Philadelphia Medicine Fall/Winter 2019 - 9

trying to keep their products out of the hands of minors while their
unregulated products help adults to quit - but the data show the
weakness of these claims.
In the context of a larger discussion about the harm vaping causes
our youth, it is vital to not lose sight of one particular vaping company.
JUUL has emerged as the market leader within the vaping industry,
commanding more than 70% of the vaping market share and is
widely believed to have ignited the current youth vaping epidemic.
JUUL is a type of ENDS with widespread popularity among youth,
with use now so common that it has its own verb: "JUULing."
JUUL achieved this market domination through a combination of
intense social media marketing to youth and an innovative chemical
formulation. A "pod," which is the nicotine-containing reservoir used
with a JUUL device, contains a proprietary nicotine salt formation
which delivers the nicotine equivalent of a pack of cigarettes. The
nicotine salt formed through the addition of benzoic acid allows
a much higher concentration of nicotine than earlier e-cigarettes
contained and is tolerable because it buffers the harshness of the
nicotine "hit." Teens and pre-teens are much more susceptible to
nicotine addiction than adults due to the developing adolescent brain.
These pods have been available in a variety of fruit and candy
flavors which have been consistently demonstrated to entice and
allure youth to experiment with these products. JUUL made
extensive use of imagery and marketing channels designed to appeal
to youth by promoting "JUULing" as part of an identity and social
lifestyle. This is highly reminiscent of the decades of tobacco industry
campaigns that sought to frame tobacco use in the very same light for
youth. With these similarities, it is not at all surprising that the lines
separating the tobacco industry and the vaping industry are blurring.

This year, Altria, formerly Phillip Morris and the largest tobacco
company in the nation, invested $13 billion for a 35% share of JUUL.
In fact, Altria's "chief growth officer" recently stepped in to lead
the company after the sudden resignation of JUUL's former CEO.
JUUL has attempted to mitigate their role in the vaping epidemic by
enhancing age verification to purchase their products, by removing
certain flavors from the market, and by curtailing product marketing
that could reach youth. But the recent Congressional investigation
showed that behind the scenes, efforts to addict youth continued.
There is no longer any doubt that JUUL is a tobacco company,
despite their claims to the contrary.
Countless public health advocates, health care professionals
and parents have worked tirelessly to drive down the rates of adult
and youth tobacco use only to see these important gains eradicated
by the vaping epidemic. With the timeline for definitive federal
regulation of vaping uncertain and the voluntary self-regulation
of the vaping industry at best being disingenuous, there is an
undeniable imperative for state and local action to stem the tide of
the vaping epidemic. Here are a few actionable items that a health
care professional or member of the public can do to support state
and local efforts to protect both youth and adults from the public
health harms of vaping:
* Share accurate and up-to-date information regarding vaping.
* Given the recent incidents of severe respiratory illness due to vaping, the CDC recommends
that adults and youth refrain from using any ENDS.
continued on next page

Fall/Winter 2019 : Philadelphia Medicine

Philadelphia Medicine Fall/Winter 2019

Table of Contents for the Digital Edition of Philadelphia Medicine Fall/Winter 2019