Two men vape in a store in Philadelphia. Research is inconclusive on the health effects of e-cigarettes.­

Credit Mark Makela / The New York Times

Two men vape in a store in Philadelphia. Research is inconclusive on the health effects of e-cigarettes.­

February 5, 2018

E-Cigarettes: A Shiny Alternative To Smoking?

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Smoking is cool again. Who would have thought?

Just when many thought smoking was on the decline, with stomach-churning advertisements of charred lungs on public television and the preeminence of smoke-free environments, an alternative form of nicotine delivery is gaining popularity: high-tech e-cigarettes. One of the most popular of these is the JUUL, which accounts for 32 percent of the U.S. e-cigarette market share.

The JUUL is about one-fifth the size of an iPhone and uses patented nicotine juice cartridges, called JUULpods. With a metallic finish and shaped like a USB drive, JUULs’ marketing and style takes total advantage of millenials’ infatuation with technology and sleek design.

Since 2015, more than one million JUULs have been sold. In 2017 alone, JUUL Labs brought in $224 million in sales, which is a 621 percent increase from the previous year. Additionally, as of Oct. 2017, 20 million pods are being produced per month, and JUUL Labs is struggling to meet demand, according to Business Insider.

JUULs were designed to make conventional smoking obsolete and decrease public health risks. On Jan. 23, the National Academies of Sciences, Engineering, and Medicine revealed a comprehensive report about e-cigarettes and their implications after analysis of 800 journals and experiments. They found conclusive evidence that substituting conventional smoking for e-cigarettes completely reduces users’ exposure to carcinogens and toxins in nicotine and lowers risk for short-term health issues.

While the JUUL is a ‘safer’ alternative to cigarettes, the NASEM study also showed there is insufficient evidence that e-cigarettes like these are successful in helping people quit conventional smoking completely.

Prof. Donald Kenkel, policy analysis and management, has emphasized the complexity of the health implications of e-cigarettes.

“Banning e-cigarettes from public spaces might prompt some smokers to continue smoking instead. So banning e-cigarettes might easily hurt public health,” he said.

Additionally, the study claimed that e-cigarettes are less harmful than conventional cigarettes in the short-term, but that there are many unknowns about the long-term effects of vaping.

Current smokers, who are the target market for e-cigarettes, often overestimate the risk of e-cigarettes and continue smoking cigarettes.

“If we conducted a public health education campaign that helped people realize the true riskiness of e-cigarettes, it’s possible that e-cigarette use would increase,” Kenkel said. “This could lead to a big improvement in public health — if the new information prompts smokers to become vapers.”

Although e-cigarette awareness might possibly reduce adult cigarette smoking, a new demographic has developed an interest for e-cigarettes: non-smoking adolescents, making the rise of vaping a double-edged sword.

In 2016, a study at Weill Cornell Medicine showed that 13.2 percent of teens opt for JUULs, compared to 9.2 percent for conventional cigarettes. According to the Food and Drug Administration, more than two million middle and high school students were users of e-cigarettes in 2016.

Previously non-smoking teenagers, who likely would never have touched a traditional cigarette, have caught the nicotine bug and vaping is on the rise in school communities.

At the University of Southern California, Dr. Jessica Barrington-Trimis has been researching JUULs and teenagers for two years. She has found that more than 40 percent of high schoolers who use e-cigarettes have never smoked a conventional one, suggesting that JUULs and similar products are indeed enabling the emergence of vaping culture.

“You cannot walk into a library on any college campus without seeing kids juuling,” Marisa Gerard ’20 said.

Teens are not only becoming addicted to nicotine but are also falling into the trap of peer pressure. Often, having a JUUL can signify wealth, social status and popularity among teens. Listed at $34.99, the JUUL device is not cheap, even when bought legally. On the black market, JUULs are being sold for $80 to $100.

“The addiction is so severe that I have witnessed Canadian students traveling to the U.S. just to refuel their JUULs,” Shraddha Harshvardhan ’20, an international student from Canada, said.

In concurrence with Kenkel, Weill Cornell Medicine reported that, since e-cigarettes are a substitute for conventional cigarettes, regulation to remove them from the market would drive nicotine users — some of whom only started due to the invention of the JUUL — to conventional cigarettes.

Policies from 2016 that upped the minimum age to legally buy e-cigarettes to 21 are also no obstacle for American teens, who are finding creative methods of getting their hands on these products. A Boston psychologist reported to the Boston Globe that one of his patients “used his parents’ credit cards to buy thousands of dollars of JUULs online, and then turned around and sold the devices and flavored pods to other kids at a profit.”

The Weill Cornell investigators’ report suggested that a minimum purchasing age of 21 for conventional cigarettes would be better than a minimum age of 21 for e-cigarettes to regulate adolescent smoking. This way teenagers addicted to nicotine would at least have access to the ‘safer’ option of e-cigarettes.

What began by two Stanford students as an alternative for adult cigarette smokers to decrease their smoking habit is now a teen sensation.

While the original goal of PAX Labs, which was responsible for producing JUULs until July 2017, was to reduce “the number of minors who possess or use tobacco products, including vapor products, and to find ways to keep young people from ever trying these products,” according to a company spokesperson, the company is aware that their product is reaching an unintended market.

“An individual who has not previously used nicotine products should not start, particularly youth,” the spokesperson said. “Recent science raises serious concerns about the adverse effect of nicotine on adolescent neurodevelopment.”

Former CEO Tyler Goldman reiterated his desire to fulfill this goal.

“[We have] actually stopped trying to create new users by leaving some stores purposefully out of stock of the vaporizers. It sells only refill cartridges to those stores, so people who use JUUL and switched off cigarettes can stay switched,” Goldman said.

Despite the company’s efforts to stay true to their original intentions, the combination of users’ addiction to nicotine with their obsession with the sleek look of the JUUL have led to a booming accessory market, including JUUL cases, stickers and vape art.

If e-cigarettes worked for their intended goal and ended conventional smoking, then they would result in a net public health benefit. However, with the significant increase in smoking teens who previously had never touched a cigarette, the long-term impact of e-cigarettes is unknown.

Originally conceived as a safer alternative to traditional cigarette smoking, e-cigarettes are currently fueling an interest among non-smoking juveniles. The jury is still out on the long-term societal impacts of vaping.