Nearly every person in America can name someone they’ve known who is or was addicted to nicotine. Some might think of their grandparents, who were uninformed of potential consequences of the habit until later in life. Others might think of their son or daughter who is addicted to electronic cigarettes. Nicotine addiction spreads far and wide despite health risks, and the tobacco industry continues to thrive.
Nicotiana tobacco, often referred to as the tobacco plant, has grown naturally in the Americas for 8,000 years, and has been chewed and smoked for religious and medicinal reasons by Native Americans for over two millennia. It wasn’t long before the tobacco plant was industrialized by European settlers, becoming the primary cash crop of the early United States of America. By the early 1900s, cigar and cigarette industries were booming.
The high and consistent value of tobacco among all demographics persists due to the plant’s highly addictive alkaloid, nicotine. According to the National Library of Medicine, it wasn’t until the 1940s and ’50s that American scientists first linked smoking tobacco to lung cancer, and the hazards were publicized. Today, according to the Centers for Disease Control, one in every five deaths is related to cigarette smoking.
Over time, doctors and scientists developed smoking cessation aids to help people quit smoking. Meanwhile, inventors and entrepreneurs continued to monetize tobacco in every way imaginable, developing new forms of tobacco products and consumption. Eventually, electronic cigarettes, or e-cigarettes, came to America in 2006, initiating an entirely new epidemic of nicotine addiction.
“[E-cigarettes] are just as dangerous, if not more dangerous, than cigarettes.”
E-cigarettes have been banned in at least 37 countries around the world, but the United States is not one of them. Controversy between the U.S. Food and Drug Administration and e-cigarette manufacturers is extensive, and consists of three major disagreements regarding marketing techniques and harmful chemicals being used in the products.
Smoking Cessation Aid Scheme
E-cigarettes were initially marketed as tools to help people quit smoking, but according to the FDA this is false information. Dr. Jamie Lujan, a nurse practitioner who counsels patients on smoking cessation at Lung Specialists of Las Cruces, said she does not view e-cigarettes as a smoking cessation aid. She regularly shares that information with her patients. According to Lujan, e-cigarettes are “just as dangerous, if not more dangerous, than cigarettes.”
“You are heating, you are aerosolizing these carcinogens and so you’re not dealing with just the nicotine, you’re dealing with the polyethylene glycol, you’re dealing with the metals that are in these e-cigarettes, and there’s even been arsenic seen in these e-cigarettes,” Lujan said.
The FDA has also linked e-cigarette usage to seizures, mostly among young users. Several large legal settlements have been reached between e-cigarette manufacturers and those affected by their products. According to the FDA and other experts like Lujan, vape products include chemical metal particles that can cause irreversible lung damage.
“We’re seeing it cause permanent damage to the bronchial walls. It shows evidence of what we call popcorn lung, the permanent dilation and thickening of the inside of the bronchial wall. Young kids … we’ve hospitalized teens and [people] in their early 20’s with these lung injuries, and we’ve even put them on ventilators.”
Despite FDA evidence and widespread warnings from health professionals, some do still claim e-cigarettes help smokers quit smoking, including the Consumer Advocates for Smoke-free Alternatives Association, a non-profit organization formed in 2009 that is aimed at protecting the e-cigarette industry.
“With companies like Juul, I think that’s when it became targeted toward younger people or people that did not already smoke. If someone is trying to quit, they don’t want raspberry or blueberry flavors. They want the flavors of actual cigarettes. Whether they admit it or not, those types of companies were designed for people that did not smoke before.”
There is also the issue of e-cigarette manufacturers marketing their products in a way that targets young people. As manufacturers started offering flavored cartridges and packaging products to look cartoonish and without clear warning labels, tobacco consumption among high school students rose from just 1.5% in 2011 to 16% by 2015.
In 2016, the FDA issued many marketing denial orders to manufacturers in pursuit of protecting young people from nicotine addiction. In 2018, the FDA took historic action against over 1,300 retailers and five major vaping product manufacturers for their roles in perpetuating youth access, requesting manufacturers to provide a plan for mitigating youth sales. The FDA has yet to fully regulate the industry.
In 2019, Juul Labs, Inc., one of the most popular vaping products among the youth demographic, was issued a warning letter from the FDA for describing its products as “totally safe” in a presentation to children at a school. Juul products were eventually banned last year, but the ban was put on an administrative hold until the FDA can review the corporation’s marketing application again. Juul has faced more than 5,000 lawsuits for failure to warn consumers of the dangers of its products and for intentional misrepresentation. As of March 16, 2023, Juul has agreed to a $255 million class-action settlement, making money available to those who bought Juul products before December 2022.
When examining the reasons why addiction to e-cigarettes is most common within the Generation Z age demographic, it’s important to consider the timeline. As the e-cigarette industry emerged in the early 2010s, manufacturers marketed their products as better alternatives to cigarettes. Early Generation Z youth were in or entering their adolescent years at that time, the age when curiosity around substance use begins.
By the time the FDA was granted regulation of the e-cigarette industry in 2016, many young people had already picked up the habit. In 2019, former President Donald Trump amended the Federal Food, Drug and Cosmetic Act, raising the minimum age to purchase tobacco from 18 to 21, leaving many 18-, 19- and 20-year-olds with an addiction to a product they could no longer purchase. According to Dr. Lujan, 2019 is also the year America began to see a surge in lung injuries related to e-cigarettes and vaping.
“By February 2020, we had almost 3,000 hospitalizations within the U.S. because of lung injury related to vaping and e-cigarettes … and about 68 deaths,” Lujan said.
Madison Davenport, 23, started using Juul products at age 17 and says that at that time, she believed vaping was not nearly as bad for you as cigarettes. By the time more health research emerged and the minimum age to purchase tobacco products was raised, it was too late for her and others her age; they were already addicted. Beyond that, the new minimum age requirements were not universally enforced.
“In 2019 [when the minimum tobacco age was raised], they did nothing to help people our age that were already addicted, so we found the loopholes like anything else. We had already been doing it for two to three years, fully addicted. We just found the gas stations where it was easy to buy,” Davenport said.
Davenport remembers when the e-cigarette industry first emerged and said she thinks at first, e-cigarettes were falsely marketed as smoking cessation aids.
“With companies like Juul, I think that’s when it became targeted toward younger people or people that did not already smoke,” Davenport said. “If someone is trying to quit, they don’t want raspberry or blueberry flavors. They want the flavors of actual cigarettes. Whether they admit it or not, those types of companies were designed for people that did not smoke before.”
Dr. Lujan’s opinion aligns with Davenport’s. “In teens or young adults who have not previously had traditional smoking habits, they start using these flavored vapes, and it really perpetuates the habit and they become smokers,” Lujan said.
A single Juul cartridge contains 20 cigarettes worth of nicotine. Davenport said she doesn’t think she would have a nicotine addiction if she never would have started using Juul products.
“I think it’s harder to quit vape than cigarettes because of the potency. Cigarettes are also more numerical. You can see how much you’re smoking.”
Between 2006 and 2016, the FDA had no regulatory power over the e-cigarette industry. During that time, the industry’s aggressive marketing tactics cultivated a $6 billion market by 2020. According to Lujan, this type of regulatory delay is typical in evidence-based practice.
“Research, and the implementation of that research, can take up to 10 years. Nothing is from today to tomorrow. We just don’t do things quickly in science because research takes time,” Lujan explained.
Long-term Effects and Resources
Long-term effects from using e-cigarettes are not yet identifiable, but e-cigarettes are classified as tobacco products, which have been proven to cause clinical lung and cardiovascular disease.
“[E-cigarettes] are harmful and the complete degree of harm is still unclear. Being in your young adolescence or early adulthood, you have 30-40 years that you’re going to need those lungs. If you damage them permanently now, it’s going to be a lifetime of consequences,” Lujan said.
The story of e-cigarettes presents a similar narrative to the story of tobacco use among older generations. In both cases, widespread nicotine addiction was already in place before consumers were informed of the dangers and repercussions of the addictive behavior. The tobacco industry strikes again.
Those suffering from nicotine addiction in New Mexico can access free cessation services in a variety of languages by visiting the QuitNowNM website or calling the statewide toll free number at 1-800-QUIT-NOW (1-800-784-8669). Students seeking personalized services can contact the Aggie Health and Wellness Center for counseling and addiction support.