San Francisco Bans E-Cigarettes, Citing Teen Nicotine Epidemic

This week, San Francisco became the first U.S. city to effectively ban the sale of e-cigarettes, prompting both praise and condemnation from health officials and the public.

Citing an “epidemic of youth vaping,” city officials approved an ordinance on Tuesday banning the sale of e-cigarettes that don’t have FDA approval. This is essentially a blanket ban, as no e-cigarettes currently bear this approval.

Advocates of the ban have rejoiced, calling it an important step in reducing teen use and protecting the public from an untested product. Opponents claim that e-cigarettes are an effective alternative to smoking, and that the ban leaves traditional cigarettes as the only option for those with nicotine addiction. In evaluating the ban, we’ll look at the pros and cons, the safety of e-cigarettes, and the potential case study that could result.

Teen Vaping vs. Smoking Cessation

E-cigs were first introduced to the U.S. in 2006. Celebrated as a safe alternative to smoking, e-cigs and other vape products deliver nicotine through a water vapor delivery system that eliminates the tar and other toxins created from burning cigarettes. Many lifetime smokers turned to the new products, satisfying both the nicotine cravings and the physical habit of smoking.

Lighting a cigarette creates more than 7,000 chemicals – about 70 of which are known carcinogens.

And chemicals are created regardless of whether it’s organic tobacco or conventional tobacco. When both organic and conventional tobacco burn, they release a multitude of harmful toxins, including carbon monoxide, formaldehyde, and arsenic.

Then, all of these chemicals are inhaled when you smoke a cigarette. In addition, sugars in tobacco produce a compound called ‘acetaldehyde’ when burned, and this has been linked to an increased cancer risk.

To be completely transparent, there are definitely MORE chemicals in conventional cigarettes than “self-rolled” cigarettes, since “Big Tobacco” companies typically add chemicals to control how quickly the cigarette burns right below the filter. Also, conventional cigarettes contain tobacco “filler” which is comprised of chopped tobacco leaves, reprocessed pieces, stems, and scraps. The reality is that dangerous chemicals can form on tobacco during the actual processing. Then, when the tobacco filler is burned, MORE hazardous chemicals are created and inhaled into the lungs.

And if that is not enough of a reason to avoid conventional cigarettes, many “Big Tobacco” companies also add chemicals (like ammonia) in an effort to optimize nicotine delivery and lung absorption. And exposure to ammonia has been shown to amplify breast cancer cell proliferation.

There’s no question that smoking causes cancer, and the battle to eliminate nicotine addiction has been waged for decades. But although e-cigarettes seemed like a breakthrough at first, there are some unintended consequences. As the market grew, so did the user base. And vaping found a new and profitable demographic in young people – especially teens.

The U.S. Surgeon General has described teen use of e-cigarettes as an “epidemic” and the CDC estimates that more than 1 in 5 middle and high school teens use them. For the past few years, regulators have been trying to stop manufacturers from marketing them to children, but to little avail. While there have been some promising new laws (including a San Francisco ban on flavored e-cigarettes), the progress has been slow.

Companies often use sweet, fruity flavors to make their products more attractive, and the use of cartoon characters to sell the products is common. The e-cig industry has ballooned over the past several years and is exempt from the regulations imposed on tobacco products. But nicotine is extremely addictive and can be detrimental to brain development in young people. So why are nearly 20% of our teens using them?

As with most public health issues, we simply need to follow the money.

Cash, Juuls, and Big Tobacco

A 2018 study published in JAMA showed that the e-cigarette industry has grown exponentially in just a few short years. In 2011, global spending on vape products was around $2 billion. In 2018, that number is closer to $15 billion – and expected to grow substantially in 2019. What’s interesting is that the companies with the largest market share have changed since then.

Juul, which spun off from PAX Labs in 2017, is a San Francisco-based company. Their product has been on the market since June of 2015 and is now the most popular e-cigarette in the U.S. with a market share of nearly 75%. In late 2018, Juul sold 35% of its stake to Marlboro manufacturer Altria at a valuation of $38 billion. Their staff has grown from 200 to 2,000 employees in the last year, and they’ve invested heavily in their hometown of San Francisco.

Just this month, Juul closed on a 29-floor building in the downtown area worth an estimated $400 million. It was the largest real estate purchase in history by a San Francisco company that was not in the real estate business. But the party may soon be over for Juul and companies like them.

Juul claims that they aren’t marketing to children, stating:

We do not want non-nicotine users to buy JUUL products and that is why our marketing is aimed at adult smokers age 35 and up.”

The company claims that their mission is to eradicate smoking, and says that a ban on their products will create an underground “black market” for e-cigarettes and lead to increased use of tobacco products. But a report from Forbes says that Juul’s marketing has directly contributed to the epidemic use in children, leading to heavier FDA restrictions. According to the report:

Dr. Robert Jackler, the cofounder of a group called Stanford Research Into the Impact of Tobacco Advertising (SRITA), a Stanford University-affiliated program, says that Juul deleted the vast majority of its social media posts in several waves sometime before September this year, but Jackler and his group have maintained an archive of Juul’s deleted posts (much of which is available on SRITA’s site), including more than 2,500 tweets and 400 Facebook and Instagram posts, as well as material from Juul’s website, emails and print campaigns dating back to its launch in June 2015.

Jackler says the company’s marketing clearly appealed to youth, most overtly from mid-2015 to 2016, the year following Juul’s launch. His archived Juul ads are filled with attractive young models socializing and flirtatiously sharing the flash-drive shaped device, displaying behavior like dancing to club-like music and clothing styles more characteristic of teens than mature adults. Often, early marketing contains little to no reference to Juul being an option for switching from cigarettes.”

With billions in annual revenue, it seems that profits have once again taken precedence over public safety.

The Health Effects of Vaping

While vaporized nicotine avoids many of the cancer-causing chemicals found in conventional tobacco products, the long-term effects have not been studied. E-cigarettes have been shown to help adults quit smoking, but a growing body of evidence suggests that e-cigarettes may be plenty harmful on their own.

One study found that the nicotine-infused liquids used in e-cigarettes becomes much more toxic when vaporized, adversely affecting our immune system’s ability to clear our lungs and prevent harmful chemical buildups. Many studies evaluate the liquid before it’s vaporized, leading to different results.

Another study found that mice exposed to e-cigarette vapor experienced DNA damage in their lungs, bladder, and heart, raising the risk of developing heart disease and cancer. Human lung and bladder cells that were exposed to an equivalent of 10 years showed the same damage, suggesting that long-term exposure to e-cigarettes could directly contribute to the 2 leading causes of death in the U.S.

According to a recent article published in Science News magazine, significant amounts of cancer-causing chemicals such as formaldehyde are absorbed by the respiratory tract during a typical vaping session, underscoring the potential health risks posed by vaping.

The ban certainly put more pressure on the FDA, who will undoubtedly be lobbied by companies like Juul to approve their products. Hopefully this will lead to more research and testing to learn exactly how vaping affects the human body. But there’s one more question that this ban may answer: is vaping an essential tool in reducing smoking – or a gateway drug for young people?

According to Lindsey Freitas of the American Lung Association of California,

Throughout the history of the tobacco control movement, cities and localities have served as laboratories to see what measures will be most effective to reduce the death and disease caused by tobacco.”

San Francisco has a relatively low rate of smoking in adults at around 11%, but the use of e-cigarettes has skyrocketed over the past several years. Will the city see a sudden uptick in adult smoking? Or will we find that vaping has created a new generation of smokers ready to line the pockets of the tobacco industry?

Only time will tell.