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Government regulators are banning menthol cigarettes and chipping away at flavored e-cigs — but not in the way some thought

Government regulators are banning menthol cigarettes and chipping away at flavored e-cigs — but not in the way some thought

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Eduardo Munoz/Reuters
  • Federal regulators on Thursday proposed a ban on menthol cigarettes and a move to place flavored e-cigarettes like the Juul behind a stronger regulatory fence.
  • The move is less severe than what some expected to see: an immediate ban on flavored e-cigs being sold at convenience stores and gas stations.
  • Menthol and mint e-cigarettes aren’t affected by the government’s proposal.
  • Earlier this week, the Silicon Valley e-cig startup Juul announced it would temporarily stop selling its flavored e-cigarettes in stores – a move it probably made in anticipation of the government’s latest statement.

Instead of announcing what was expected to be a sweeping and immediate ban on flavored e-cigarettes like the Juul, government regulators on Thursday proposed banning regular menthol cigarettes and revisiting a year-old policy designed to put new e-cig products behind a stronger regulatory fence.

Food and Drug Administration’s commissioner Scott Gottlieb said his agency would revisit its policy as it applied to all flavored e-cigs except for tobacco, mint, and menthol varieties. The FDA didn’t provide a timeline for the changes in its statement.

The changes Gottlieb aims to see, he said, would protect teens and minors by ensuring those products are sold only in locations that cater exclusively to adults. Online sales would also be allowed “under heightened practices for age verification,” he said.

The move may surprise Juul Labs, the Silicon Valley startup that has 80% of the e-cig market.

Earlier this week, the company announced its own immediate (albeit temporary) ban on flavored e-cigs at all retail stores.

“As of this morning, we stopped accepting retail orders for our Mango, Fruit, Creme, and Cucumber Juul pods to the over 90,000 retail stores that sell our product, including traditional tobacco retailers and specialty vape shops,” Juul CEO Kevin Burns said in a statement on Tuesday.

Read more: Juul will soon stop selling flavored e-cigarette packs in retail stores, but a workaround could make the ban pointless

Juul’s move was most likely made in anticipation of an expected similar action from the FDA, experts say. Last week, The Washington Post reported that the agency would ban “most flavored e-cigarettes in tens of thousands of convenience stores and gas stations across the country.”

But the FDA didn’t ban flavored e-cigs on Thursday.

A ban on menthol cigarettes and a plan to eventually put e-cigs behind a stronger regulatory fence

cigarettes

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Matt Cardy/Getty Images

Instead of banning flavored e-cigarettes, the FDA on Thursday proposed barring the sale of menthol cigarettes, which Gottlieb said he believed “represent one of the most common and pernicious routes by which kids initiate on combustible cigarettes.” FDA also plans to propose a ban on flavored cigars.

He also outlined plans to eventually regulate e-cigs more strictly using a policy he initially proposed last year and then waived.

Thanks to that policy, any e-cig introduced before August 2016 was essentially grandfathered in to the market, meaning its makers did not have to seek FDA approval to sell their products until at least 2022.

That waived policy has been the door through which e-cig companies like Juul were able to aggressively market and sell their products.

Read more: $15 billion startup Juul used ‘relaxation, freedom, and sex appeal’ to market its creme-brulee-flavored e-cigs on Twitter and Instagram – but its success has come at a big cost

Gottlieb said he hoped that revisiting that policy would place e-cigs back behind a regulatory fence and ensure that they are marketed and sold in a responsible manner that doesn’t target youth.

The government is also publishing new data that suggests a troubling increase in e-cig use among teens. From 2017 to 2018, Gottlieb said, there was a 78% rise in e-cig use among high-school students and a 48% increase among middle-school students.

“These data shock my conscience,” Gottlieb said in the statement.

“The bottom line is this: I will not allow a generation of children to become addicted to nicotine through e-cigarettes,” he added.

‘Most scientists believe flavorings are used to target teenagers’

sriracha hot sauce e-cig vape pen california prop e poster

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California Department of Public Health

Flavors have been at the epicenter of much of the debate around young people and e-cigarettes.

Experts say e-cig varieties like Apple Pie, Watermelon, and even Hot Sauce are designed intentionally to hook teens on nicotine, a highly addictive substance that’s especially influential on a developing brain.

“Most scientists believe flavorings are used to target teenagers into becoming users,” Ana Rule, a professor of environmental health and engineering at Johns Hopkins University who was an author of a recent study on e-cigs and teens, told Business Insider this summer.

“There are of course many other factors such as marketing and peer-pressure, but when you look at the flavoring names, one has to wonder.”

In Juul’s statement announcing its own temporary halt on flavored e-cigs, the company acknowledged that its flavored varieties might appeal to youth.

Other regulators have taken action on flavors as well.

Over the summer, San Francisco residents voted to pass a sweeping tobacco-flavor ban that barred the sale of flavored e-cigs as well as menthol cigarettes. Several big names including former Mayor Michael Bloomberg of New York came out in support of the ban, suggesting at the time that it could spur similar moves in other cities.

“This vote should embolden other cities and states to act, because it demonstrates the public will not allow tobacco companies to stand in the way of policies that are proven to reduce smoking and save lives,” he said in a statement.

Read more: San Francisco has passed a sweeping ban that should scare the $23 billion vaping industry

With these moves and the Washington Post story in mind, many experts believed the FDA would crack down immediately on both flavored e-cigs and menthol cigarettes today. But while the menthol cigarette ban is directly outlined in the new policy, no such ban is outlined with regard to flavored e-cigarettes.

Instead, flavored e-cigs will still be widely available – so long as the locations they are sold in follow age-restriction protocols.

“The changes I seek would protect kids by having all flavored [e-cig] products … sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification,” Gottlieb said in the statement.

We just got our first look at how many minors are using Silicon Valley’s favorite e-cig, and it doesn’t look good

We just got our first look at how many minors are using Silicon Valley’s favorite e-cig, and it doesn’t look good

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Shutterstock
  • A new study provides the first hard data on how many minors and teens may be using the Juul, Silicon Valley’s favorite e-cigarette.
  • The company behind the devices is a startup called Juul Labs that was recently valued at $15 billion. Their products have surged in popularity, amassing 70% of the e-cig market.
  • But Juul faces a growing backlash from public-health experts and scientists who worry about its popularity among young people.
  • Juul maintains that its products are for adult smokers who want to move away from traditional cigarettes.

For the first time since Silicon Valley e-cigarette startup Juul Labs unveiled its flagship product – a sleek, flash drive-like device packed with the same nicotine content as a pack of cigarettes – researchers are getting an idea of how many of its customers are young people. The results don’t look good.

The findings of a survey published on Tuesday suggest that, compared with their older counterparts aged 25-34, a higher portion of young people aged 15-17 are using the Juul at least once a month.

Overall, the researchers found that 6% of the 15-17 year olds and 8% of the 18-21 year olds in their sample had used a Juul between one and 30 times in the past 30 days – a figure that’s roughly the same as it is for conventional cigarettes, according to data from the Centers for Disease Control and Prevention.

Meanwhile, only about 1% of people aged 25-34 said they’d used a Juul any time in the past month.

Juul maintains that its products are for adult smokers who want to move away from traditional cigarettes.

“Underage use is directly opposed to our mission of eliminating combustible cigarettes by offering the world’s one billion existing adult smokers a true alternative,” a Juul representative told Business Insider last week in an emailed statement.

But the new survey data suggest for the first time that underage ‘Juuling’ is a real phenomenon and not simply the result of overblown fears propelled by media hype.

Younger people are more likely to say they ‘Juul’ than older people

To conduct their study, five researchers from the Truth Initiative and a handful of top-notch public health universities across the US including the Bloomberg School of Public Health, Johns Hopkins, and New York University recruited more than 9,000 participants between the ages of 15 and 21. They then combined that data set with more survey data from people recruited as part of a national survey called the Knowledge Panel for a total of roughly 14,300 people.

Then, they asked the participants a series of questions about their use of tobacco products between February and May of 2018. The questions ranged from how frequently they used a Juul to how frequently they smoked conventional cigarettes.

Younger people in the survey were significantly more likely to say they’d either ever used a Juul or regularly used a Juul compared with their older counterparts. The group with the highest rates of Juul use was 18-21 year olds, but people aged 15-17 were a close second.

A 2016 Juul ad.

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A 2016 Juul ad.
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Pax Labs

Overall, about 6% of participants said they’d used a Juul at least once in their lives and about 3% said they were “current users” or had used a Juul anywhere from one to 30 times in the last 30 days.

But the figure was substantially higher for both young people aged 15-17 and young adults aged 18-21.

Among the teens aged 15-17, roughly 10% had ever used a Juul and about 6% said they had used a Juul at least once in the past month. Among the young adults aged 18-21, about 11% had ever used a Juul and roughly 8% had used a Juul at least once in the last month.

That’s cause for alarm, according to the researchers.

“Further surveillance efforts are … required to monitor how and to what extent this product may be expanding nicotine addiction among young people,” they wrote.

Still, the results are limited by several important factors.

The data was collected on behalf of a nonprofit anti-smoking advocacy group called the Truth Initiative, which was formed as part of the historic accord between tobacco companies and US states who sued them for tobacco-related healthcare costs. In addition, the researchers defined “current users” as anyone who said they’d used a Juul at least once in the past 30 days. This means someone who said they used a Juul just once in a month-long period was lumped into the same category as someone who said they’d used a Juul every day for the past 30 days.

Roughly the same percentage of teens are ‘Juuling’ as they are smoking, but that could be set to increase

Based on the figures from the study, roughly the same percentage of teens are “Juuling” as they are smoking. According to the most recent data from the CDC, 7.6% of high school students reported smoking a cigarette within the past 30 days.

The researchers said that’s a worrisome trend – not only because it’s a substantial figure to begin with, but also because the majority of their data was collected several months before Juul experienced a surge in popularity.

The survey was conducted during the spring of 2018, several months before Juul’s meteoric rise to capture 70% of the e-cigarette market share. That could mean, the authors suggest, that their figures significantly underestimate the current patterns of teen use.

“While rates of Juul use are highest among the younger segments of the sample, the data only reflect use patterns from February through May 2018. The most recent Nielsen sales data for Juul indicate dramatic increases since then,” they wrote.

Indeed, while Juul made up only about a third of the e-cigarette market share in March, that figure skyrocketed to roughly 72% by mid August.

“Given the rapid uptake of this product, strong regulatory efforts are needed to prevent further increases in Juul prevalence among young people,” the researchers concluded.

$15 billion startup Juul used ‘relaxation, freedom, and sex appeal’ to market its creme-brulee-flavored e-cigs on Twitter and Instagram — but its success has come at a big cost

$15 billion startup Juul used ‘relaxation, freedom, and sex appeal’ to market its creme-brulee-flavored e-cigs on Twitter and Instagram — but its success has come at a big cost

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Shutterstock
  • A Silicon Valley e-cigarette startup called Juul has surged in popularity, amassing 70% of the e-cigarette market.
  • The company was recently valued at $15 billion, but it faces a growing backlash from public-health experts and scientists who worry about its popularity among young people.
  • Juul maintains that its products are for adult smokers who want to move away from traditional cigarettes.
  • A recent study found that Juul stood out from other e-cigarette companies by marketing its devices on social-media platforms such as Twitter, YouTube, and Instagram.
  • That marketing campaign was a big success, the study suggests, with Juul’s social-media activities being “highly correlated” with sales.

One big question about the booming Silicon Valley e-cigarette startup Juul is whether the company deliberately marketed its products to teens.

Juul has said that its sleek vaping devices are intended for adults trying to quit smoking traditional cigarettes – and that its marketing has had little impact on its sales. But a recent study raises some questions. It suggests that Juul’s social-media ads – which were posted across platforms popular with young people including YouTube, Twitter, and Instagram – were a runaway success.

Public-health experts, scientists, and the Food and Drug Administration have been targeting vaping companies in recent months after dozens of reports suggested they were encouraging more young people to both vape and smoke. A handful of researchers have said a combination of the company’s marketing efforts and product offerings – such as slick designs and sweet flavors – are intended to hook young people on nicotine.

The researchers behind the paper focusing on Juul, published this summer in the journal Tobacco Control, concluded that Juul stood out from other e-cigarette brands by advertising predominantly on social media, as opposed to places like on billboards or in magazines. And the campaign took off, according to the researchers, who wrote that sales of the flash-drive-style devices were “highly correlated” with the company’s social-media posts.

The social-media campaign had another added benefit: It was cheaper than traditional marketing strategies, the researchers suggested.

The social-media blitz wasn’t all directly from Juul, however, further complicating any efforts designed to help scale back the products’ allure among teens. Several other corporate social-media accounts besides Juul’s official platforms heavily promoted Juul products.

The overall impact was significant, the researchers concluded.

“Targeted cross-platform social media campaigns, although they cost little, can have substantial influence on people’s attitudes, beliefs, and behaviors related to these products,” they wrote.

‘Taking advantage of the reach and accessibility of these platforms’

juul girl 2016

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An ad on Juul’s website from 2016.

Jidong Huang, an associate professor of health management and policy at Georgia State University who was lead author of the study, told The Washington Times over the summer that he felt the company’s use of social media was a deliberate attempt to target young people.

Huang said Juul was “taking advantage of the reach and accessibility of these platforms to target youth and young adults,” adding, “Basically everybody can see their product because there are no restrictions.”

Juul has been adamant that its devices are not intended for young people.

“We cannot be more emphatic on this point: no minor or non-smoker/vaper should ever use Juul products,” a Juul representative told Business Insider in an emailed statement. “Underage use is directly opposed to our mission of eliminating combustible cigarettes by offering the world’s one billion existing adult smokers a true alternative.”

Many social-media users, however, are young people.

Roughly half of teens ages 13 to 17 use Twitter, according to a survey conducted last year by the nonpartisan Associated Press-NORC Center for Public Affairs Research. That platform has been particularly lucrative for Juul, according to the researchers. YouTube is the most recognized content brand among kids ages 12 to 15, a 2017 report concluded. To that end, a Juul representative told Business Insider in July that the company had worked with Instagram to remove several accounts and thousands of posts that were inappropriately targeting youth.

But before then, a handful of social-media accounts – including Juul’s official platforms – attracted the attention of thousands. And that attention appears to have had strong links to sales of Juul’s products, the authors wrote.

In particular, the researchers found that the number of Juul-related tweets – most of which were posted last year – was “highly correlated” with the company’s quarterly retail sales, which they tracked using data from market research company Nielsen. That said, correlation isn’t necessarily causation. The researchers couldn’t say that the tweets necessarily led to the sales, only that the two were linked.

“The growth trend in Juul tweets noticeably tracks well [with] the growth in Juul retail sales,” the researchers wrote.

The relationship between Juul-related tweets and Juul sales was so strong, the authors found, that “the number of tweets alone accounted for 93% of the variation in Juul sales in retail stores.” Put another way, the number of Juul tweets could be used to roughly predict how many Juuls would be sold at any given time.

‘When you look at the flavoring names, one has to wonder’

A 2016 ad tells people to

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A 2016 ad tells people to “Save room for Juul” and says its flavors are “easy to pair with your favorite foods.”
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Juul

According to Huang and his coauthors, Juul’s official Instagram account, called JuulVapor, garnered tens of thousands of “likes” by evoking feelings of “relaxation, freedom, and sex appeal.” While that strategy is somewhat standard in the advertising industry, something that made Juul’s campaign stand out to the researchers was its emphasis on flavors.

At the time, those flavors included options like “Fruit Medley,” “Cool Cucumber,” and “Creme Brulee.”

Several researchers have said that sweet, candy-like flavors are part of what makes e-cigarettes attractive to teens.

“Most scientists believe flavorings are used to target teenagers into becoming users,” Ana Rule, a professor of environmental health and engineering at Johns Hopkins University, told Business Insider this summer.

“There are of course many other factors such as marketing and peer-pressure, but when you look at the flavoring names, one has to wonder.”

With that in mind, the city of San Francisco also recently voted to ban all flavored tobacco products. And on Thursday, Altria announced that it was pulling two of its e-cigarette products and eliminating all of its flavor offerings except tobacco and menthol until “the current situation with youth use” was resolved.

Earlier this year, Juul changed the names of its flavor offerings. “Cool Cucumber,” for example, is now simply “Cucumber”; “Creme Brulee” is now “Creme”; and “Fruit Medley” is now “Fruit.”

“We have taken numerous actions to prevent and combat underage use, including focusing our website and social media exclusively on the adult smoker community and removing all product-related content from our social media accounts,” the Juul representative said.

Doit4Juul: The most followed account for Juul products

Importantly, the new study found that the social-media blitz wasn’t all Juul’s direct doing. Beyond Juul’s Instagram account, at least seven other accounts that promoted the Juul collectively amassed more than a quarter of a million followers on the platform, the authors wrote. And despite Juul’s preventive actions over the summer, many of those accounts remain active in one form or another, Business Insider found.

One of the accounts was called “@Doit4Juul.”

The account asked followers to share selfies, photos, and videos documenting themselves using Juul devices. And share they did. Images included youngsters jamming as many Juuls as they could in their mouths at once and then blowing out massive plumes of vapor; children openly using Juul devices in classrooms; and kids sharing tips on how to sneak the devices into school by encasing them in the bodies of Sharpie pens.

“This campaign proved highly successful,” the researchers wrote, noting that the account amassed close to 82,000 followers and quickly became the most followed account featuring Juul products on Instagram as of February.

Over the summer, Juul worked with Instagram to remove the account, along with at least two others.

“We have aggressively worked with social media platforms to remove posts and accounts that portray our product in unauthorized and youth-oriented manners,” the Juul representative said. “We stand committed to working with those who want to keep nicotine products out of the hands of young people.”

But while the official account is gone, the #Doit4Juul hashtag remains active. Several similar accounts have also sprung up in recent months across the platform, including one called Doingit4Juul that shows several youngsters in braces and even in classrooms using the devices.

Using the hashtag symbol, anyone with an Instagram account can post to the series. At present, roughly 7,000 posts exist under the #Doit4Juul label alone. One of them features a young boy in a colorful shirt with a gold plastic crown on his head inhaling the vapor of two Juuls at once, then blowing out a large cloud.

“These kids doing this sh*t,” the post’s caption says.

Scientists are starting to learn how e-cigs like the Juul can impact your health — and the results are troubling

Scientists are starting to learn how e-cigs like the Juul can impact your health — and the results are troubling

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Shutterstock

Smoking kills. No other habit has been so strongly tied to death.

In addition to inhaling burned tobacco and tar, smokers breathe in toxic metals like cadmium and beryllium, as well as metallic elements like nickel and chromium – all of which accumulate naturally in the leaves of the tobacco plant.

It’s no surprise, then, that much of the available evidence suggests that vaping, which involves puffing on vaporized liquid nicotine instead of inhaling burned tobacco, is at least somewhat healthier. Some limited studies have suggested that reaching for a vape pen instead of a conventional cigarette might also help people quit smoking regular cigarettes, but hard evidence of that remains elusive.

Very few studies look at how vaping affects the body and brain, however. Even fewer specifically examine the Juul, a popular device that packs as much nicotine in each of its pods as a standard pack of cigarettes.

But a handful of studies published in the last few months have begun to illuminate some of the potential health effects tied to vaping. They are troubling. Most recently, researchers at the Stanford University School of Medicine surveyed young people who vape and found that those who said they used Juuls vaped more frequently than those who used other brands. The participants appeared to be insufficiently aware of how addictive the devices could be.

Most e-cigs contain toxic metals, and smoking them may also increase the risk of a heart attack

marijuana vaporizer vaping vape

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Eduardo Munoz/Reuters

Researchers took a look at the compounds in several popular brands of e-cigs (not the Juul) this spring, and found some of the same toxic metals (such as lead) inside the device that they normally find in conventional cigarettes. For another study published around the same time, researchers concluded that at least some of those toxins appear to be making their way through vapers’ bodies, as evidenced by a urine analysis they ran on nearly 100 study participants.

In another study published this summer, scientists concluded that there was substantial evidence tying daily e-cig use to an increased risk of heart attack. And this week, a small study in rats suggested that vaping could have a negative effect on wound healing that’s similar to the effect of regular cigarettes.

In addition to these findings, of course, is a well-established body of evidence about the harms of nicotine. The highly addictive substance that can have dramatic impacts on the developing brains of young adults.

Brain-imaging studies of adolescents who begin smoking traditional cigarettes (not e-cigs) at a young age suggest that those individuals have markedly reduced activity in the prefrontal cortex and perform less well on tasks related to memory and attention, compared to people who don’t smoke. Those consequences are believed to be a result of the nicotine in the cigarettes rather than other ingredients.

Nicholas Chadi, a clinical pediatrics fellow at Boston Children’s Hospital, spoke about the Juul at the American Society of Addiction Medicine’s annual conference this spring. He said these observed brain changes are also linked with increased sensitivity to other drugs as well as greater impulsivity. He described some anecdotal effects of nicotine vaping that he’s seen among teens in and around his hospital.

“After only a few months of using nicotine [these teens] describe cravings, sometimes intense ones. Sometimes they also lose their hopes of being able to quit. And interestingly, they show less severe symptoms of withdrawal than adults, but they start to show them earlier on. After only a few hundred cigarettes – or whatever the equivalent amount of vaping pods – some start showing irritability or shakiness when they stop,” Chadi said.

A new survey suggests that teens who use Juul e-cigs aren’t aware of these risks

A Juul advertisement from 2016.

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A Juul advertisement from 2016.
source
Pax Labs

The Juul, which is made by Silicon Valley startup Juul Labs, has captured more than 70% of the e-cig market and was recently valued at $15 billion. But the company is facing a growing backlash from the FDA and scientists who say it intentionally marketed to teens.

Yet very little research about e-cigs has homed in on the Juul specifically.

So for a study published this week, researchers from the Stanford University School of Medicine surveyed young people who vape and asked them whether they used the Juul or another e-cigarette.

Their results can be found in a widely accessible version of the Journal of the American Medical Association called JAMA Open. Based on a sample of 445 high-school students whose average age was 19, the researchers observed that teens who used the Juul tended to say they vaped more frequently than those who used other devices. Juul users also appeared to be less aware of how addictive the devices could be compared with teens who vaped other e-cigs.

“I was surprised and concerned that so many youths were using Juul more frequently than other products,” Bonnie Halpern-Felsher, a professor of pediatrics and a lead author of the study, said in a statement.

“We need to help them understand the risks of addiction,” she added. “This is not a combustible cigarette, but it still contains an enormous amount of nicotine – at least as much as a pack of cigarettes.”

America’s leading food and drug regulator might ban online sales of e-cigs — a move that could threaten brands like Juul

America’s leading food and drug regulator might ban online sales of e-cigs — a move that could threaten brands like Juul

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Eduardo Munoz/Reuters
  • A leading government regulator could make selling e-cigarettes online illegal.
  • On Tuesday, Food and Drug Administration commissioner Scott Gottlieb said the agency is considering a ban on online sales of e-cigarettes.
  • The move could have an outsize effect on brands like Juul, which has a large online customer base.
  • Juul has faced a growing health backlash despite its surging popularity, largely over claims of marketing to young people.

Selling e-cigarettes online could soon become illegal.

At a breakfast meeting with journalists on Tuesday, Food and Drug Administration commissioner Scott Gottlieb said the agency is considering a ban on online sales of e-cigs. The move would include barring popular e-cig startup Juul, recently valued at $15 billion, from selling its products over the internet.

Juul, which currently dominates the e-cig market, has faced a growing backlash from public health advocates and researchers over claims that it marketed to teens.

The company has refuted those claims.

Meanwhile, e-cigarettes have been surging in popularity – both among adults, as well as among teens, whose brains are uniquely vulnerable to nicotine addiction.

“We’re in possession of data that shows a disturbingly sharp rise in the number of teens using e-cigarettes in just the last year,” Gottlieb said in a statement last week.

Preliminary versions of that data, while not yet public, suggest the number of high school students who’ve used e-cigs sometime in the past 30 days climbed by 75%, CNBC reported on Tuesday. Other public data suggests a similar story: Between 2011 and 2017, e-cig use skyrocketed from 1.5% to 11.7% among high school students and from 0.6% to 3.3% among middle school students, according to a recent report from the Centers for Disease Control and Prevention.

“Over the past several years e-cigarettes were the most commonly used tobacco product by youth,” Gottlieb said on Twitter in a discussion about the data this week.

A growing public health backlash against Juul

juul e-cig vape pen california prop e poster

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California Department of Public Health

Despite Juul’s financial success, the startup faces a growing backlash from researchers and public health advocates who are concerned that the company’s products are creating a new generation of nicotine addicts.

Those researchers cite several peer-reviewed studies suggesting that teens who vape are seven times more likely to smoke regular cigarettes than young people who never use e-cigs.

Ana Rule, a professor of environmental health and engineering at Johns Hopkins University, told Business Insider that device-makers fail to address “the increased risk to this huge market they are creating among teenagers and young adults that never have smoked, and would have never even considered smoking” had they not vaped.

Nicholas Chadi, a clinical pediatrics fellow at Boston Children’s Hospital, spoke about the Juul at the American Society of Addiction Medicine’s annual conference in April.

“After only a few months of using nicotine, [these teens] describe cravings, sometimes intense ones. Sometimes they also lose their hopes of being able to quit,” Chadi said.

Regulatory agencies are making moves to keep these products out of teens’ hands.

The FDA recently cracked down on sales of the Juul to minors and ordered five nicotine vaping brands – Juul, Vuse, MarkTen, Blu E-cigs and Logic – to submit plans showing they have strategies to prevent minors from using their products.

Meanwhile, several states and countries are launching their own initiatives to prevent youth from using the Juul. The Massachusetts Attorney General is investigating whether Juul violated state consumer-protection laws by failing to keep minors from buying its products, and the city of San Francisco recently banned flavored tobacco products like the Juul. More recently, Israel became the first country to ban Juul devices entirely.

In a statement issued last month, Israel’s Health Ministry said the devices pose “a grave risk to public health.”

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