The FDA has sounded the alarm on adolescent use of e-cigarettes, calling their growth an epidemic and requiring large manufacturers — namely Juul — to submit concrete plans in 60 days to curb teenage use or face market restrictions.
“The FDA won’t tolerate a whole generation of young people becoming addicted to nicotine as a trade-off for enabling adults to have unfettered access to these same products,” Scott Gottlieb, the FDA commissioner, said in a statement on Sept. 12.
Jessica Pepper, an e-cigarette researcher at the Research Triangle Institute, said Juuls and other e-cigarettes are still vastly understudied but do pose health risks to users.
“All e-cigarettes, regardless of whether they have nicotine, have harmful chemicals like formaldehyde in their vapor," Pepper said. "The types and amounts of these chemicals varies a lot, but it’s usually true that there are fewer chemicals and less of them than what you’d find in cigarette smoke.”
Pepper said the risk of e-cigarette use is magnified for adolescents, with nicotine exposure causing long-term alteration to brain structure and functioning, as well as a greater likelihood of transitioning to more dangerous nicotine substitutes.
“Another thing we worry about when talking about younger people is a ‘gateway effect,’" she said. "That is, whether vaping with nicotine increases the chance that you’ll start using more harmful products like cigarettes.”
In January 2018, a National Academy of Medicine report concluded teenage vape users are more likely to transition to cigarettes than teenagers who don't use vaping products.
Abbie Ashford, a sophomore at UNC, said she began vaping in high school in order to quit smoking, but transitioned to Juul last month due to its small amount of vapor and popularity in Greek life.
“Probably half of girls in my sorority have one,” she said.
Another sophomore at UNC, Isaac Jessen, recently quit his nicotine habit. He said he began vaping in high school, and transitioned to Juul as the product’s popularity boomed.
“When I got into college, it was smaller, it was easy to conceal, everyone had them," he said. "It was almost too easy to start."
Jessen said he eventually stopped for health and financial concerns — spending over $20 a week on pod packages — though quitting was more difficult than he expected.
“I wanted to not have to need an alternated mindset to be happy,” he said. “But it’s hard because you don’t really realize exactly what the addiction is until withdrawal. You just think you want more of it, but whenever I’d not have it for two days, I’d be irritable, and Juul pods were all I could think of. I’d just tell myself it’d be okay if I got Juul pods one more time.”
As Juul prepares its proposal to the FDA, Pepper said the simplest solution to curb adolescent use is removing appealing flavors, such as mango and cucumber, though such a move would likely plummet adult sales.
“They’d lose a ton of money if they stopped selling flavors," she said. "The only way I could see that occurring is if the government stopped allowing the sale of flavored e-cigarettes, the way they did with flavored cigarettes many years ago.”
Pepper also suggested Juul modify their advertising content to remove any appeal to teenagers, ensure that external sellers are following age restrictions and support localities raising the tobacco age from 18 to 21.
"We’re especially focused on the flavored e-cigarettes," Gottlieb said in the statement. "And we’re seriously considering a policy change that would lead to the immediate removal of these flavored products from the market."
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