In banning the marketing of JUUL the popular e-cigarette, Israel’s Ministry of Health rejected what would have been its most effective tool reducing smoking in teens as well as adults.
A recent report by the United States Centers for Disease Control and Prevention found smoking of any tobacco product “declined from 24.2% to 19.6% among high school students and from 7.5% to 5.6% among middle school students”. During that same time e-cigarette use among high school students increased during 2011–2017 (1.5% to 11.7%).
But there’s more to the story. Since JUUL was introduced in 2015, e-cigarette use has declined from a high of 17 percent of high schoolers. Meanwhile, Middle school student use of e-cigarettes declined from 5.5% to 3.3%. All this was happening while JUUL was increasing its share of the e-cigarette market to about 68%. As JUUL use went up smoking and vaping among kids went down.
It may be just a coincidence. However, there are three data points that suggest the relationship may be causal and that JUUL is achieving what the company claims is its mission: to reduce adult tobacco use while discouraging young people from smoking or vaping at all.
First, JUUL could be a better product. By that I mean that it provides teen smokers with a way to stop smoking tobacco and an alternative that makes it easier to stop consuming nicotine. We would need a lot more research on whether that is happening or how, but wouldn’t the Health Ministry want to know?
Second, it is possible that JUUL is less addictive which makes abstinence easier. Critics who claim that JUUL is more addictive because of the amount of nicotine it delivers have no idea what they are talking about. To be sure, as a recent study in the British Medical Journal notes: “most people who smoke cigarettes are addicted, and the main vehicle of that addiction is nicotine. When stopping smoking, people experience cravings for cigarettes, which drives return to smoking.” But as studies have shown, these cravings for smoking are less intense when nicotine is substituted. Perhaps the way in which the JUUL device delivers nicotine — as well as the amount — is more effective in reducing or stopping addiction? The Ministry doesn’t seem interested in finding out.
Third, JUUL’s efforts to restrict use of their product – by changing their marketing approach and through its education programs – may be working. An article in the New York Times magazine entitled Did Juul Lure Teenagers and Get ‘Customers for Life’? tries to claim it did. But the fact, the piece actually shows how JUUL, despite some missteps, has been working as hard on discouraging underage use of their product as they have in marketing it to adults. All JUUL ads include real consumers who are over 35. JUUL stopped producing flavors with catchy names which were deemed to be targeting teenagers. And when it found that its social media campaign was attracting people under 18 as opposed to over 21, it shut it down.
Moreover, the company is developing a Bluetooth-equipped JUUL to provide a way for adult vapers to measure their nicotine use. The New York Times article notes: “It also might discourage teen use by disabling the device unless it’s in the presence of its adult buyer, perhaps by linking it to the buyer’s cellphone. The solution would still require effective controls on sales to minors at brick-and-mortar stores and online retail outlets.”
The Health Ministry knew all this and banned JUUL anyway. It’s assertion that JUUL is more addictive is unproven because it is untrue. Indeed, most the available evidence suggests that JUUL’s corporate mission of reducing smoking is effective and is part and parcel of its business model. What more could you want from a private sector partner?
But the Ministry has a different agenda driven by anti-smoking zealotry. And greed. JUUL is displacing tobacco products. What better way for competitors to protect market share than to get the Health Ministry to declare JUUL is more addictive?
Ironically, the “nicotine is addictive” meme is a scare tactic right out of the anti-vaccine playbook: tell people a product has hidden dangers and use public fear to discourage use. The result of the anti-vax campaign was a decline in immunization rates that led to one of the worst public health problems in the past decade. Similarly, demonizing JUUL could cause lead more smoking and create a public health crisis of even greater proportion. Unfortunately, that could be the impact of the Ministry’s decision, even thought that was never the intention.