When Ohio Gov. Mike DeWine announced his plan last month to raise the state tobacco age to 21, he joined what has become a critical mass of states and localities trying to stem an epidemic of underage e-cigarette use.
The numbers are shocking – between 2017 and 2018 alone, e-cigarette use increased 78 percent among high school students and 48 percent among middle school students, according to the Food and Drug Administration.
In all, 15 states have passed bills raising the age to 21 as of May 1. Twelve have enacted those laws and three are awaiting a governor’s final approval, according to the Campaign for Tobacco-Free Kids. More than 450 localities have passed similar laws as well.
Even the federal government is getting involved. Sen. Sherrod Brown has cosponsored a bill that would raise the tobacco age to 21, and Senate Majority Leader Mitch McConnell, a Kentucky Republican who counts the tobacco industry as a major force in his state, signaled he, too, plans to put a bill on the Senate floor that would increase the purchase age to 21.
The Food and Drug Administration, meanwhile, recently closed a comment period on regulations that would require flavored tobacco products to be in age-restricted sections of retail stores.
The products have become omnipresent in high schools, where kids sneak hits off of popular products like Juul all day long. The products are largely odorless, are easy to hide, and some companies have gone so far to sell hoodies or backpacks designed to allow e-cigarette users to stealthily take a hit. To a less street-smart parent, they might look like a USB device.
The devices hit the U.S. market in 2007 and began gaining in popularity in 2013 and 2014 and Juul – which controls about 75 percent of the e-cigarette market – soared in popularity in 2017, according to Linda Richter, director of policy research and analysis for the Center on Addiction, which recently merged with the Partnership for Drug-Free Kids.
Marketed as a safer alternative to cigarettes, the devices were initially targeted at adults who were trying to quit cigarettes. But critics say they’ve evolved into a lure aimed at creating a new generation of nicotine addicts.
“This is a huge public health concern,” Sarah Denny, attending physician in the Division of Emergency Medicine at Nationwide Children’s Hospital in Columbus. “Nicotine is highly addictive – especially in the developing brain of a teenager.”
The nature of the product doesn’t help, said Richter. While teens have to sneak smoking cigarettes, they can take hits off e-cigarettes discreetly, with some companies marketing sweatshirts or backpacks designed to easily hide a vaping device. E-cigarettes are largely odorless. And the dose is far higher – one pod is the equivalent of a pack of cigarettes’ worth of nicotine, she said.
“Kids are using it basically all day long,” she said. “The amount of nicotine they’re ingesting is huge.”
But local vape shop owners say its unfair to punish all retailers who sell e-liquids for the mistakes of others. Ben Randall, owner of Dayton’s NeXgen Vapors, said it’s not the vape shops that sell to underage youth.
It’s convenience stores, websites and drive throughs that don’t properly check identification. At Vapor Haus stores in the Dayton-area all IDs are checked as customers enter the door, said Chris Voudris, owner of the chain.
The target market of Vapor Haus is over 30, he said, but there are a lot of customers between 18 and 20 years old. He also has a few employees that age that he’s worried may be forced out of their jobs depending on how legislation is handled.
“The government shouldn’t limit the opportunity for somebody to choose a safer alternative to smoking. If someone is 18 to 21 and they want to get off cigarettes, you’re eliminating that chance to have a safer alternative,” Voudris said.
Prolonged vaping, Richter said, can affect memory and cognition, making kids more irritable and hurting their ability to concentrate. And because the doses are so high, it’s all the more difficult to get them to quit. Nicotine patches and gum, she said, do little to satisfy the appetite of teenagers addicted to sky-high doses of nicotine.
They’re even more harmful to small children. Henry Spiller, director of the Central Ohio Poison Center said nationally, two children have died from ingesting the products over the last five years.
Nicotine, he said, is classified as a nerve poison. Up until 1980, it was a registered pesticide: People used it to kill the bugs on rose bushes.
“For little kids, because of two things – the small body weight and the high amount of nicotine – they can get in trouble pretty quickly,” he said.
Spiller said concentration of nicotine in an e-cigarette can be as high as 60 milligrams per milliliter compared to the six to eight milligrams one typically gets from a traditional cigarette.
In some cases of particularly high exposure he said, that much nicotine can cause a seizure. “It’s rare,” he said. “But yes, you can.”
The unknown is even scarier. Richter said some of the chemicals used to flavor the nicotine have been found to be carcinogenic. And because the products aren’t well regulated, “you have no sense of what you’re getting…there’s no way to check.”
The growing movement to raise the legal age for tobacco purchase to 21 is only one of a handful of efforts that anti-tobacco groups are using to stem the epidemic.
John Schachter, director of state communications for the Campaign for Tobacco-Free Kids said while there’s been clear momentum to raise the tobacco age to 21, the tobacco industry has also tried to work that change to their advantage.
He said the e-cigarette industry has largely backed raising the age but has worked for laws that include few enforcement mechanisms or exemptions that effectively keep states from passing any other laws that would hurt their industry.
“We’re seeing in more and more states where the industry is getting involved and pushing bills that are not very good,” he said. “They’re trying to get the benefit, saying, ‘see, we support raising the age, we’re good corporate citizens,’ but they’re actually supporting bad bills.”
He said he is wary of McConnell’s decision to introduce legislation to raising the age to 21, saying he’s worried that law will also include measures aimed at protecting the tobacco industry at the expense of youth smokers.
Raising the age alone, he said, won’t do much to stem what has become an epidemic. Instead, he said, there need to be provisions to enforce the law that would put retailers at risk if they sell the products to minors.
Richter said raising taxes on the products wouldn’t hurt, either.
“A lot of research shows teenagers and young adults are especially price sensitive,” she said. “When you raise the price of alcohol and tobacco products, you see a real decline in kids buying these products.”
Schachter said he also supports the idea of banning flavors that clearly market to the young. Former FDA Commissioner Scott Gottlieb had threatened to ban flavors if the industry didn’t work to curb the youth epidemic. For their part, JUUL has stopped selling fruity flavors in retail stores, opting only to sell them online, Richter said.
But Schachter said an outright ban on flavored products would be more effective.
“We want them to ban these products right away,” he said. “The FDA has the ability to do it.”
Gregory Conley, president of the American Vaping Association, an advocacy group for e-cigarettes, said while his organization doesn’t love the idea of raising the legal age of tobacco purchase to 21, “there are far worse proposals in the world than tobacco 21.”
Still, he said, his organization will only back it if existing 18-21 year olds are grandfathered into being able to use the products legally.
One thing they’ll fight, he said, is any effort to ban the flavors. “Flavors are very important to smokers looking to quit,” he said.
Even raising the age, he said, won’t stop youth who are determined to vape.
“The reality is just as with alcohol, cigarettes and marijuana, if youth are determined to get their hands on it, they will get their hands on it,” he said. “Regardless of what you try to do.”
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