Samuel Rose says he was raised by a devoted single mom who warned all her seven children to avoid drugs, alcohol and cigarettes. But when his high school friend urged him to try making vapor rings with a Juul e-cigarette five years ago, Rose figured there was no danger — vaping was billed as a healthier alternative to smoking.
"I never picked up a cigarette, but I picked up a vape just fine because I was like, 'OK, I can still get the buzz of nicotine but not get cancer from it — it's not dangerous,' " Rose says. Plus, he says, every living soul his age in Gaffney, S.C, seemed to think the same thing back then.
But soon, daily vaping made his lungs feel too small to power him down the football field. He worked 30 hours a week after school, largely to fund his habit. Though a minor, he was able to buy replacement e-cigarette cartridges and pods from young adults at his church who could buy them legally. The small device and the vapor clouds it emitted were easy enough to hide, he says. Still, the escalating addiction scared him, and he didn't like who he was becoming.
To cover the habit and avoid lying about it, he was distancing himself from his mother. "I really didn't like lying to my mom," says Rose. "She's been to hell and back for me, and it really hurt our relationship because I was hiding this."
Rose, now 21, is among a generation of nicotine users who got hooked on vaping at a time when the technology was new and marketed virally to young people over social media. The advent of vaping transformed youth nicotine use in the U.S., reviving its popularity and reversing a dramatic decline in smoking over the prior decade. Today, 14.1% of high school students say they vape — but despite the rapid rise in nicotine use, the regulatory response has been slow.
FDA got 8 million applications
In 2020 the Food and Drug Administration initiated a requirement that all e-cigarette products apply for and receive regulatory approval in order to remain on the market. A bit of a time lag for enforcement was permitted as the FDA worked through applications; the FDA said a product could continue to be sold until its application was evaluated.
Gain a Better Understanding of Today
MPR News is not just a listener supported source of information, it's a resource where listeners are supported. We take you beyond the headlines to the world we share in Minnesota. Become a sustainer today to fuel MPR News all year long.
What happened next may help explain why teen vaping hasn't yet slowed. The agency was overwhelmed with nearly 8 million applications for various e-cigarette products, says Brian King, the director of the FDA's Center for Tobacco Products. Each review must be done carefully, he says, because "everything the FDA does, particularly the Center for Tobacco Products, gets litigated." So, he says, "on the front end it's really critical that we ensure that everything we're doing is both scientifically defensible and legally defensible — and that takes time."
An FDA crackdown could be coming soon
King says the agency is very near the end of its review process. While he did not discuss the results of the reviews that have not been made public, experts expect the FDA to step up its removals of various vaping products from the market over the next few months.
"I think we will see a relatively rapid removal from the market of the products that have been the primary cause of the youth e-cigarette epidemic," says Matthew Myers, president of the Campaign for Tobacco-Free Kids.
Myers and others point to a few recent actions by the agency as the signs a crackdown is coming. This month, the FDA denied e-cigarette maker Logic's application for its menthol e-cigarettes; they were pulled from the market. That marked the first time the FDA denied a menthol product — something it has long treated as being in a separate category from other flavors. In June the agency tried to pull other e-cigarette products made by Juul, the company widely credited with popularizing vaping. (That decision hasn't taken effect, as Juul pursues its appeals.)
"Prevention of e-cigarette use among kids remains a top priority," King says.
Meanwhile, some states — most recently California — are taking their own steps, banning all flavored tobacco products, including e-cigarettes, and menthol. Massachusetts and Washington, D.C. have similar bans; other states have limited bans on flavors.
Other countries are increasing regulation, too. China recently banned fruit-flavored e-cigarette products, and the European Union is considering a similar broad ban on flavors. Many other countries in Asia and the Middle East completely ban vaping.
In the U.S., cracking down on the devices themselves would be the most effective form of prevention, say many experts like Matthew Myers, president of the Campaign for Tobacco Free Kids. "The greatest immediate effect will come from cutting off the spigot."
That might sound simple, but Dr. Robert Jackler says regulators have always played a cat-and-mouse game with the tobacco industry. "By the time [regulators] implement something, the industry's already figured 10 ways around it," says Jackler, a professor at Stanford University School of Medicine and a prominent researcher of tobacco marketing.
Jackler notes, by way of recent example, how the FDA's 2020 ban on flavored cartridges had no impact on youth vaping rates because it left plenty of alternative technologies — such as disposable devices and refillable pods — on the market. "It left an eight-lane highway of escape," he says, because very similar alternatives were readily available using another unregulated device.
That's precisely how Sam Rose, the vaper from South Carolina, remembers what happened in 2020. When the FDA cut off access to their favorite mango-flavored vaping cartridges, Rose and his teenage friends just shifted to a different flavor.
"Pretty much everybody that was doing it was addicted, so they just moved over to the menthol flavors" or disposable vaping devices, Rose says.
That's the kind of work-around that drives parents like Meredith Berkman crazy. The co-founder of Parents Against Vaping E-Cigarettes says until this month, the FDA seemed reluctant to regulate or ban menthol for reasons she couldn't understand.
"It makes the poison goes down easier," says Berkman, "and until those flavored products are taken off the market, we really can't make a dent in the youth vaping epidemic and we really can't prevent young kids from starting."
Stanford researcher Jackler agrees, and says regulators need to act on the three primary things that make vaping attractive to youth: "One is flavors, two is nicotine, and three is price."
$20 gets a teen the nicotine equivalent of 800 cigarettes
Companies have steadily increased the concentration of nicotine in their e-cigarette fluids — from about 1% to about 6% or higher, Jackler says. That makes vaping more potently addictive, and a very cheap source of nicotine, in comparison to tobacco products. For $20, a teenager can buy the nicotine-equivalent of several cartons of cigarettes — roughly the equivalent of 40 packs, or 800 cigarettes.
To combat that, Jackler argues states and cities should tax e-cigarettes at the same high rates that have made cigarettes largely unaffordable for most young people.
In less than four years he spent more than $10,000 on his vaping habit
Cost was, in fact, a big a factor in making Sam Rose want to quit. He estimates that, over three-and-a-half years of vaping a cartridge and a half a day, he spent more than $10,000 on vaping. "Every time I think of that number I almost gag," he says.
Yet his early attempts to quit failed, until he and his younger brother came clean with their mom. "She was surprised, but her attitude was: 'Let's move forward,' " he says. "That was 100% game changer," Rose says, because feeling accountable to his family helped him fight the nicotine cravings until they subsided, a few weeks after he quit.
Rose, now a college sophomore, is an ambassador for the Truth Initiative, an anti-smoking group. He's also a manager at a fast-food restaurant, where he works alongside his siblings and his mom. He mentors a mostly teenage staff — discouraging them from vaping, and taking them to play sports on the weekends.
"It's awesome to be in that role and give them a safe place to come and know that they don't have to worry about somebody bullying them for not vaping or something like that," says Rose. He says he sees far fewer people vaping these days in his community. And, he says, he feels closer than ever to his mom "because I know how much I don't deserve her, and how much she did for us."
Copyright 2022 NPR. To see more, visit https://www.npr.org.