with their marketing.”

Over the past few years, vaping has become increasingly popular with teenagers, some of whom would never reach for a traditional tobacco product. According to the FDA, more than 3.6 million teenagers have used a vaping device.

“Fun flavors and colors attract a younger demographic,” says Olivia McCue, a senior at Pinecrest High School. “I would say at least a third of the student body regularly use vaping devices, and I’m sure that more have tried it.”

On Monday, Sept. 9, the FDA announced in a press release that it had sent official warning to JUUL Labs, Inc., citing concerns over the company’s marketing tactics — including a school presentation during which a JUUL representative told New York ninth-graders that the company’s products were “totally safe,” and that “FDA would approve it any day.” 

The FDA also asked why JUUL makes cartridges containing a 5 percent nicotine concentration, one that is considered highly addictive. And Elliott and her peers have noticed that the devices mimic flash drives so effectively that parents can’t tell the difference. 

For its part, JUUL Labs maintains that it exists as a “satisfying alternative to cigarettes." And in response to the scrutiny, the company has stated that its only desired customer is the former smoker. Still, its website sells cartridges in flavors like mint, mango and creme, and a Google search found “alternative JUUL pods” being sold from numerous websites, in flavors like watermelon, strawberry milk and cappuccino.

“Not only are users getting high doses of nicotine, but these flavors are produced with chemicals which weren’t meant to be inhaled,” says Cindy Loyd Laton, a health education specialist and certified tobacco treatment specialist at FirstHealth. And Laton also worries that, because their brains remain in a developing stage, students in middle and high schools are more likely to become addicted to nicotine.

A 'Re-Normalization' of Smoking?

FirstHealth was the first hospital system to adapt tobacco-free policies, becoming North Carolina’s first tobacco-free healthcare system in 2004. The policy has since been updated to include e-cigarettes and vaping devices.

Vaping has been ruled as a tobacco product by NC General Assembly. Because many people are unaware of this fact, Elliott says the best practice is to include vaping and e-cigarette language in policies, and to make sure signage reads “tobacco-free” versus "non-smoking" — to include any tobacco products such as e-cigarettes and chewing tobacco.

“Most establishments are now tobacco-free, but does that include vapes?” says Dr. Scott Johnson, a FirstHealth pulmonologist. “Consider the steps forward that we have taken to try to avoid tobacco and prevent more tobacco-friendly attitudes from developing. Smoking is no longer convenient. If we allow vaping, are we taking a step back and encouraging a re-normalization of smoking?”

Cessation experts in particular bemoan the devices. Though they have long been touted as a way for smokers to kick the habit, Laton finds that far from the truth.

“What we’re finding is that people are using these products instead of quitting smoking," she says. "People mistake it for a cleaner, more natural form of smoking — but smoking is smoking. If you are using an e-cigarette, we don’t consider you to be a former smoker.”

According to the North Carolina State Center for Health Statistics, tobacco use remains the No. 1 cause of preventable death in the U.S. It's important to note that statistic counts tobacco use in all forms.

“The concern here is that we’re not yet able to pinpoint the exact cause of these vaping-related illnesses,” Dr. Johnson says. “People need to be very, very careful with what they’re using and what they’re vaping. If they’re getting stuff off the street, chances are they could be the next victim.”

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