E-Cigarettes, aka: personal vaporizers, vape pens, vaping devices, e-cigars, mod or pod
systems, are everywhere, spreading their aerosolized mixture of nicotine, flavored liquids, and
who-knows-what-else into the atmosphere.
Vaping has become so ubiquitous that in 2014, the Oxford Dictionaries actually named “vape”
the word of the year, because its use had more than doubled in just one year.
According to a study in the Annals of Internal Medicine, 10.8 million American adults were
using e-cigarettes in 2016. But that leaves out users in middle and high school, a group
that it growing rapidly. A November 2019 study in the Journal of the American Medical Association
found that, “an estimated 28% of high school students and 11% of middle school students
said they’d used e-cigarettes within the past month.” And there are currently estimated
to be 5.3 million young users in America.
How did e-cigarettes become so popular? Why are some groups advocating for the right to
smoke e-cigarettes while others are fighting to expose their health risks and to have them
banned? Furthermore, what can be learned from comparing the marketing and debates surrounding
e-cigarettes to the marketing and debates surrounding tobacco products from years past?
Let’s begin with the early history of the e-cigarette.
Although people have been inhaling vaporized chemicals for centuries, the first electric
delivery devices emerged in the early 20th century. For instance, one 1927 patent describes
an ‘electric vaporizer’ that would, “[hold] medicinal compounds which are electrically,
or otherwise, heated to produce vapors for inhalation.”
Fast-forward to 1963, when a scrap-metal dealer (and two-pack-a-day cigarette smoker) from
Beaver Falls, Pennsylvania, named Herbert A. Gilbert, filed a patent for a device that
he hoped would wean people off tobacco. As reported in Smithsonian Magazine, Gilbert
hoped that his, “smokeless non-tobacco cigarette” might prevent diseases that, at the time,
were only suspected to arise from tobacco use. Gilbert also hoped that his nicotine-free
device, which came in ten flavors, could help dieters lose weight, because it enabled them
to, “smoke their favorite food.” Gilbert produced a prototype of his e-cigarette, but
he failed to find a company to produce it commercially.
Unfortunately for him, but fortunate for many dieters that didn't get hooked on his products,
Gilbert was ahead of his time. As viewers of AMC’s “Mad Men” know: during the
1950s and early 1960s, advertisers were still billing smoking cigarettes as a fresh, natural,
and sensuous experience. Some ads featured attractive adults smoking while engaging in,
“refreshing” outdoor sports. Others showed them puffing while attending highbrow cultural
events associated with, “good taste.” And many depicted smokers with cigarettes
dangling suggestively from their lips.
Soon enough, this naïveté would be tempered (at least somewhat). In 1964, the Surgeon
General released the first in a series of reports on “Smoking and Health.” These
reports identified cigarette smoking as being a cause of lung and laryngeal cancer in men,
likely a cause of cancer in women, and the most important cause of chronic bronchitis.
In fact, the link between smoking and lung disease was one of the top news stories of
1964.This report led to important legislation, including the Federal Cigarette Labeling and
Advertising Act of 1965 and the Public Health Cigarette Smoking Act of 1969. These laws
required health warnings to be put on cigarette packages, banned broadcast media from advertising
cigarettes, and called for an annual report on the health consequences of smoking.
Speaking of consequences, many were linked to inhaling a combination of carbon monoxide
and tar. If these could be eliminated, the thinking went, users could potentially acquire
their nicotine more “safely”. In the late 1970s, Phil Ray, a computer scientist-slash-smoker
was having trouble quitting smoking. Ray teamed up with physician Norman Jacobson to create
their version of a nicotine-delivery device. This is how it worked: filter paper soaked
in nicotine was placed in a plastic tube designed to look like a paper cigarette. All a user
had to do was inhale through the tube. There were neither electronics nor combustion involved.
A 1980 article in Medical World News quotes Dr. Jacobson as saying their product could
provide, “would-be ex-smokers the satisfaction they need without requiring them to breathe
carbon monoxide and tar.” However, this device was not a commercial success. This
was partly due to the fact that its nicotine was not encapsulated and did not need to be
heated to vaporize. This meant that some evaporated on the shelf. As a result, it was difficult
to control how much would reach end users.
Despite their lack of commercial success, these early e-cigarette prototypes, are important
to our story because they begin to hint at a trope that many e-cigarette lobbyists rely
on today—that the e-cigarette might provide a healthier alternative to tobacco.
For example, consider this print ad for an early e-cigarette-like product first marketed
in the mid-90s by R.J. Reynolds: the “heat-not-burn” “Eclipse.” As you can see, Reynolds would
later bill the device as: “A cigarette that may present less risk of cancer, chronic bronchitis,
and possibly emphysema.” For someone who desperately wants to quit smoking tobacco,
that may seem attractive, even with all the qualifiers.
The first e-cigarette that was commercially-successful was promoted using similar language. In 2003,
Hon Lik, a Chinese pharmacist, inventor, and cigarette-smoker, developed a device for what
was then Golden Dragon Holdings and later rebranded as Ruyan. Lik’s device used piezoelectric
ultrasonic technology to vaporize a nicotine solution. In 2008, Ruyan’s English-language
website pitched the e-cigarette as, “a healthier choice to make in place of tobacco products,”
and as, “a real way to put the power of choice and clean living back into your hands.”
Notice how the company merges the pitch that e-cigarettes are potentially safer with claims
that these devices give the user “power” and access to “clean living” (ideas that
we have just seen in old cigarette ads!). You'd be surprised at how blatantly 21st century
e-cigarette ads mimic mid-20th century tobacco ads.
But saying that e-cigarettes are safe and healthy doesn’t give us the full picture.
Two potential points:
First, the issue of whether or not an e-cigarette poses a relatively smaller risk to a tobacco
cigarette for a particular illness, such as cancer, distracts consumers from considering
the other dangers that an e-cigarette might pose. The Eclipse, for example, ran into problems
after after loose glass particles were found in its filter tips. Sure, the Eclipse “may”
have presented “less risk of cancer.” But it definitely presented more risk of “glass
particles in lungs.”
Second, the question of whether smoking e-cigarettes can curtail tobacco addiction is a matter
of debate. In 2008, the World Health Organization issued a press release stating that it did
not find e-cigarettes to be a legitimate tool for tobacco smoking cessation. Ruyan countered
these findings by commissioning its own study through a group called “Health New Zealand,”
which determined that e-cigarettes offered a “safe” alternative to smoking tobacco.
In 2011, the American Journal of Preventative Medicine, came to a more cautious conclusion,
stating: “Findings suggest that e-cigarettes may hold promise as a smoking-cessation method
and that they are worthy of further study using more rigorous research designs.” So,
depending on who you ask, the jury is still out on e-cigarettes as a smoking cessation
method.
So how has the group of new e-cigarette users grown so quickly, despite the ongoing controversies?
The quick answer: sleek product designs, candy-like vape flavors, and marketing campaigns that
deploy sophisticated social media tactics.
Consider, for example, how the largest e-cigarette company, JUUL has become so popular with new
users. According to Nielsen data, JUUL accounts for almost 75% of the market share and, as
of early 2019, had a market valuation of $38 billion dollars.
JUUL devices, like many other brands that are currently available, are pleasing to the
eye and easy to conceal. JUUL even launched a model that looks a lot like a computer flash
drive.
The flavor pods are also small and easy to hide. These added flavors, like crème, cucumber,
mango, and “fruit medley,” entice younger smokers. After the Food and Drug Administration
put pressure on JUUL in 2018, the company stopped selling flavored e-cigarettes in retail
stores, but still made them available via their supposedly “age-restricted” website.
In October 2019, JUUL stopped selling fruit flavors all together, but is still selling
menthol , which according to the Centers for Disease Control and Prevention’s 2019 National
Youth Tobacco Survey, is actually the second most popular flavor among high school students.
So even though the fruit flavors were designed to appeal to minors, banning them may do very
little to curtail JUUL use overall.
Robert Jackler, MD, is the co-founder and director of Stanford Research into the Impact
of Tobacco Advertising. His team has studied JUUL’s meteoric rise, assembling a website
featuring 1,400 JUUL advertisements. One section sorts where (and how) these ads appeared.
Some were presented on social media platforms like Twitter, Facebook, and Instagram. Others
were distributed by email or as part of an online promotion. Some even opted for the
“old school” route— print ads, store displays, electronic billboards and so on.
But perhaps the most insidious were those created by paid “influencers”— people
with large social media followings, who posted and hashtagged about their glamorous love
for e-cigarettes
Advertising like this is difficult for parents or the government to regulate. In 1965, the
Federal Acts mandated that advertisers include health warnings on their advertisements. They
even banned the ads from broadcast media. Today’s Food and Drug Administration has
been locked in legal battles with these companies, but even then it can do little to regulate
peer-to-peer viral marketing.
Instead, the government has turned to counter-messaging. The Center for Disease Control and Prevention
has issued warnings about the dangers of e-cigarettes. Take, for example, this hand-out, aimed at
educators and parents.
The press also plays an important role. On November 8, 2019, The Washington Post reported
that Federal data shows that there are, quote, “more than 2,000 cases [of illnesses] across
every state but Alaska connected to vaping or e-cigarettes” and that, according to
the CDC (at the time this episode was written), “at least 47 deaths in 25 states and the
District of Columbia have been confirmed.”
Raising public awareness of the dangers of e-cigarettes is critical— especially because
there is still so much we don’t know about how their use affects the human body over
time. Vitamin E Acetate has been used as a thickener in vaping fluid sometimes put into
black market vape cartridges (some of which contain THC, the ingredient that provides
the high from marijuana). According to the Centers for Disease Control, Vitamin E Acetate
was found in lung fluids of many who have experienced vaping-related lung injuries and
deaths.
And here’s a critical point: Just because you purchase a pod through a “legitimate”
corporation, and just because it’s free of Vitamin E Acetate, that doesn’t mean
that it’s “safe.” E-cigarettes are simply too new for scientists to have all of the
answers. Returning to the example of “Eclipse”: Who knows what “glass particles” today’s e-cigarettes will leave behind.