The decades-long battle between the tobacco industry and public health officials in the U.S. has recently shifted to uncovering the effects of electronic cigarettes and vaping on both established tobacco users and young people. The conversation has reached a fever pitch as regulators propose new limitations and even bans on specific products and manufacturers.
The tobacco industry is constantly innovating and finding new ways to give users the quickest and most impactful rush. That’s evident in the popularity of e-cigarettes.
“A good way to view tobacco products is that they’re all nicotine delivery devices,” says Dr. Theodore Wagener, director of the Center for Tobacco Research at The Ohio State University Comprehensive Cancer Center. “Nicotine on its own isn’t all that harmful. From everything that we’ve seen, it doesn’t cause cancer in any way. But, when you deliver it through a dirty nicotine device like combustible tobacco, like cigarettes, cigars, hookah – not good for you.”
These different avenues of using nicotine exist on a spectrum, Wagener says. He describes tobacco leaves as the “dirtiest” because they’re loaded with carcinogens and toxic chemicals.
For those who are addicted to cigarette smoking, Wagener says there are certain brands that minimize harm and encourage smokers to break the habit.
Since 2020, research by the Food and Drug Association (FDA) has differentiated between brands of e-cigarettes, approving some while labeling others as not fit for public consumption.
Earlier this year, the FDA banned the sale of e-cigarettes made by Juul, the 2021 leader of the e-cigarette market, due to what it says is an overall negative effect on public health. In July, though, the FDA temporarily suspended its order banning Juul. As of August, the order is under review to research more about scientific issues pertaining specifically to Juul devices.
When Juul released its first e-cigarette in 2015, the company’s years of research and careful planning paid off. Juul’s e-cigarette delivered three times as much nicotine as its competitors’
maximum output at the time, creating a potent rush that is hard to resist once a user is hooked – in other words, highly addictive.
When e-cigarettes first reached the market, nicotine levels were usually between three and 20 milligrams per milliliter. A Juul can deliver an unprecedented 59 milligrams per milliliter, according to the company’s website. What has made it an even more galvanizing product is how easy it is to use.
Juul products use almost entirely synthesized nicotine through a process called protonation, which allows for heightened nicotine concentration and a smoother inhaling experience.
“It makes it incredibly palatable, even for new people to inhale,” Wagener says, “because essentially, you’re moving almost to the feeling of if you just put your mouth over a humidifier. There’s no burning.”
This means the Juul became more attractive to new users who were turned off of other brands or traditional cigarette smoking due to unpleasant side effects such as that burning sensation. The increased addictive qualities combined with fewer unpleasant side effects has culminated in a marked increase in youth e-cigarette use.
“What Juul was then able to do is go, ‘Great, now there’s no harshness so we can increase the nicotine concentration to make this more appealing and satisfying to nicotine dependent users’ and also, we (researchers) find, to youth,” Wagener says.
A 2021 study by the FDA and the Centers for Disease Control and Prevention (CDC) estimated that nearly 2 million middle and high school students currently used e-cigarettes. At the same time, the CDC estimates that two-thirds of Juul users age 15-24 don’t know that the devices always contain nicotine.
Juul has become notorious for targeting its marketing at young people. Some Juul ads display attractive young adults as they use the products and talk about how the product is smooth and flavorful. The ads might sound familiar to anyone who remembers when cigarette ads were pervasive on TV.
The harmfulness of e-cigarettes does depend on the product, though. The voltage of the device and the contents of the nicotine concentrate contribute heavily.
Still, there remain unknowns about the technology. A heating coil must burn nicotine juice so that the juice can pass through a user’s lungs, and Wagener says the effects of this process on the body will take years to fully understand.
The U.S. Surgeon General offers tips for discussing the effects of tobacco with your teen. Read more at e-cigarettes.surgeongeneral.gov.
Tyler Kirkendall is an editor at CityScene Media Group. Feedback welcome at tkirkendall@cityscenemediagroup.com.
