Inside the Vape Utopia
While the FDA moves to add regulations, industry insiders defend e-cigarettes and wonder whether new rules would be effective in protecting teens.
The National Vape Expo 2019 attracted thousands of e-cigarette users, advocates and vendors as well as public health experts from across the U.S. to the Mohegan Sun casino in southeastern Connecticut.
Without checking IDs, the expo workers scanned the QR code printed on the admission tickets and quickly directed attendees to the security area. Holding a $25 two-day pass ticket, I entered the expo on a Saturday afternoon in mid-March.
The moment I stepped into the event space, a dense cloud of smoke from vaping fogged my eyes and glasses, and I was immersed in sweet and fruity smells. Two hundred vendors were packed into the casino, competing for attention with colorful billboards and displaying various shapes and types of e-cigarette and e-juice samples. Attendees roamed through the space, making brief stops at different booths to seek information or try products. Many of them periodically inhaled from their own e-cigarettes and exhaled into the cloud that enveloped the expo.
As I stood in front of a vendor, a worker promptly grabbed a one-time-only plastic mouthpiece, put it on an e-cigarette sample and handed it to me to try. At the same time, he began to pitch his products in Mandarin after identifying that I’m Chinese. It was difficult to walk ahead between the rows of vendors because of the huge crowd. Finally, I found a relaxing space with fabric couches in the central part of the expo, where a Vape Radio stage was set aside for musical performances, vaping trick shows and experts’ speeches. Everywhere I looked, attendees were talking, laughing, vaping and enjoying cocktails bought from an improvised mini bar next to the couches.
In stark contrast to this vape utopia, much of the discussion in the outside world has focused on efforts by the U.S. Food and Drug Administration to tighten restrictions on the growing e-cigarette industry, in particular by proposing measures to curb what public health officials are calling an epidemic of vaping by teenagers.
A report from the U.S. Centers for Disease Control and Prevention published in February said that the number of high school and middle school students using e-cigarettes grew by 1.5 million in 2018, a 71.4% increase from 2.1 million youth users in 2017.
Those numbers sounded the alarm at the FDA, and new anti-vape actions were launched.
Flavors Are at the Heart of the Debate
The FDA started by focusing on flavored e-cigarettes. Last November, the agency first declared the rise of teens’ vaping an epidemic and recommended imposing limits on the sale of flavored e-juices in retail stores and gas stations as a way to make the products less attractive to young people.
“In order to close the on-ramp to e-cigarettes for kids, we have to put in place some speed bumps for adults,” Dr. Scott Gottlieb, the FDA commissioner at the time, told The New York Times.
In March, the FDA moved forward with draft guidance for the vaping industry that would restrict the sale of most flavored e-cigarettes, other than tobacco-, mint- or menthol-flavored, which, in the agency’s view, are targeted to adults who are using the devices to quit smoking. However, under the recommendations, all other flavored e-cigarettes would be banned at retailers because they pose a great risk for minors to access such products.
Recent evidence, the FDA said, “indicates that mint- and menthol-flavored ENDS products are preferred more by adults over other flavors, but that other flavors are preferred by minors over mint and menthol flavors.” ENDS, which stands for “electronic nicotine delivery systems,” is the catch-all term for the electronic devices that are used to vape. The FDA includes vape pens, e-cigarettes, e-pens, e-hookahs, e-cigars and e-pipes, among other devices, under this definition.
Anti-tobacco advocacy groups have also zeroed in on the role of flavors in the rapid rise of vaping. According to the Campaign for Tobacco-Free Kids, 81% of children who have used tobacco products started with a flavored product, including e-cigarettes and cigars. There are 15,500 tobacco flavors in the market, according to the California Department of Public Health’s Tobacco Free California campaign. More than 6 out of 10 high schoolers using e-cigarettes said they use those with flavors, among which menthol, alcohol, candy, fruit, chocolate and sweets are the most popular.
“These flavored e-cigarettes are kid-friendly,” said April Mayers, sitting in the booth of the Smoke-Free Alternative Trade Association at the National Vape Expo. “They hide the bad taste of tobacco.”
“These flavored e-cigarettes are kid-friendly,” said April Mayers, sitting in the booth of the Smoke-Free Alternative Trade Association at the National Vape Expo. “They hide the bad taste of tobacco.”
However, Mayers, the board president of SFATA, which advocates for the vape industry, disagrees with the FDA’s recommended restrictions on flavored e-cigarettes.
“They believed that it was just the flavors that the teens were attracted to the vape products,” she said. “But that’s not the case.”
Mayers said the number of teens vaping didn’t spike until 2017, even though flavors had been sold since 2009 and been prevalent in the market since 2012. What matters, she said, is the introduction of high-nicotine concentrations in e-cigarettes.
“The FDA doesn’t address quality control and marketing standards of e-cigarettes,” Mayers said. “So we should reduce the nicotine concentrations, which would eliminate a lot of the teen issues.”
According to its website, Juul, which controls about 70% of the e-cigarette market, sells flavored e-liquids with nicotine concentrations of 3% and 5% by weight. A 5% Juul pod contains about 35 milligrams of nicotine, which is equivalent to one pack of traditional cigarettes, and a 3% Juul pod contains 23 milligrams.
Mayers said SFATA is lobbying the federal government to “put regulations in place” because she thinks e-cigarettes that are designed to be a solution to smoking shouldn’t be deemed as tobacco products and regulated by tobacco laws.
“Ideally in the U.S., we would reduce the nicotine concentrations, which would eliminate a lot of the teen issue because they’re chasing a buzz,” Mayers said. “And then we can start really talking to the adults and getting them off these combustible cigarettes, which are going to kill them.”
The Influence of Cartoons and Social Media
In addition to enticing flavors, e-juice packages with cartoons have also been linked to attracting teens to sample and use vaping devices. Research from USC’s Tobacco Center of Regulatory Science indicates that e-cigarette manufacturers are using cartoons to market their products on Instagram.
Jon-Patrick Allem and his team at USC Keck School of Medicine analyzed 3,481 Instagram posts that contained the hashtags #ejuice or #eliquid posted from Nov. 3 to 17, 2017. Their findings show that e-cigarette companies are using cartoons to market their products on Instagram in ways that could be accessible to youth. Many companies’ logos use cartoons for highlighting brand recognition.
“What we found was that these cartoon advertisements and logos were influential with respect to the appeal of electronic cigarettes among 18- to 25-year-olds,” Allem said. “Later down the line, we hope to show similar results among teenagers among the 14- to 17-year-olds.”
“In these online communities, certain values start to develop,” he said, adding that his team is researching whether these online values can influence offline attitudes and behaviors related to e-cigarettes.
“There’s very limited regulation in terms of what can be said on behalf of an individual user,” Allem said. “So they can talk about vaping as much as they like on social media platforms.”
Vaping tricks also attract youths to try e-cigarettes. At the National Vape Expo, the booth of an e-cigarette manufacturer called Avid Lyfe Inc. gathered vape trick performers who wore the company’s T-shirts and sweatshirts.
Peter Koti, a vape artist from New Zealand as well as one of the performers, said he enjoyed manipulating the air, making different smoke shapes and entertaining the audience with his tricks. He added that the company utilized the vaping tricks for promotions.
“Vape tricks could attract any age. I have 15-year-olds coming out saying, ‘Man, I love the tricks,’” Koti said. “People enjoy watching it, and I might as well inspire people to learn different tricks.”
“The government is not your kids’ parent.”
Pat Dwyer, an e-liquid wholesaler from New York whose products are strictly restricted by the FDA, believes that the agency’s actions are unconstitutional. As an American, he said at his booth at the National Vape Expo, he believes in freedom and doesn’t agree with the government’s intervention in personal choices.
“Parents need to be parents. The government is not your kids’ parent,” Dwyer said. “The kids’ vape epidemic we have is because parents are failing to be parents.”
Protecting personal choice was a common theme at the expo. Peter Alhimo, 27, who said he owned an e-juice company in New York City that was squashed by FDA regulations, is a big advocate for e-cigarettes.
“Thankfully, a lot of the big manufacturers are doing the right thing to get vaping more mainstream to other people who are smoking,” said Alhimo, who has attended the National Vape Expo for five years.
When it comes to actions to protect teens from e-cigarettes, Alhimo said he didn’t agree that people shouldn’t be allowed to use e-cigarettes until they are 21.
“Eighteen to 21 is a good age to start making their own decisions in life,” he said.
“You can join the United States Army at 18, but you can’t smoke or drink,” Alhimo said. “So if you can sacrifice your life in war, why can’t you make a choice as an adult to do whatever else you want?”
Alhimo said he wouldn’t be angry with his son or daughter if they picked up the vaping habit, as opposed to smoking tobacco, in the future.
The Question for Science: Can Vaping Save lives?
“Vaping saves our lives!”
While a crowd of attendees chanted, Michael Siegel, a professor of public health at Boston University, took the stage at the National Vape Expo to deliver a message: The evidence cannot prove that vaping “causes any type of acute health effects on young people who are using these products.”
“It does cause some mild respiratory irritation,” Siegel said. “But it’s not clinically meaningful.”
Siegel, a strong advocate of vaping as an alternative to traditional combustible cigarettes, said nobody knows whether the long-term use of vaping can cause negative health effects. But certainly it is less harmful than smoking, he said, adding that “there’s no evidence that vaping is causing kids to get addicted to vaping and then become smokers.”
He believes that the FDA’s regulations on the vape industry are undermining small businesses and protecting cigarette companies, with the result that people will go back to smoking. That, he said, “would be a public health disaster.”
“There are two and a half million vapers who are former smokers who quit specifically because of vaping,” Siegel said. “I think it is a technology that truly has the potential to save lives and literally make smoking history in the United States.”
Siegel suggested that the FDA should regulate nicotine concentrations in e-cigarettes so that they are not addictive to youth.
“At the same time, the FDA should keep the e-cigarettes available on the market,” Siegel said, “because people rely on them to get off cigarettes.”
Across the country, another university researcher, Jon-Patrick Allem of USC, is studying user experience with emerging tobacco products, including e-juices. He sees dangers in vaping by young people.
“We really wouldn’t want kids to vape at all,” he said. “While it could be safer compared to combustible cigarettes, it’s not a safe behavior to engage in.”
Allem, an assistant professor of research preventive medicine and a project co-investigator with the federally funded Tobacco Center of Regulatory Science at USC, points to the composition of e-juices as potentially worrisome.
“The research is a little early to tell what the cardiovascular or pulmonary effects are going to be from vaping,” he said. “But we know for a fact that there are a lot of harmful chemicals in these juices.”
Allem and colleagues are trying to parse out the specific flavors that are particularly appealing to youths. He added that “our research hopes to make parents and kids informed about the potential harms of nicotine use on the developing brain in future public health campaigns.”
Local Conflicts: Can Businesses Survive?
In February, following the FDA’s proposed restrictions, Los Angeles County took up the issue of e-cigarettes and safety.
The Public Health Department held an informational session to announce proposed changes to the regulation of tobacco retailers based on the Tobacco Retail Licensing law of 2007. These new ordinances, if enacted, would include prohibiting sales of tobacco products near youth-sensitive areas, such as schools and parks; prohibiting sales of flavored tobacco products, including flavors allowed by the FDA; and restricting the sale of electronic smoking devices.
Retailers in attendance resented the proposed changes. Carlos, a Lancaster-based vape shop owner who would not give his last name, was the first person to express his dissatisfaction.
“It’s not fair for any business to be stripped of their rights to sell tobacco products or vaping tobacco with flavors because these businesses are selling tobacco for adult smokers,” he said, speaking alongside three other vape shop workers.
Such regulations, he said, are “just BS.” Businesses like his would collapse, he said, as customers would switch to buying products online or in other counties without the regulations.
“These regulations are hurting people who’ve been in the business. They rely on it for the income, they have a lease signed for five or 10 years, they have the inventory,” Carlos said. “The children are buying their stuff online, where there is no regulation.”
Teen vaping, he said, is not a big issue when “people are also dying from alcohol, sugar, soda and from all kinds of stuff.”
Wandering the event space at the National Vape Expo and speaking to attendees, I found Richard Veca quietly sitting alone at the booth of Veckridge Chemical, a family-owned chemical distributor based in New Jersey. Seeing me, he explained that the booth was set up to provide ingredients for e-juice manufacturers and said that his brother, the sales director of the company, had left for a moment and would be back soon if I would like to wait.
Learning that I didn’t intend to buy ingredients and preferred an interview from him, he said that his inner voice told him that vaping is still about addiction.
“There’s still a good deal of nicotine,” Veca said. “The nicotine content you get from e-juice is as much as from smoking a pack of cigarettes.”
Veca thinks the FDA’s regulations on the vape industry, a fresh market, as he called it, have been loose so far. He believes that the FDA should launch anti-vape campaigns as it has done for tobacco previously.
“Nobody should be addicted to anything,” he said.
