Does this sound like the beginning of a joke (i.e. “a rabbi and a priest walk into a bar…”)? It’s actually not funny at all, but a sad reality I witnessed myself just a few days ago.
I live in Teaneck, New Jersey. One of our main streets is Cedar Lane and, apparently, much to my personal dismay, a vape shop recently opened up there. This is an addition to another new vape shop that opened on Queen Anne Road, another main thoroughfare. While out on an errand last week on Cedar Lane, I noticed a young boy (who could not have been older than 16-17 years old) walk past me on the sidewalk. When I came out of the store I had entered, he was browsing in the vape shop nearby. The store employee appeared to be standing at the back counter observing. To the best of my knowledge, the boy left empty-handed and was not illegally sold an e-cigarette or vape product, but I wonder why was he in there in the first place, and why he wasn’t immediately turned away, as he was obviously nowhere near the age of 21 and would not be able to purchase anything.
I am concerned because that kid was one step away from possibly buying a product that is incredibly dangerous to our youth. If he didn’t buy it there, it might not be because he was not allowed to. What if he just didn’t find what he was looking for, or he didn’t have enough money on him? The mere fact that he was allowed to browse just emboldens him to keep going into vape stores and coveting those products, possibly purchasing them instead of going into other stores for legal and age-appropriate merchandise.
Youth and E-Cigarettes
We are in the midst of an epidemic when it comes to youth and nicotine use. The 2020 Monitoring the Future Survey (a survey measuring drug and alcohol use among adolescent students nationwide conducted by the University of Michigan on an annual basis since 1975) indicates that 16.6% of 8th graders, 30.7% of 10th graders, and 34.5% of 12th graders report vaping nicotine in the past year. We have not yet begun to reverse the alarming increase that saw our youth use more than double from 2017 to 2019.
In another troubling finding, the survey indicates that decline in cigarette smoking among 12th graders has stalled since 2018, with 7.5% of youth reporting smoking traditional tobacco cigarettes. The CDC determined that 99% of e-cigarettes sold in the United States contain nicotine, the addictive substance in tobacco products. This finding warrants close attention to the impact of e-cigarette use on youth smoking tobacco cigarettes.
Some e-cigarette labels do not disclose that they contain nicotine or are marketed as containing 0% nicotine, when they have been found to contain nicotine. Aside from being highly addictive, nicotine can harm the developing adolescent brain, which only fully matures at the age of 25, and can permanently harm parts of the brain that control attention, learning, mood, and impulse control. Each time a new memory is created, synapses are built between brain cells. Nicotine changes the way these synapses are formed and also increases the risk for future addiction to other drugs.
Aside from the terrible harm that nicotine causes, the e-cigarette aerosol itself that a user breathes from the device contains harmful substances like ultrafine particles that are inhaled into the lungs, cancer-causing chemicals, heavy metals, and other substances linked to lung disease.
Advertising Lures Youth to Become Consumers for Life
Knowing what we know about cigarettes, is it any surprise that Altria, the tobacco giant that produces Marlboro cigarettes, owns a 35% stake in JUUL? Our youth were turned off to tobacco cigarettes, knowing the health risks and rejecting traditional tobacco products. Big Tobacco was hurting. How would they replace the smokers they were losing now that we were wising up to the dangers of smoking tobacco cigarettes?
In early days, JUUL took a page from Big Tobacco’s marketing strategies, marketing to youth to attract and addict young consumers. Researchers from Stanford University School of Medicine published a study in January 2019 that examined JUUL’s marketing campaign from its launch in 2015 to 2018. The study concluded that its social media, ads, and emails were specifically targeted at youth. Images of young people using e-cigarettes, the sleek design of the cartridges (which look like a USB device), and the social media channels were all ways to market to young consumers.
The availability of literally thousands of flavors like Unicorn Milk, Bubblegum, Cotton Candy, Blue Razz, Crème Brulee, marketed by e-cigarette companies only increases the attraction to kids. While federal policy enacted in 2020 prohibits most flavors of one type of e-cigarette (cartridge or pod-based products like JUUL), there were gaping loopholes that allowed e-cigarette makers to continue luring youth with other flavored products. These products are typically sold in colorful packaging, yet another way to target young consumers.
Aren’t E-Cigarettes Safer Than Tobacco Cigarettes?
To be clear, e-cigarettes are not an FDA-approved smoking cessation device, although they were originally marketed as such (which has not been proven to be effective since a significant number of smokers become dual users, smoking tobacco cigarettes and also using e-cigarettes, instead of quitting altogether). Over time, e-cigarettes became a stand-alone product so, just when we thought nicotine addiction was on its way towards eradication, e-cigarettes ended up initiating new users into nicotine use, creating a new generation of nicotine addicts.
Nicotine in any form is unsafe. It is a highly addictive drug and is particularly dangerous to the developing brains of teens. The Surgeon General also determined that nicotine use can increase the risk of future addiction to other drugs. Studies have found that young people who use e-cigarettes are 4 times more likely to move onto traditional cigarettes and become smokers than those who do not use e-cigarettes.
What is the Law?
There has been significant movement in making it more difficult for e-cigarette companies to sell their products and market them to our kids. On December 20, 2019, legislation was signed raising the federal minimum age for the sale of tobacco products from 18 to 21 years of age. It is illegal for any retailer to sell any tobacco product, including e-cigarettes, to anyone under the age of 21.
As of December 31, 2020, 15 states (including New Jersey and New York) passed comprehensive smoke-free indoor laws that include e-cigarettes. These laws prohibit the use of these products in indoor areas of private workplaces, restaurants, and bars.
Also in December 2020, Congress amended the Prevent All Cigarette Trafficking Act (the “PACT Act”) to apply to e-cigarettes and vaping products. Among other things, the PACT Act prohibits the use of the U.S. Postal Service to deliver cigarettes and smokeless tobacco products to consumers. The definition of a cigarette includes electronic nicotine delivery systems, which includes all e-cigarette or vaping products, liquids, components, and accessories. In addition to the postal service, major carriers like DHL, FedEx, and UPS all enacted policies to comply with the PACT Act, which is a big blow to vendors who ship vapes to consumers, a channel commonly used by underage customers to purchase products.
But is it Enough?
The FDA has the authority to ban all flavored e-cigarette products and strengthen its policies around this issue. When the FDA reviews applications from makers of e-cigarettes to keep or put products on the market, they should not authorize the sale of any flavored or high-nicotine products. Until the Federal government acts, states and cities can continue their efforts to end the sale of flavored products.
Raising the minimum sale age for tobacco products to 21 has been an important strategy in reducing smoking and other tobacco use, but it needs to be enforced and should be part of a comprehensive strategy along with other strong measures such as higher taxes. Numerous economic studies have documented that cigarette tax increases reduce both adult and underage smoking. Generally speaking, every 10 percent increase in the price of cigarettes reduces adult smoking by about 2%, reduces the number of kids who smoke by 6-7%, and overall cigarette consumption by approximately 3-5%.
Jurisdictions should consider taxing e-cigarette products to disincentivize use. Some states seek to tax e-cigarettes at a rate that is equivalent to tobacco products. Given the likelihood that these products can serve as a gateway to other tobacco products, and their harmful health effects, taxing them at the same rate as other tobacco products would seem the best way to protect our youth from initiating use.
New Jersey requires vendors of e-cigarette products to obtain a special license to sell e-liquids and imposes a tax on such sales. In addition, New Jersey is one of a few states that has banned the sale of flavored e-cigarettes.
Watching vape stores open up in my neighborhood, enticing kids to walk in the doors (and, possibly, being illegally sold products) saddens and concerns me. Even though they would benefit from the taxes imposed on such businesses, some jurisdictions have prohibited the sale of e-cigarette products altogether. It would be wonderful to see that happen here in Teaneck (and everywhere, frankly), but, instead, vape shops are opening up for business, which is just increasing the risk to our youth and the chances that the greater exposure and availability of products will take them down a path with irreparable consequences. If I had my way, I would want my town to put the health and safety of our kids first and focus on protecting our youth. My message? Ban vape shops and save kids’ lives.