Debate Will Heat Up in 2019 Over Vaping, E-Cigarettes

Flavored products as well as marketing to teenagers are among the issues flaring up.

The number of high school seniors who vape rose significantly from 2017 to 2018. Getty Images
Have electronic cigarettes and vaping devices replaced cigarettes as the public health nuisance of our time?

New research suggests we’re heading in that direction.

The number of high school seniors who vaped in the past 12 months increased to 37 percent, up from 28 percent in 2017, according to the latest findings of the National Institute on Drug Abuse’s 2018 Monitoring the Future report.

Nicotine vaping in particular — the closest analog to smoking a traditional cigarette — also increased from 11 percent to 21 percent year-over-year.

This isn’t the first report to show a rise in teen vaping.

In November 2018, in response to rising vaping trends, U.S. Food and Drug Administration (FDA) Commissioner Dr. Scott Gottlieb directed the agency to restrict — but not outright ban — the sale of flavored e-cigarettes and vaping products to help curb the burgeoning epidemic.

“I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” he wrote in a statement. “We won’t let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build.”

Flavored products are just one of the many fronts on which the e-cigarette debate is being waged.

Here’s a look at some of the issues and what we can expect in 2019.

Flavors and marketing
Vape cartridge flavorings, which range from mango and sour apple to crème brûlée, are a major sticking point and what many researchers feel is helping drive the surge in teen vape use.

“We know that flavors are very appealing to youth,” Dr. Susan Walley, a professor at University of Alabama at Birmingham’s department of pediatrics and chair of the Section on Tobacco Control for the American Academy of Pediatrics (AAP), told Healthline. “These are all things that were banned from conventional cigarettes because we knew youths were more likely to use them.”

The FDA appears to agree, launching an investigation into the largest e-cigarette manufacturer, Juul, as well as several other e-cigarette companies, specifically looking at the ways in which these companies have targeted younger users.

Dr. Osita Onugha, director of thoracic surgery research at the John Wayne Cancer Institute at Providence Saint John’s Health Center in California, welcomes the additional FDA scrutiny to help reduce the public health risks of e-cigarettes.

“If the FDA finds that companies are using illegal or illicit chemicals in e-cigarettes, it could potentially lead to a ban on e-cigarettes from certain companies,” Onugha said.

“Overall, this would likely force companies to harbor less toxic chemicals in their e-cigarettes, which would ultimately drive its use. I am optimistic that the more the public pays attention to the chemicals in e-cigarettes, the less likely people would want to place these chemicals in their body,” he said.

Will it work?
But will this FDA crackdown help reduce teen vaping rates, or simply make them more alluring?

Anamara Ritt-Olson, PhD, a clinical assistant professor at the University of Southern California’s online Master of Public Health program, is cautiously optimistic.

“We know that with knowledge doesn’t always come behavior change,” she told Healthline. “[However,] I am hopeful that now that parents, educators, and pediatricians are learning about how dangerous vaping truly is, that will have an impact. But tobacco researchers know… that we need a multipronged approach.”

For instance, a new study in the journal Pediatrics found that areas with the strictest retail licensing requirements for shops that sell tobacco products helped reduce teen smoking rates significantly compared to places with softer requirements.

That model, the study argues, could extend to e-cigarettes and help reduce teen vaping.

For example, study participants living in A-grade communities (which require annual licensing fees, regular compliance checks, and stiff penalties for sales to minors) were 26 percent less likely to start using e-cigarettes and 55 percent less likely to report initiation and use in the previous 30 days than those living in communities with a “D” or “F” score, the research shows.

Juul, for its part, announced in November that it would stop selling all flavored e-cigarettes aside from mint and menthol — although it left the door open to resuming these sales if retailers adequately tightened their age verification requirements.

What the future holds
Those requirements could represent yet another loophole, experts say.

Many online sellers, for instance, currently only require a simple age check, easily circumvented by making up a birthdate. And kids are really good at ordering things online.

“There’s really no system that’s foolproof to prevent youths from purchasing online,” Walley said. “The FDA is really just counting on companies to have a better verification website.”

Moreover, e-cigarettes and nicotine vaping products have higher concentrations of nicotine than traditional cigarettes, said Dr. Jennifer Lowry, director of the division of clinical pharmacology, toxicology, and therapeutic innovations at Children’s Mercy-Kansas City and chair of the AAP’s Council on Environmental Health.

“You’re going to have a harder time getting them off of it because of the addiction potential,” she told Healthline.

As to whether current vaping trends have peaked, plateaued, or will continue to rise, it’s hard to say, Walley says.

“A lot of us in the medical community were sort of blindsided by how aggressive all the marketing was and how fast the uptake was in youth,” she said.

But, she adds, the FDA appears to be moving in the right direction, taking vaping seriously and cracking down on major players such as Juul.

“Juul, their mission statement says they are to help adult smokers quit, but they sold 30 percent of their shares to Altria, one of the largest — and arguably worst in terms of deceiving the public — tobacco companies,” Walley said. “I think that raises the question, if your goal is really to put these tobacco companies out of business?”

“I don’t think they can use that same argument anymore,” she said.