Why has the electronic cigarette invented for quitting smoking become a new addiction tool?
- In 2018, 1.5 million American teenagers joined the army of e-cigarettes, with the use of high school students soaring by 78% and that of junior high school students soaring by 48%. “We have seen amazing growth. Electronic cigarettes, originally intended to replace cigarettes, are prompting teenagers to start smoking.”
- In the United States, the best-selling electronic cigarette brand is “JUUL”. The company, founded in 2015, accounts for 72% of the market and has a valuation of more than US$ 15 billion. It has become the sixth largest start-up in the United States and has successfully become the “super unicorn” like Uber, Airbnb and Lyft.
- U.S. FDA Director Scott Gottlieb Daimler warned that in August 2019, the results of the U.S. Youth Tobacco Survey will announce that if the use rate of electronic cigarettes among young people continues to rise, electronic cigarettes aimed at the youth market may be completely banned.
This article may involve some product names, but this is only for the filling of articles. We have no intention to subjectively evaluate the advantages and disadvantages of any product.
When all over the world follow the example of the United States in tobacco control and issue tobacco control policies one after another, they do not know that the United States is facing the most severe tobacco control problem in history.
“First of all, the good news is that the smoking rate in the United States has been declining.” Dr. Brian, Deputy Director of the Centers for Disease Control and Prevention (CDC) Office of Smoking and Health, said, “This is a victory for public health.” On the chart he showed, the smoking rate in the United States dropped to 14% in 2017, the lowest in 30 years. In contrast, the smoking rate in China is as high as 27%, with more than 300 million smokers.
Soon, Dr. Bryan’s voice dropped-“What we don’t want to see is that one consumption has dropped while the other (tobacco products) is surging.”
This is Brian’s opening remarks at a tobacco control seminar in Richmond, Virginia, in February 2019. His speech became the hottest topic of discussion all day.
It is worth mentioning that Philip Morris (PM), the largest tobacco company in the United States, is headquartered in Richmond, where more than half of the tobacco products in the United States are produced, and Marlboro, its most famous brand, has also spread to the world. As a result, Richmond has always been one of the cities where tobacco control supporters and tobacco manufacturers struggle most fiercely. Every year, countless tobacco research conferences are held here.
The World Health Organization (WHO) is also concerned about this mysterious product.
On March 15, 2019, after CCTV’s “March 15 party”, WHO wrote on its official WeChat, “There is a product that has multiplied in the global market in recent years, especially the usage rate among young people has increased significantly … We found that this kind of product is not only harmful, but also makes young people who do not smoke originally become new smokers.”
Yes, they are talking about electronic cigarettes. This is a new type of nicotine delivery system (ENDS), which generates aerosol for users to inhale by heating a special solution. Some products are shaped like traditional tobacco products, and some are like daily articles such as pens and USB sticks. They are very convenient and hidden to use, and are popular with teenagers all over the world.
Smoking electronic cigarettes has become a trend among young people in the United States and Britain. In the streets and lanes, it is hard to see people smoking with traditional cigarettes and replacing them with colorless and tasteless electronic cigarettes.
But if you ask American teenagers, do you know Electronic cigarette? The response may be dismissive. In their view, e-cigarette is a word used only by old-school scholars and government departments. They call it “Vape” or “Vaping”. The original meaning of the word “inhalation” and “gasification” has been widely referred to as “e-cigarette or smoking e-cigarette”. In 2014, Vape (smoking electronic cigarettes) was selected as the annual vocabulary of the Oxford Dictionary.
Electronic cigarettes entangle teenagers
Because of the declining smoking rate year by year, Brian’s office was widely praised for its tobacco control work. In 2017, the number of high school students smoking traditional cigarettes dropped to an all-time low of 8.8%. In February 2019, when they released a report on tobacco use among middle school students (high/junior high) in the United States from 2011 to 2018, the problem became more difficult.
In the report, in 2018, one in every four high school students and one in every 14 junior high school students in inside used tobacco products. Among them, the smoking rate among high school students was as high as 38.3%, while the increase was mainly for electronic cigarette consumers. 1.5 million American teenagers joined the ranks of electronic cigarettes. Among them, the use of high school students increased by 78%, while that of junior high school students increased by 48%.
This makes the whole tobacco control system in the United States very depressed, because almost all tobacco consumption started in adolescence. “We have seen an amazing growth. Electronic cigarettes, originally intended to replace cigarettes, are prompting teenagers to start smoking.” Brian said CDC’s attitude is very clear. Any tobacco products are harmful, including electronic cigarettes. For minors, nicotine will affect the developing brain and impair learning and memory.
Originally invented for adults to quit smoking, e-cigarette has become a new addiction tool for teenagers.
Compared with the electronic cigarette sales chart, the correlation is even more obvious. Since the World Health Organization Framework Convention on Tobacco Control was formally signed in 2003, governments of all countries have restricted the development of the tobacco industry. The growth rate of the tobacco industry worldwide has been greatly reduced, and even negative growth has occurred in some years. The emergence of new tobacco products has given the industry new vitality.
In the United States, the best-selling electronic cigarette brand is “JUUL”. The company, founded in 2015, accounts for 72% of the market and has a valuation of more than US$ 15 billion. It has become the sixth largest start-up in the United States and has successfully joined the “super unicorn” like Uber, Airbnb and Lyft. At the end of 2018, JUUL’s management decided to award an average of 1.3 million US dollars per person-equivalent to the base salary of “coding peasant” in Silicon Valley for 10 years.
From smoking cessation products to new addiction tools
There is no doubt that electronic cigarettes have extraordinary advantages over traditional tobacco. It was born wearing a “health” halo-to help people quit smoking and reduce the harm of tobacco.
Although nicotine in tobacco is addictive, the greater harm of smoking lies in a series of harmful substances produced by combustion. For a long time, people mainly use Nicotine replacement therapy (NRT)’s smoking cessation drugs to stop smoking. However, the success rate of quitting smoking with electronic cigarettes is twice as high as that with Nicotine replacement therapy (NRT). Many Americans with a smoking age of 20 to 30 years have given up traditional cigarettes completely by using electronic cigarettes after receiving doctor’s advice, thus greatly reducing the health risks of tobacco.
But in the world, public health experts have many different opinions on electronic cigarettes. At the heart of the debate is whether e-cigarettes really help people quit smoking or create a new addiction way that attracts countless teenagers to take the bait.
Jiang Yuan, former director of the Chinese Center for Disease Control and Prevention Tobacco Control Office, has had many exchanges with US tobacco control agencies and visited JUUL, but has always expressed confusion about the future of electronic cigarettes. He said that there are more than 200 kinds of harmful substances in traditional tobacco, which will be released during the burning process. Electronic cigarettes reduce the release of harmful substances to a certain extent, but they still release harmful substances, and the use of minors is also harmful to health.
Air pollution is also a new worry, although the evidence is still insufficient. However, many organizations including WHO have begun to study the pollution of secondhand smoke. “Compared with smokeless fresh air, secondhand aerosol can cause PM1.0 value to be 14-40 times higher, PM2.5 value to be 6-86 times higher, nicotine content to be 10-115 times higher, acetaldehyde content to be 2-8 times higher, and formaldehyde content to be 20% higher. Some of the metals it produces, such as nickel and chromium, are even higher than the second-hand smoke produced by traditional cigarettes. ” WHO said.
In August 2016, the American Association of Surgeons released an important report on the use of electronic cigarettes by teenagers and young people. Surgeon Dr. Vivek H. Murthy said: “Second-hand aerosols from electronic cigarette smoking devices are not non-toxic water vapor. These aerosols may contain substances harmful to public health, including nicotine, fine particles (ultrafine particles) that can cause serious lung diseases, unknown chemical components such as double Acetyl, volatile organic compounds and heavy metal components.”
The American Academy of Pediatrics released a study that analyzed the urine of 86 teenagers and found that people who used electronic cigarettes and mixed tobacco produced three times as many volatile organic compounds in Urinalysis, including Acrylamide, acrylonitrile and propylene oxide, as compared with the group who did not smoke at all.
Soon everyone began to understand that the real harm of e-cigarettes is to let those who have never smoked before go to tobacco. “Overall, our research found that e-cigarettes are far better than helping people quit smoking in encouraging young people to start smoking. “
In March 2018, researchers at Norris Coton Cancer Center in Dartmouth College announced a study of electronic cigarettes. These scientists used the 2014 US population data to predict that a total of 2,070 adults will use electronic cigarettes to give up smoking completely in 2015. However, 168,000 teenagers who have never smoked are addicted to it.
According to the scientific community, this industry has completely deviated from its original intention and is frantically promoting and selling to teenagers.
On social networking sites, promotional videos of these e-cigarettes and promotion advertisement can be seen everywhere. According to statistics, 70% of the minors have been sent by analogy. Another worrying phenomenon is that since these devices can inject liquid by themselves, some people begin to inject illegal liquid, including drugs, and take video of the operation to spread on the network.
Tighter supervision and continuous policies
In various countries of the world, there are great differences in the supervision of new tobacco products, including electronic cigarettes. Some are regulated according to common consumer goods, and some are regulated according to tobacco products, medical drugs, etc. The United States, like traditional cigarettes, is regulated by the Food and Drug Administration (FDA). Its current director Scott Gottlieb Daimler is a strong supporter of electronic cigarette regulation, and a series of new policies have also been introduced during his tenure.
In December 2016, FDA placed electronic cigarettes under agency supervision for the first time and jointly abided by the “Tobacco Control Act” with traditional tobacco. For electronic cigarette manufacturers, FDA has given a time limit for them to register like cigarettes and provide scientific data on specific ingredients and manufacturing processes. The FDA will also review these companies and prohibit the sale of electronic cigarettes to U.S. citizens under the age of 18.
The new regulation caused great controversy at that time, especially for those groups that promoted electronic cigarettes to help quit smoking. At the same time, public health experts believed that there were big loopholes in the policy at that time. First, FDA did not exhaust the types of electronic cigarettes and had a vague attitude towards some nicotine-free electronic cigarette devices. Second, there is no standard electronic cigarette advertising and promotion methods, which in the following years had a great impact; Third, these policies will not be fully implemented until August 2019.
The Minnesota-based Center for Public Health Law believes that the FDA’s introduction of electronic cigarettes only requires producers to mark the ingredients of their products before May 8, 2018 and the harmful substances and content in their products before November 8, 2019. Although pre-market review may control the harmful ingredients of these products, FDA has extended the registration application time for JUUL non-combustible tobacco products, requiring them to submit application materials only before 2022, and existing products can be allowed to move freely in the market before FDA review.
In the United States, tobacco control policies mainly rely on individual states to formulate their own regulations. In 2019, the U.S. Public Health and Tobacco Policy Research Center under the new york Department of Health combed the e-cigarette policies of 50 states across the United States and found that as of December 2018, only 11 states had a clear definition of e-cigarette, some places had the same management of e-cigarette as traditional cigarettes, and some were relatively loose.
Just as all new industries started, soon people found the lag of law and supervision.
“Legislation on e-cigarettes began to rise after 2013, peaked in 2015, and then slowed down.” In December 2017, CDC released a report on its website summarizing the current legislative progress in various states.
According to statistics by Dr. Brian and others, as of September 30, 2017, 10 States (regions) in the United States have included electronic cigarettes in the indoor smoking ban, 18 States and regions need licenses to sell electronic cigarettes, 26 States prohibit self-service retail stores from displaying electronic cigarettes, 5 States and regions have raised the age of using electronic cigarettes to 21 years old, 11 States and regions have imposed taxes on electronic cigarettes, but 16 States still do not have any relevant laws.
At first, the regulation of electronic cigarettes in the United States did not extend to the control of taste, but now the problem is more and more serious.
In order to attract consumers, JUUL and other brands will introduce limited packs and flavors at every other stage to attract young people-mint, tropical fruit, fresh cucumber, caramel pudding, etc. The company even imitated Apple’s sales strategy and sold peripheral products, including case covers of different patterns and materials.
And a few years ago, they also distributed free trial clothes to teenagers everywhere. These are very tempting to teenagers. In 2015, an FDA study showed that the vast majority of teenagers started smoking from tobacco products with different flavors.
On April 18, 2018, five national public health agencies jointly wrote to FDA to restrict and regulate the tastes of these electronic cigarette products, hoping that FDA would remove all tastes that failed the review after August 2016. In addition, they also hope to restrict Internet sales.
Soon, on April 24, 2018, FDA announced a set of new measures to regulate electronic cigarettes. Director Scott Gottlieb Daimler cited 40 retailers that illegally sell JUUL electronic cigarettes as examples, stating FDA’s serious stance.
Scott Gottlieb Daimler said they found that teenagers have been completely confused by the nicotine product, which looks like a small USB stick, especially the JUUL brand. They have different tastes and novel appearance. Some intentionally imitate some famous liuchengjun biscuit brand packaging, which is lovely and easy to hide. They secretly use them in the school’s storage room, toilet and other very secret spaces.
In fact, JUUL, under the banner of better health, has no difference in nicotine content between some kinds of cigarettes and ordinary cigarettes. A recent study found that only 37% of young consumers of electronic cigarettes knew that such products still contained nicotine, and most people believed that they were nontoxic and harmless and could be used for a long time.
Regulators also found that the nicotine content of many e-cigarette companies did not match their labels. inside, which claimed not to contain nicotine, had not only detected nicotine but also other illegal substances. What is even more disturbing is that these sellers ignore the FDA’s existing regulations and illegally sell to minors online and offline. A month ago, regulators carried out a surprise inspection and investigated and dealt with 8 companies and 40 cases of violations against JUUL brand alone.
After that, FDA contacted Internet sales platforms such as eBay to request the deletion of some merchants who illegally sell JUUL products, and asked them to promise to abide by the latest regulations to protect teenagers from infringement of electronic cigarette products such as JUUL.
At the same time, FDA sent a letter of inquiry to JUUL, requesting the company to provide all laboratory test data and product information. “We do not fully understand why these products are so popular among young people, but we must solve this problem as soon as possible to prevent these products from inducing more children to use them.” Scott Gottlieb Daimler said that if brands such as JUUL cannot provide them as required, companies will be punished by law.
On March 15, 2019, outgoing Scott Gottlieb Daimler warned that in August 2019, the results of the National Youth Tobacco Survey would announce that if the use rate of electronic cigarettes among young people continued to rise, electronic cigarettes aimed at the youth market might be completely banned.
“If we cannot reverse this trend this year, FDA will have to take stronger measures.” He told Fox News, “At that time, we will have to remove all electronic cigarette devices sold on the market as a category.”