Massachusetts Medical Society: Vaping: Physicians Confront the Challenge of E-cigarettes and Youth

Vaping: Physicians Confront the Challenge of E-cigarettes and Youth

By Gwen Stewart, MS, Executive Director, Tobacco Free Mass
Lauren A. Smith, MD, MPH
Lauren A. Smith, MD, MPH, vice chair of Tobacco Free Mass, moderates a panel on vaping at the TFM policy forum at MMS Headquarters.

A new generation of nicotine products — “pod mods,” a type of electronic cigarette — is changing the way that young people are exposed to nicotine, and putting the onus on physicians and public health advocates to address and counter the emerging addiction risk.

Pod mods are a group of products that use a disposable “pod” with a reusable electronic device (“mod”). The most popular pod mod is JUUL, a discreet device that looks like a flash drive. Pod mods use nicotine salts to deliver an addictive level of nicotine without any harshness. The pods are available in a range of sweet flavors.

The sophisticated marketing of pod mods to young people and the environmental accessibility of these products in some communities have emerged as public health risks, said experts at a September event organized by Tobacco Free Mass, a statewide coalition, and hosted by the MMS. In addition, the overlap between electronic products delivering nicotine and cannabis complicates efforts to monitor and talk about health risks.

E-cigarette Use among the Young

Recent years have seen a striking jump in youth use of electronic cigarettes (e-cigarettes). By 2015, 24 percent of Massachusetts high school students reported using e-cigarettes (“vaping”) in the past 30 days, compared to 3 percent of adults. Nearly half (45 percent) of high school students had tried vaping, according to the Youth Risk Behavioral Survey.

Pod mod devices soared in popularity among youth over the past year, driving up the number of young people using nicotine regularly. Eighty percent of people aged 15–24 who try Juul continue to use it, a 2018 study suggests.

How Pod Mods Got Popular

The popularity of pod mods is the result of a sophisticated marketing effort aimed at young people, reported Youn Ok Lee, PhD, research public health analyst at RTI International, at the September conference. JUUL’s official marketing content references helping smokers quit combustible tobacco. But the product is also being marketed to young people on social media, and promoted by retailers and affiliate marketers. The social media content tends to glamorize youth e-cigarette use.

These products are sold online and by community-based retailers. Children who live in communities with a higher density of vape stores use e-cigarettes at a higher rate than their peers who have less environmental access, said Lisa Henriksen, PhD, a senior research scientist at Stanford University School of Medicine.

Some pod systems, such as Suorin, may contain drugs other than (or in addition to) nicotine. Some systems, including KandyPens and Pax, are explicitly designed for cannabis oils. The blurred boundaries between nicotine and cannabis e-products are a challenge to monitoring these devices and even having conversations about them, said Michael Tynan, public health analyst at the CDC.

New Law in Massachusetts

In Massachusetts, new tobacco legislation will go into effect at the end of December. The age for sale of all nicotine products will rise from 18 to 21, and the use of e-cigarettes will be prohibited where the Smoke-Free Workplace Law applies.

In addition, many municipalities require stores to obtain a permit to sell e-cigarettes, and some cap the number of permits they allow. Some have restricted the sale of flavored nicotine products, a policy that is gaining traction.

Physicians on Alert

The tobacco and nicotine industry works continually to recruit new users for its products. “[W]e advise physicians and parents to remain on alert regarding this emerging public health concern,” wrote Jessica L. Barrington-Trimis, PhD, and Adam M. Leventhal, PhD, in the New England Journal of Medicine in August. Informed physicians can counter those efforts through honest conversations with their patients and by helping to shape the communities where their patients live.

Learn more about advocacy efforts and view slides from the event.

See an interactive map of local tobacco regulations.

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