A Nation Under the Influence
Strawberry-scented clouds drift across the dash of my ’03 Jeep Grand Cherokee Laredo as it nears 80 miles per hour down a straight-away on Ocean Parkway in Long Island, New York. The angsty 19-year-old in the passenger seat turns up the song “Wizard of Oz” by Logic as he sucks down another hit of his vape—the device crackling steadily like a summer fire. More clouds swarm the console as if they are phantoms; the rather sunny day is young… and we are out for a drive.
Nick Maione, 19, is one of many underage people who vape in the United States. He started smoking marijuana at 14 and moved onto vaping shortly after. The number of underage individuals who vape has increased steadily in recent years. The vapor industry, anti-smoking campaigns and the American government remain in dissonance with one another.
People like Maione continue to fight the battle against nicotine addiction.
“Vapes are a more advanced cigarette, and it’s the cigarette of our generation,” Maione said. “We’re putting chemicals in our body that don’t belong… any ingested chemical is not healthy, it’s just a matter of how it’s going to kill us.”
Maione said what began as a social activity progressed into an emotional habit. He frequently turns to his device, a SMOK Novo, in times of stress.
“Smoking is nice for me because it forces me to take a second, take my face out of my book, take a rip, relax and go back in,” Maione said. “It sounds like I am super dependent on it, and maybe I am, but I can put it down at any time.”
Vaping in America
According to a joint study conducted by the U.S. Department of Health and Human Services and the Center for Disease Control (CDC), tobacco usage among teens has become increasingly prevalent than it has in the past with combustible products like cigarettes, cigars and chewing tobacco.
In recent years, the usage of combustible tobacco products among teens has actually decreased and appears to be on a downward trend. A study from 2017 conducted by the U.S. Department of Health and Human Services and the CDC, reported that in 2011, 21.8 percent of high school students used combustible tobacco products, but in 2017, usage decreased to 12.9 percent.
While the use of tobacco products like cigarettes and cigars has been decreasing steadily among teens, vaping has increased. The CDC said that in 2011, only 1.5 percent of high school students used vapor products. However, in 2018 almost 21 percent of teens reportedly used these devices.
It is clear that more teens are vaping instead of smoking, and because of this, the Food and Drug Administration (FDA) is cracking down on e-cigarette companies to prevent any further product misuse. According to the Truth Initiative, the non-profit organization whose mission it is to eradicate tobacco use among American teens and young adults, the FDA’s plan, if implemented, would reduce the rate of adult smoking from 15 percent to 1.4 percent by 2060.
The FDA proposed a plan to deter teen nicotine use involving the ban of certain e-juice cartridges, flavored cigars and menthol cigarettes from the market. All of these products, collectively, have attributes like flavors that make them more appealing to underage smokers.
A press release by the Truth Initiative stated that “Flavored e-cigarettes are especially dangerous, not only because they attract youth, but because their young users are likely to be misinformed about the harmfulness of the products.”
The most popular vapor product today, JUUL, has found its way into the hands of underage youth with its flavored nicotine products. Before the recent ban, which went into effect in February 2020, the company’s pods came in flavors like fruit, mint, mango, cucumber and crème.
The basis for the FDA’s proposal is that fruity flavors appeal to younger, inexperienced smokers. According to the Truth Initiative, research shows that these flavors make smoking seem less severe among teens and are more popular than other flavors. The 2017 study from the CDC and Department of Health and Human Services reported that e-cigarette use was the highest among high school students who were white and male.
Maione said vaping is popular during social activities, especially those that involve underage drinking.
“From my experience, alcohol and nicotine are a great mix,” Maione said with not only a smile, but a laugh as well. “Taking a few hits from a pen that delivers nicotine amplifies that level of intoxication—it makes you feel two different sensations simultaneously.”
Health Risks of Vaping
The amount of nicotine in a single JUUL pod is 5 percent, which is equivalent to the amount of nicotine in a whole pack of cigarettes. Like many vaporizers, JUUL pods contain a wide array of chemicals that are inhaled into the lungs. Some of these chemicals include glycerol, propylene glycol, nicotine and benzoic acid.
Benzoic acid is often used as an additive to antifreeze and causes irritation to the respiratory system when smoked. The highly-addictive chemical, nicotine, has its own plethora of side effects, especially when it’s frequently used by underage smokers. Nicotine boosts concentrations of dopamine in the brain and activates a reward pathway similarly to how opiates and other drugs do. It also kills existing brain cells and prevents the production of new ones. According to the University of Rochester, the prefrontal cortex, the part of the brain that controls planning and behavior, doesn’t stop developing until age 25. This puts teens at risk for impeded brain function, especially in tandem with alcohol consumption.
“Nicotine in any form has a negative impact on developing brains continuing through early adulthood and risks teen and young adult susceptibility to other addictions,” Robert Koval, CEO and President of the Truth Initiative, said in an article.
In a survey from the University of Chicago, University of Minnesota and University of Cambridge, nearly 10,000 college students who vaped and/or drank alcohol were asked about their impulsive, compulsive and mental health tendencies. The survey showed that there was a correlation between e-cigarette users and various mental health issues. The report states that “Those who used e-cigarettes were significantly more likely to have mental health histories of ADHD, PTSD, gambling disorder, anxiety, report low self-esteem, and endorse traits of impulsivity.”
A study conducted by Wolters Kluwer Health concluded that people who vape are more prone to hypertension, or increased blood pressure. This is caused by arteriolar micro-constrictions in blood vessels. Scientists from the American Physiological Society also conducted a study that corroborated this information when they found that vaping causes “arterial gas constriction” reduced oxygen flow in the bloodstream and irritation of the lungs.
The continued inhalation of foreign particles into the lungs can cause bronchitis obliterans, which is commonly known as popcorn lung. The condition, according to MedicineNet, is a lung disease that causes shortness of breath, coughing, night sweats and fevers. The onset of this is specifically caused by diacetyl, a chemical in e-juice used for flavoring.
Can Vaping Cause Cancer?
Although the chemicals in vaporizers are not known carcinogens, doctors have speculated the cancer-causing potential of vaping.
Dr. Laura E. Crotty Alexander, Associate Clinical Professor at the University of California at San Diego and Staff Physician with the VA (Veterans Affairs) San Diego Healthcare System, conducted a study with 12 other doctors on the effects of e-cigarettes on cells in 2015. They found that vaping causes double-stranded DNA breaks and increases cell death.
“Every time you have a double-stranded DNA break, it’s harder to repair and you often make mistakes with your repair machinery inside your cell when it tries to repair that DNA break, it makes mistakes and those mistakes can lead to cancer because it changes the cell,” Crotty Alexander said. “We found other things that have direct effects on the cells that can be an indicator that this can lead to cancer down the line.”
The ingredients in e-liquid typical of vaping devices are not carcinogenic. However, when vaporized these chemicals become carcinogenic substances.
“Nicotine is converted to nitrosamines when the e-cigarette vapor hits your airways and nitrosamines cause damage and harm to the body,” Crotty Alexander said. “When the glycerin and the propylene glycol are vaped and are exposed to air and humidity, they get converted to formaldehydes.”
Crotty Alexander said that the chemicals present in e-liquid change as they are vaped, and the human body is exposed to chemicals that are considered carcinogenic.
“If you go one step further . . . the chemicals that you see there were not what was in the e-liquid or vapor,” Crotty Alexander said. “These things, they evolve as they interact with the mammalian system.”
In 1964, when people realized when smoking caused cancer, motions to regulate the widespread and falsely advertised product began. Although the research on the correlation of vaping and cancer is filled with predictions, a direct link between the two has yet to be officially established.
“We didn’t know cigarettes caused cancer for like 50 years,” Crotty Alexander said. “Hopefully, e-cigarettes are not going to cause cancer . . . but there are multiple signals that show they are causing very similar patterns if you put them side-by-side with conventional tobacco.”
The Influence of JUUL Labs
An entire subculture has emerged surrounding the three-and-a-half-inch, nicotine-brandishing flash drive from JUUL Labs and other devices like the Suorin Drop, SMOK Nord and myblu pen. According to a CNN article from December 2018, JUUL once collectively paid Instagram influencers nearly $10,000 to promote the product. This was terminated in October 2018 and had just under 20 paid individuals involved in the ad campaign.
“JUULs are extremely, extremely crafty because the company has done something pretty ingenious,” Maione said. “Not only have they created those fruity flavors, but they also made a small, sleek device that resembles the appearance of a flash drive.”
JUUL has infiltrated American culture. Aside from the countless memes that can be found in an Instagram search for the device, terminology related to vaping has changed as per JUUL’s domination of the industry.
“People ask me ‘Can I see your JUUL?’” Maione said. “The device I use is not a JUUL, the device I use is by a company called SMOK, S-M-O-K; JUUL has become so well-known, and so widespread, everybody just assumes [that] every vaporizer is a JUUL—I find that kind of funny.”
The FDA’s Proposal and its Effects on the Vaping Industry
In July 2017, the FDA announced its policy to prevent teens from using tobacco products. In their announcement, the FDA made it clear that they were finally cracking down on the e-cigarette market that had been responsible for selling nicotine products to underage youth. Companies that were targeted included goliaths like Logic, Vuse, Blu and JUUL to smaller companies like, Suorin SMOK, Pax Labs and hundreds more.
In this proposal, they stressed the establishment of pre-market applications, which require e-cigarette companies to undergo a series of tests used to determine whether or not their vaporizers can continue to be sold on the market. The FDA is also ordering e-cigarette companies to prove that vaping has a benefit to overall public health.
Testing required of these companies would have to be done on a gargantuan scale. Not only will all e-cigarette companies need to undergo tests that evaluate ingredients and recipes, but various laboratories must also conduct physiological and psychological studies.
Cheryl Richter, Executive Director of the New York State Vapor Association (NYSVA) said that this testing would bankrupt the vaping industry.
“What they’re describing would cost each manufacturer millions of dollars,” Richter said. “We have to prove that there is a benefit to public health in order to keep our product on the market — no other product, by the way, has to prove that.”
Small-time vape companies have called for more guidance in FDA policy throughout the long process of refining pre-market application deadlines. Richter said that without guidance, the hundreds of smaller vaping brands on the market will go out of business because of the FDA’s plan.
“We don’t have any final guidance from the FDA of what they truly expect from us,” Richter said. “It’s going to put everybody in the industry out of work—every distributor [and] every vape shop out of business.”
In 2009, the Family Smoking Prevention and Tobacco Control Act, which gave the FDA the right to regulate tobacco products, set the stage for the tobacco market in years to come. It required that all tobacco companies restrict tobacco advertising, stop the illegal sale of tobacco products to minors, prohibit the distribution of health claims that are not scientifically proven, the display of the ingredients, the health implications of those ingredients and larger health warning labels that warn against the dangers of nicotine.
This Obama-era reform most notably limited cigarettes to tobacco and menthol flavors, which would go on to affect the sale of e-cigarettes.
Once electronic nicotine delivery systems (ENDS) gained prevalence, the FDA placed them under the umbrella of tobacco products. This made it so e-cigarette companies had to meet the same requirements. This means that any flavors, other than tobacco and menthol, would be eliminated from the entirety of the market.
“Long story short, what the FDA has planned for us currently will wipe out the market and the only people left that would be able to afford to do it are the tobacco companies,” Richter said. “You would have companies like Altria and R.J. Reynolds with their products to be able to probably go through a [pharmaceutical evaluation].”
The vaping industry relies on these other flavors to survive. The most favored pod, according to a poll of 38,000 people conducted by Vaping 360, was mango—followed by mint and then crème. Virginia tobacco, one of the least popular flavors, was only favored by 6 percent of those who answered the poll. Other companies that feature flavored pods similar to those from JUUL in their products’ lineup are at risk of going out of business.
Implications of the Master Settlement Agreement
Big tobacco, like Altria and R.J. Reynolds, were able to barter a deal with the American government with the Master Settlement Agreement, which was implemented in 1998. Cigarettes and cigars don’t face the same threats as the vaping industry because of how technologically practical they are as opposed to e-cigarettes, which remain threatened by proposed legislation.
“They did that because the tobacco companies made a deal with the government basically [gave] them a share of the market,” Richter said. “They knew that they wouldn’t be able to manufacture any new products, but they were fine with that because . . . cigarettes are a 150-year-old technology and they’re still making [them] the way they always have.”
Big tobacco like Altria and R.J. Reynolds knew that the practicality of cigarettes wouldn’t be affected by the proposed regulation. However, the threat of e-cigarettes has compromised the sale of cigarettes and ultimately hurt big tobacco.
“The Master Settlement Agreement and the beginning of the Family Tobacco Prevention Act was negotiated by the large tobacco companies to keep their products on the market without these kinds of questions,” Richter said. “Years ago, the gov’t decided that they didn’t want any more tobacco products on the market than there already were—that’s why there’s never been a new cigarette since 2009.”
Instead of paying damages to the American people directly, they opted to be taxed more annually. The money from this was intended for Medicaid efforts to prevent lung cancer and other preventable illnesses caused by smoking. However, it seems to have ended up elsewhere.
According to a follow-up study by the Campaign for Tobacco Free Kids (as well as the following organizations: Truth Initiative, Cancer Action Network, American Heart Association, American Lung Association, Robert Wood Johnson Foundation and the Americans for Nonsmokers Rights), states will receive $27.3 billion from the 1998 settlement but will only spend $655 million, which is just over 2 percent, on tobacco prevention. In other words, the other 97.6 percent is going towards whatever public works each respective state needs funding for.
“The states got addicted to that tax money and started using it for other things besides Medicaid,” Richter said. “That Master Settlement Agreement goes to pay for schools, roads—name something that the state pays for—it’s like a slush-fund.”
In 2018, Altria, the same big tobacco company that created Marlboro, bought 35 percent of JUUL—that’s $12.8 billion in shares. JUUL also owns VMR Products, another vapor company.
Already, Altria, a big tobacco company, has its hands in the e-cigarette industry, which now holds an uncertain future. Smaller vape brands, if are unable to meet the FDA’s demands, will be forced to sell their holdings to larger companies like JUUL or file for bankruptcy and liquidate their products.
“It’s going to put everybody in the industry out of work—every distributor [and] every vape shop out of business,” Richter said.
Although the date for vape companies to submit pre-market applications has been moved to
2022, Richter fears that she, as well as other vape shop owners, won’t be able to jump through enough hoops needed to save both their respective businesses and the thousands of jobs currently at stake within FDA’s proposed timeline.
Richter has refused to go down without a fight, and she’s willing to see it through until the end.
“We either fight or make them change this, or after 2022 that’s it and . . . go back to doing what we used to do,” Richter said. “Advocates . . . will come to them with what we consider good manufacturing processes and industry standards, [hopefully] they will accept that as the real way to regulate as opposed to regulating to kill, which is what the proposition is right now.”
The Pharmaceutical Cycle and the Consequences of Corporatocracy
The pharmaceutical industry is a large one and its exertion over the American people has operated for decades through lobbying and high-stakes deals behind closed doors.
With states succumbed to the tasteful taxation bonus provided by big tobacco, which is merely pocket-change for these massive companies, they risk perpetuating and even worsening a cycle of smoking-related illnesses, like lung cancer, in the United States. Without e-cigarettes on the market, or a diminished presence of such, traditional cigarettes will continue to sell.
Richter calls the threats to the vaping industry a slippery slope for public health because cigarettes will regain their dominance, and pharmacies will sell their anti-nicotine products to a population with smoking-related illnesses that they themselves created.
“You have the FDA that gets the majority of its funding from the pharmaceutical companies and [those] companies don’t want to see a whole bunch of people quitting smoking, not using their products like their gums and patches,” Richter said. “I hate to say it but if people aren’t getting cancer, they stop selling those drugs too.”
Richter had her own experience with pharma-control when she was working on a commercial by the NYSVA concerning the truths about vaping for local radio in upstate New York. She had met with representatives from iHeart Radio about airing the commercial and warned them that their pharma-investors may feel threatened. After they had told her that they’d already cleared it with their lawyers, she and her team began preparing the commercial.
A week before the ad was scheduled to be aired, iHeartRadio returned the $10,000 the NYSVA had paid them for advertising.
“[iHeart Radio’s] lawyers were contacted by the pharmaceutical company who said if [they] ran the ads, they’d pull all of [their] advertising across the United States,” said Richter. “There’s a lot of suppression of freedom of speech that’s going on as well.”
In a nutshell, pharmaceutical companies that paid iHeart Radio to run their advertisements threatened to pull their collective payments if they aired the NYSVA’s commercial.
While this amount of money is still unknown, it caused one of the largest media companies in the United States to return the NYSVA their money and cut the commercial a week before it was supposed to be aired.
“We have a lot of really big enemies that we’re fighting,” Richter said. “I honestly thought the government was working in our best interest until I entered the vaping industry and I realized just how dirty everything is.”
The Future of American Youth
Maione is looking to ultimately quit vaping before starting his sophomore year of college. He also vowed to improve his physical health by curbing the addiction. He has relapsed three times.
“My body is not working to its full potential because of the drawbacks from vaping,” Maione said. “A couple years ago I was in the best shape of my life and I haven’t been able work out as frequently as I’d like to, but even if I was afforded that, that vape would interfere.”
Although conducted on vaping by the CDC and U.S. Department of Health and Human Services has provided a wealth of information about the short-term effects of vaping, there is a little knowledge concerning the long-term effects of the habit—especially on teen brain development. The fact that significant long-term research hasn’t been published yet hasn’t appealed to Maione’s invincibility fable.
“Generally, I think that, as hypocritical as it sounds, it’s an issue that has to stop; it’s destroying this generation and it’s really becoming a health crisis,” Maione said. “We’re discovering new things about the outcomes of vaping and it’s horrifying.”
Maione said the lack of longitudinal research is to blame for the minimal impact of scare-tactics used by advocacy groups targeting underage smokers.
“Cigarettes are a turnoff for our generation,” Maione said. The [number] of studies we’ve done to learn about the impacts [of] those chemicals from cigarettes have far surpassed that knowledge of vaping.”
Truth Initiative launched “This is Quitting” in January 2019—a hotline for youth smokers who want to quit smoking. Of the 38,000 people who reached out to the Truth Initiative, 14,000 were teens and 15,000 were young adults. The website is www.thisisquitting.com, and those looking to curb smoking can also text “QUIT” to (706) 222-QUIT.
Maione frequently still uses his device on a daily basis. He stressed that if more research was available about the long-term effects of vaping, he would seriously consider quitting.
“What would it take me to quit? Just opening my eyes and waking up,” Maione said.
James Baratta is a sophomore journalism major who smuggles flavored pods into the United States and sells them on EBay. They can be reached at firstname.lastname@example.org.