After two decades of decline, teen tobacco use has become a crisis that demands immediate, multipronged action.
The new federal law banning the sale of tobacco products to anyone younger than 21 was a good first step. To be effective, however, it needs strong state-level enforcement. State lawmakers need to align Indiana's age-of-sale laws with what we know works: retailer compliance ensured by strong enforcement, including stiff fines and license suspension and revocation for underage sales.
Current Indiana law allows youth using or possessing tobacco to face fines more than double those levied against the seller. Kids need help to quit and barriers to access, not fines. We must place responsibility for underage sales squarely where it belongs – with the entities profiting.
From 2000 to 2018, past-month cigarette use among Indiana high school students declined steadily from 32% to 5%, mirroring a trend nationwide. But with the advent of vaping, teen tobacco use rose again: between 2012 and 2018, past-month e-cigarette use among Indiana high school students rose 385%. Monitoring the Future, a spring 2019 nationwide survey of teens, revealed a whopping 37% of the nation's 12th graders had vaped in the past year, with 12% reporting daily vaping.
Why this reversal? As public health advocates rejoiced, the tobacco industry got to work. Youth aversion to its products threatened its survival. To sustain business, Big Tobacco needs a steady pipeline of newly minted nicotine-dependent teens. Attracting and hooking kids is the foundation of the tobacco business, for youth who reach adulthood tobacco-free rarely touch tobacco products as adults.
In 2007, a device hit the market that the industry could market to fly through kids' risk and revulsion filters. Made for 21st century sensibilities, with battery-powered circuitry and sleek, high-tech design, it bypassed stinky, burning leaves to deliver nicotine via a sweet-flavored aerosol mist, deceptively dubbed “vapor.” Extracted from tobacco leaf, mixed with solvents and flavorings, nicotine was turned into a solution beguilingly named “e-juice.” Because the new devices didn't fit the FDA definition of “cigarette,” their liquids could be sweetened with kid-attracting fruit, candy and dessert flavors, packaged in cute, colorful bottles and cartridges, and labeled to resemble food and drink popular with kids.
Thus was “vaping” born – and quickly on its heels, the youth vaping epidemic. The industry leaned heavily on distinguishing “vaping” from “smoking.” What could sound more benign? Every teen I've asked – and I've asked hundreds – says their first thought on hearing “vapor” is “water.” Little wonder so many kids think it is only water they are inhaling.
In fact, the cloud of fine chemical droplets contains solvents and emulsifiers, flavoring chemicals, nicotine (a brain-altering pesticide and neurotoxin), and dozens of nitrosamines, aldehydes and heavy metals. Many are the same as found in cigarette smoke. None are substances human lungs are built to handle.
By 2015, when Juul Labs invented its high-concentration nicotine-salt solution, packaged in tiny, colorful “pods” that click snugly into devices resembling flash drives, the “vape pen” solidified its popularity with the iPhone generation. Designed for stealth use, Juul and other pod-based vapes fit neatly in one's palm, slide easily into a pocket or under a bra strap, recharge in a USB port, and blend undetectably with items youth routinely carry: flash drives, computer mice, lipsticks and eyeliners. Add tens of thousands of Instagram accounts, hired by Juul Labs to aggressively market youth vaping as fun, trendy, social and harmless, and little wonder youth easily fell for this new form of tobacco use.
Drawn to flavors, sleek design and social media messaging that identifies vaping as part of teen culture, up to a third of our teens now carry pocket-sized, sweet-tasting bombs of nicotine addiction. The fruity/minty hits they sneak in classrooms, bathrooms and bedrooms have set them on a well-worn path of compromised productivity, financial drain and damaged health. What nicotine does to developing brains is not good. With just 12 years on the market, we now also know that aerosolized nicotine causes serious oral, cardiac and respiratory damage. What further harms will be revealed in 20, 30 or 40 more years?
With one of the highest adult tobacco use rates in the nation (22%), Indiana cannot afford to let its youth become the next generation of nicotine-dependent adults, handing over health and wealth to this nefarious industry. We must take action.
Precisely because strong enforcement of retailer compliance blunts youth access, industry lobbyists (including retailer industry groups that often front for Big Tobacco) will try to persuade our lawmakers to punish the kid purchaser, not the retailer. One need only look at how massively and predatorily this industry has targeted kids to see their game: render the new Tobacco 21 law ineffective.
Our lawmakers need to enact enforcement laws that aim responsibility squarely where it belongs – on those who peddle this addictive, brain-altering drug to our kids.
Nancy Cripe is executive director of Tobacco Free Allen County.