Up until a month ago, it sometimes seemed like everybody vaped, from international celebrities to local teens. Now, it can feel as if everybody is trying to quit.
Amid reports of at least 805 cases of vaping-related lung injury in 46 states and one US territory, states including New York, Massachusetts, Michigan and Rhode Island have all banned sales of flavored electronic cigarette products.
In California, where e-cigarette giant Juul Labs is headquartered, the matter has particularly hit home, with the state’s department of public health issuing an advisory this week urging “everyone to refrain from vaping” and the governor launching a $20m public awareness campaign about the dangers of it.
Even Donald Trump is developing a federal flavored e-cigarette ban.
“They’ve been touted as safer than cigarettes, even to the extreme of being safe, period,” said John Maa, a past president of the San Francisco Marin Medical Society. “But we don’t really know what the effects of chronic vaping is on your lungs.”
And yet it was not that long ago that vaping was widely accepted as the healthier alternative to cigarettes.
When e-cigarettes entered the US marketplace in about 2007, they were billed as a tool to help smokers quit smoking . Like cigarettes, they contain nicotine, but not its parent compound, tobacco, which kills up to half its users.
To many, the process of vaping also felt better than smoking and with a wide variety in flavors, they appealed to an audience much wider than smokers. “Someone who doesn’t smoke might pick up a cigarette, take a few puffs, cough, and question why they’re doing it,” Maa said. “But with an electronic cigarette, it’s tasty. It’s like having a lollipop.”
Around 2015, e-cigarette use began to shift from adults trying to quit smoking to nonsmoking youth. The shift coincided with the launch of Juul, the immensely popular small vape developed in San Francisco that would soon conquer the world. In hundreds of lawsuits filed in federal and local courts across the US, attorneys blame Juul for the rise in youth vaping, pointing to a targeted marketing campaign directed at kids and young adults.
E-cigarette use among middle and high school students increased 900% from 2011 to 2015, according to the surgeon general, with roughly 4.9 million teens using e-cigarettes in 2018 – an increase of 1.5 million from the year before.
And in far too many cases, the kids didn’t know what they were doing. Almost two-thirds of Juul users ages 15 to 24 surveyed by the Truth Initiative in 2018 did not know that their Juuls contained highly addictive nicotine, a substance known to be particularly harmful for youth whose brains are still developing.
“These kids were trying them out because they tasted nice,” said Mahzad Hite, an attorney working on a number of personal injury lawsuits against Juul. “Nicotine can have long lasting and sometimes permanent effects on the brain of people under the age of 26. We’re seeing kids who were honor students who are now failing their classes. We’re seeing kids who were athletes who can longer perform.”
Hite works at the San Francisco-based law firm Levin Simes Abrams, which has filed 60 lawsuits against Juul in the past months.
“The science is developing, and I think that’s why we’re seeing so many reports now, even though vaping has been around for years,” said attorney Rachel Abrams. “We’re seeing people going in with lung issues and not knowing what’s contributing to them and not willing to admit that they’re vaping.”
Abrams and Hite represent clients who have ended up in the hospital because of lung issues believed to have been caused by vaping. Some of their clients had such severe cases of pneumonia that they had to be intubated, or rushed to the emergency room. They also represent the family of a 14-year-old boy who died of an asthma attack he had while vaping.
In many cases, they said, it took time before their clients realized the role vaping may have played in their health issues. Medical providers have long been asking patients questions about smoking, but only recently have they begun asking if they vape, the lawyers said.
Although it may seem like all these reports of vaping-related lung injuries are suddenly coming out of the woodwork, Hite believes it is more likely that these cases have been underreported.
“They’re only just now connecting the dots,” Abrams said. “We’re using the word epidemic, and it truly is. I think we’re just seeing the tip of the iceberg.”
In June, San Francisco – where Juul is headquartered – became the first US city to ban the sale of e-cigarettes. Juul has since spent $11.5m to promote a local ballot measure to overturn the ban, depositing workers with signs outside bus stations and flooding mailboxes with literature proclaiming that overturning the ban would stop youth vaping.
Earlier this month, the Food and Drug Administration issued a warning letter to to the company, saying it had not received federal approval to promote and sell its vaping products as a healthier option.
Juul did not return requests for comment. In testifying before Congress in July, however, the company admitted to presenting the product at a school and marketing it as “much safer than cigarettes”.
The US attorney’s office of the northern district of California has opened a criminal investigation into Juul, the Wall Street Journal reported this week, though the focus of the inquiry is still unclear. On Thursday, San Joaquin County district attorney Tori Salazar announced that she was launching both a criminal and civil investigation into Juul, looking into the company’s marketing and targeting of youth.
The US Federal Trade Commission is also investigating whether Juul used deceptive social marketing that targeted minors.
On Wednesday, Juul’s chief executive Kevin Burns stepped down and was replaced by KC Crosthwaite, chief strategy officer at Altria, the tobacco giant that is Juul’s largest shareholder.
“I have long believed in a future where adult smokers overwhelmingly choose alternative products like Juul,” Crosthwaite said in a statement. “That has been this company’s mission since it was founded, and it has taken great strides in that direction. Unfortunately, today that future is at risk due to unacceptable levels of youth usage and eroding public confidence in our industry. Against that backdrop, we must strive to work with regulators, policymakers and other stakeholders, and earn the trust of the societies in which we operate.”
Effective immediately, the company suspended all broadcast, print and digital product advertising in the US.
“Juul is losing a lot of steam as more reports come out and more information gets made public,” Abrams said. “I think California and San Francisco was ahead of the curve and I think the rest of the nation is going to catch up in banning them.”
