Alt-Health: Kids and E-Cigs

They look like USB drives, but they are a delivery system of a very different kind. “Pod Mods” are a new product class of e cigarettes that are quickly gaining ground in what doctors are seeing as the next emerging public health concern. Their apprehension is well-grounded. In 2011, less than 2% of US high school students reported having used e-cigarettes. By 2015, the percentage had jumped to 16%. New policies and public education campaigns managed to bring the percentage down to 11%, but the Pod Mods new level of technology and marketing threaten to send the numbers soaring once again.

One brand in particular has taken the lead. Juul is dominating the media, capturing 49.6% of the e-cigarette market. It’s easy to see why – the product has been dressed up like a iPhone Barbie for a youth demographic that often has no awareness of what is in it. Dazzled by the sleek design and customizable adhesive covers, 63% of 15-to-24-year-olds surveyed did not even know that nicotine is the silent kicker in the “creme,” “cool mint” and “mango” flavored mist.

Therein lies the real danger – this product is a wolf dressed in slick sheep’s clothing. According to Juul’s advertising, their nicotine salt solutions contain nicotine concentrations 2 to 10 times higher than those found in most e-cigarette products. Their website promises  0.7 ml of nicotine per pod – the same amount as in an entire pack of cigarettes. Just one thing is missing: the coughing fit most people experience upon taking their first drag. This adverse effect can be enough to warn many kids off them forever. Mods Pods, however, are smoothly seductive, with a candy-like whiff of flavor. It is difficult to believe that there is anything bad in there, and this allows higher doses of nicotine to be delivered with nary a connection to the cause of the effect. Kids are getting hooked and there are no outward signs that anything is happening.  It is estimated that 80% of 15-to-24-year-olds who try Juul continue using the product. Social media posts saying “addicted to my Juul” are now all too common.

A major draw for kids is that Pod Mods are easy to conceal from authority figures. They require less electrical power than most e-cigs to deliver their doses, so they are small and inconspicuous body doubles for computer USB drives. Teens bring them to school, use them in class … the teachers never notice.

Fortunately, someone did notice – in April 2018, six public health organizations called for the FDA, which is the federal agency assigned the regulation of e-cigarettes, to suspend sales of Juul, both on the internet and in retail stores, until stronger regulations and restrictions were in place to deter sales to minors. They also requested that the 2022 decision hearing to determine whether existing e-cigarette products can remain on the market be made a  priority. Eleven members of the senate have so far written to the FDA with concerns over the targeted marketing to children.

E-cigarettes were not a bad idea in and of themselves. There are a number of health professionals that see them as a method of harm reduction for combustible cigarette smokers who have tried repeatedly, and unsuccessfully, to quit. And although the jury is out as to the comparative long-term effects on smokers themselves, it is already proven that the second hand threat from e-cigarettes is a vast improvement on the considerable harm cause by combustible cigarettes to others. Public Health England (PHE), an agency of England’s Department of Health, actually took a stance (which raised many eyebrows) that they considered it their responsibility toward public health to “encourage smokers to switch to e-cigarettes.” This attitude is diametrically opposed to that in the US, where we focus primarily on abstinence.

However, health authorities here do have a point – whether e-cigarettes are, or are not, of benefit to older smokers who are unable to quit, it is obvious that there is NO advantage in e-cigs to young kids who haven’t yet started smoking. Doctors and health experts see the Juul campaign for what it is: an unscrupulous marketing effort to hook a new generation of nicotine addicts.