While working in tobacco control program evaluation in Arizona, Aunna Elm remembers finally seeing an encouraging trend in her work.
After decades of large tobacco companies enlisting celebrity endorsements and duping the public about the safety of their products, she remembers efforts finally paying off around the mid 2000s when teen smoking rates started to drop.
Now a Clark County resident, Elm recalled being shocked after attending a presentation by the Camas School District last school year. The presentation laid out that while fewer kids were smoking conventional cigarettes, more are turning to e-cigarettes or vaping devices.
“It’s like Joe Camel all over again,” Elm said, referring to the cartoon advertising mascot that was used to market cigarettes to kids.
In recent years, e-cigarettes and other devices that vaporize nicotine, as well as THC — the active ingredient in marijuana –have become increasingly common.
Battery-powered devices that vaporize a liquid for inhalation have been presented as a safer tobacco alternative or a bridge to smoking cessation. But vaping has drawn heavy scrutiny in response to 805 incidents of lung illness that have sprung up across the country since March, 13 resulting in death.
While the Centers for Disease Control and Prevention is investigating the cause, several states, including Washington, are pursuing sweeping actions to regulate vaping devices. Each state’s response has targeted what anti-tobacco advocates say is key to keeping youth from getting hooked: flavored vaping products.
Elm and other anti-tobacco advocates say the candy-like vape products lure in youth. Some are easy to conceal and resemble flash drives. Because they don’t emit a harsh odor, they’re easy to puff on in school.
But proponents of vaping say that the deaths have been unfairly linked to devices used for nicotine. They also argue that doing away with flavored products will just push more adults toward conventional cigarettes while wiping out small businesses.
“They are putting politics above public health,” said Gregory Conley, president of the American Vaping Association, a Connecticut-based nonprofit.
The Washington Legislature is expected to take up the issue when it meets in January. While lawmakers have passed bills designed to prevent youth from picking up the habit, anti-tobacco advocates say they’ll face a deep-pocketed industry with plenty of lobbyists.
Too close to school
When Dot Com Vapor opened earlier this summer off of 192nd Street in east Vancouver, Elm was incensed. The shop is within 1 mile of three schools as well as a coffee shop popular with high-schoolers, including her son. But under state law, shops like these only have to be at least 500 feet from schools.
How kids come into contact with vaping businesses and products matter. Studies have shown that smoking rates are higher in neighborhoods with greater densities of tobacco outlets. In 771 of the cases of lung illness, the CDC has calculated demographics, and 62 percent of the cases are between 18 to 34, 22 percent are between 18 to 21, and 69 percent are male. But David Hudson, healthy communities program manager with Clark County Public Health said that anti-tobacco programs are already outgunned.
Hudson said Clark County Public Health gets zero dollars for both tobacco and vaping prevention and education. He said the agency doesn’t even have the resources to police Clark County’s ban against smoking in public places.
“When we don’t put a lot of funding behind prevention work, we’re going to see rates go up, and that’s exactly what we’re seeing with vaping,” Hudson said. He called the 500-feet rule “nothing. It’s just across the street.”
According to the 2018 Washington Healthy Youth Survey, which is conducted every two years by multiple state agencies, 33 percent of Clark County students used vapor products in the past 30 days. That rate rose from 17 percent in 2016. The National Youth Tobacco Survey found that 28 percent of high school students in the U.S. used e-cigarettes in the last 20 days during 2008. That was up from 20 percent in 2017.
One of the biggest shifts toward tobacco use came in 1998, when the nation’s five largest cigarette manufacturers entered a settlement with 46 state attorneys general. The settlement addressed litigation brought by the states over the health and economic tolls of tobacco use. The agreement limited marketing of cigarettes and required the manufacturers to give payments to states indefinitely to offset the health costs of tobacco. To date, Washington has received over $2 billion from the settlement.
Carrie Nyssen, senior director of advocacy for the American Lung Association, said the settlement provided money for anti-smoking programs, and along with higher cigarette taxes and smoke-free zones, tobacco-use rates decreased. As of 2017, 13.5 percent of adult Washingtonians smoke down from nearly a quarter in 1995.
However, she said, the settlement doesn’t limit the advertising of e-cigarettes the same way it does conventional cigarettes . Nyssen said that while many adolescents have gotten the message that cigarettes are harmful, many may see vaping as more benign or harmless.
“One of the appalling things about e-cigarettes is they are targeting kids that would have never thought about picking up a combustible cigarette,” she said.
She also said the tobacco industry has a multi-million dollar marketing effort behind these products. While Juul developed an anti-vaping program, it’s been criticized as ineffective.
“When we look at what we really need to do to protect our kids, it’s getting rid of all (flavored vaping devices),” said Nyssen.
Charlene Williams, the assistant superintendent for the Camas School District, said the devices are in fashion and considered cooler than cigarettes to youth.
“This is moving so fast,” Williams said. “Stores moving into our community, their proximity to our schools. Hoodies that are designed for vaping. You can infect a whole child top to bottom. They have found every kind of way to mask these devices. We need some regulations.”
‘Enough to take action’
The U.S, Food and Drug Administration is considering action in response to the spate of lung illnesses. In the meantime, Massachusetts has taken the most sweeping action by banning all vaping products for four months. Michigan has banned flavored vaping products and New York is moving forward with similar action.
On Friday, Washington Gov. Jay Inslee signed an executive order that would require labeling, requiring retailers to post warning and manufacturers to post ingredients. Inslee has also requested the State Board of Health to ban all flavored vaping products at its next meeting on Oct. 9.
Inslee also proposed a legislative package that would increase regulatory oversight and make the ban on flavored products permanent. Such a move would follow bills passed last session that raised the smoking (and vaping) age to 21 and another that placed a 27-cents-per-milliliter tax on vapor products.
Sen. Annette Cleveland, a Vancouver Democrat who chairs the Senate Health and Long Term Care Committee, said she’s been in touch with Inslee and public health officials to determine a response. She said that next session, the Legislature might consider better labeling, restrictions on where vaping can take place, restrictions on advertising or a ban on particularly problematic chemicals.
“Very few legislators are actually focused on what the real issue is,” said Conley, president of the American Vaping Association. He said that there is evidence that the illness is linked to illicit THC vapor cartridges.
The CDC has found no definitive link to a brand, device, ingredient, flavor or substance, although the outbreak has impacted more THC users than nicotine users.
Conley said a ban on flavored vaping products is misguided. He said that fruit and sweet flavored-vaping products were not developed to target kids. He said they are demanded by adults. If e-cigarettes were suddenly flavorless, he said, many adults would go back to cigarettes, which he considers to be more harmful.
Whether vaping is healthier than smoking remains in dispute. But Cleveland said, “it strikes me that what we don’t know can kill us.”
“In my mind, that’s enough to take action to protect public health,” she said.
Clark County Public Health Officer Dr. Alan Melnick said that regardless of what science will find in the future, vaping is not safe.
“You’re inhaling a foreign substance into your lungs,” Melnick said.
Big business and out of business
Conley said that a ban on flavor would wipe out 90-percent of vape shops. And according to the Washington Post, small business vape shops are the fastest growing retail segment of the past 10 years.
Those are shops like Dot Com Vapor. The shop’s owner, Travis McDonald, said he started smoking cigarettes around age 10. His dad died from lung cancer complications in 2010 that came from smoking cigarettes. When the first e-cigarettes came out in 2008, McDonald tried one and didn’t like it because they still tasted like cigarettes. It didn’t feel like he was quitting.
It wasn’t until 2013 when McDonald tried a watermelon flavored nicotine vape pen that he felt like he had given up smoking. Now McDonald is passionate about e-cigarettes and vaping and started his own line of juice in 2014. He said his clientele are smokers looking for a healthier option.
He said he’s getting rid of Juul products because the new Juul CEO has ties to big tobacco and feels the company might be pivoting back to combustible cigarettes.
While McDonald is in favor of more regulations, a ban on flavored products would put him out of business. He also said an outright ban would make people buy products off the black market, which is unregulated and more dangerous.
“I’m doing everything I can to keep it out of kids’ hands,” McDonald said. “And I don’t know how much more I could do.”
While small businesses will be affected, anti-tobacco advocates say that efforts to regulate vaping will be met with a well-funded lobbying effort.
An analysis of campaign finance data shows that since 2007, Altria, a large tobacco company, and affiliated companies have donated $1.3 million to political candidates in Washington. Philip Morris USA, its subsidiary, had donated $462,300.
Altria has been supportive of raising the age to purchase tobacco to 21. The company did not respond to a request for comment but its filings with the Securities Exchange Commission identify a ban on flavors as an issue.
Hudson previously worked for the Washington State Department of Health on vaping prevention. He said that when staff would visit committee meetings to provide information to legislators, they would come back with the same response.
“It was me and there was 200 people from the vaping industry in the room,” Hudson recalled. “So you know who they’re going to listen to? It’s 200 against one. That’s what we’re up against.”
But speaking at a press conference on Friday, Inslee said that the state had fought similar battles in the past and had won them.