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St. Michael's psychology professor talks e-cigarette impacts to youth in wake of Juul settlement

Packages of Juul mint-flavored e-cigarettes are displayed at a smoke shop in 2019.
Justin Sullivan
/
Getty Images
Packages of Juul mint-flavored e-cigarettes are displayed at a smoke shop in 2019.

Vermont is in line to receive about $8 million from the vaping company Juul Labs — that's after Vermont and 33 other states reached a settlement with Juul over its aggressive marketing toward young people.

A multistate investigation revealed the company specifically targeted young people in its advertising and was not transparent about the amount of nicotine in its products.

Juul will pay the states a combined $438 million doled out over six to 10 years. And the settlement prohibits the company from marketing its products to young people.

Dr. Ari Kirshenbaum is a professor of psychology at St. Michael's College in Colchester. He's done extensive research on the effects of e-cigarette products on young adults.

Vermont Public’s Mitch Wertlieb spoke with Kirshenbaum. Their conversation below has been edited and condensed for clarity.

Mitch Wertlieb: In a statement about this settlement, Vermont Attorney General Susanne Young said Juul “led the charge in reversing decades of progress in fighting nicotine addiction.” Decades of progress — is she right about that?

"...Youths who really have no intention to ever move on to combustible cigarettes — to ever use them at all — if they use [electronic nicotine delivery systems] sometime in their high school career, they're 30% more likely to move on to combustible tobacco."
Dr. Ari Kirshenbaum, St. Michael's College

Dr. Ari Kirshenbaum: I think that's a strong statement and perhaps not unwarranted.

And why do you feel that? 

Well, there have been some large-scale studies, mostly out of southern California, tracking youths and e-cigarette use and whether or not those youths graduate to later combustible tobacco use. So I'm just going to call electronic cigarettes "electronic nicotine delivery systems." Or, one acronym we can use is "ENDS."

So what they have found in these large-scale studies is that youths who really have no intention to ever move on to combustible cigarettes, to ever use them at all, if they use ENDS sometime in their high school career, they're 30% more likely to move on to combustible tobacco. So I think that maybe that's what Suzanne Young is referring to. I think that there's some renormalization of smoking that happens when people vape.

And, you know, this multistate investigation that I was talking about at the top said that not only was the company targeting young people in its advertising, they were actually hiding the amount of nicotine that was in their e-cigarette products. I'm so curious, why is it not standard to make a company reveal that information? It seems kind of important.

You know, I think it's important to point out that this is a settlement. And Juul is clearly trying to mitigate the immense risks associated with further litigation, right? So at minimum, it's an acknowledgment that they behaved egregiously in the eyes of the public, and they're reacting to correct that wrong and defend their image.

And I also see it as an admission that Juul used marketing and sales strategies targeting youths. And this is so important because a population of youths is very different than adult tobacco smokers. And Juul can no longer claim that their primary objective all along has been to create a cessation tool for those addicted individuals. So Juul really abused public trust in a number of ways.

And was this targeting towards youth — using things like flavored products — to make them be a little bit tastier for a young person so that they might want to use the product more?

E-cigarettes presented initially this wonderful opportunity as a new cessation tool to help us in our fight against smoking. So, I think that that's really important to point out. And if you're a smoker, going from a tobacco cigarette, you would probably want something tobacco flavored. Why on earth should these e-cigarettes come in bubblegum flavor, or blueberry flavor or cotton candy flavor? It just doesn't seem to make sense to me. So, I think that these flavors are really there to sort of introduce nicotine to a new population of users.

Let me ask you this. I really want some clarification on this particular question, because it's always confused me. I thought that the purported goal of e-cigarette companies — and you mentioned as a tool for smoking cessation, kind of weaning you off tobacco, let's say — but I thought there was also a claim that these e-cigarettes were safer than regular cigarettes. Now, was that a deceptive claim? Are e-cigarettes just as dangerous as combustible, you would call them, regular cigarettes?

"Why on earth should these e-cigarettes come in bubblegum flavor, or blueberry flavor or cotton candy flavor? It just doesn't seem to make sense to me. So, I think that these flavors are really there to sort of introduce nicotine to a new population of users."
Dr. Ari Kirshenbaum, St. Michael's College

I think that we have to be concerned about this. Part of the hazardous compounds that are produced in the e-cigarette liquids and heated by these elements produce aerosols that contain formaldehyde, acetaldehyde, acrolein. And these are all known carcinogens. But in terms of other tobacco smoking, I haven't seen evidence yet linking ENDS products to things like lung cancer in the same way that tobacco smoking has been linked to lung cancer and stroke. So I think that they are safer.

But there could be other risks as you were talking about with some of these byproducts. They may be technically safer than tobacco cigarettes. But they bring other risks along with them. 

Yeah, absolutely. And those other risks, unfortunately, are unknown at this point. And the risks that are associated with e-cigarettes is one, of course, it's introducing a new population — young adults, adolescents — to vaping, to nicotine. And I think that's a cause of concern.

Nicotine itself is associated with a number of not just health ramifications, but also mental health ramifications. Things like depression and anxiety. So I'm concerned about that. And, you know, in fact, maybe it would be worth these risks, health risks, mental health risks, if e-cigarettes were indeed a really good cessation tool for people to quit smoking. But the evidence there is not really strong; it doesn't weigh in one direction or the other.

I had suspected initially that e-cigarettes were going to be our way of treating tobacco dependence in the future. But I don't feel like the evidence weighs hugely in that direction. And it surprises me.

In addition to your research on the addictiveness of e-cigarettes on young people, I understand you've also worked with companies that make products helping Juul users cut down on their use. What are those products? How do they work?

Oh, there are a variety of products out there that are available to try to either reduce the amount of nicotine in some of these ENDS products, or try to maybe filter out some of the chemicals that are in these products. And right now, all of those are still in their infancy.

But I think it is just really important to note that Juul is the largest manufacturer. And I think that this settlement should send up a flare to all e-cigarette manufacturers, and it should allow them to be a little bit more careful.

The monetary value seems huge. You mentioned $438 million, and this is across many states. Again, the important part of that settlement I think is the injunctive relief to prevent Juul from sustaining their marketing and sales toward youth.

Have questions, comments, or concerns? Send us a message or tweet your thoughts to @mwertlieb.

Karen is Vermont Public's Managing Producer of Morning News. She manages the morning news content on broadcast and digital platforms, and works with Morning Edition host Mitch Wertlieb to bring listeners the latest news and information, along with relevant interviews. Karen has a long history with public radio, beginning in the early 2000's with the launch of the weekly classical music program, Sunday Bach. Karen's undergraduate degree is in Broadcast Journalism, and she has worked for public radio in Vermont and St. Louis, MO, in areas of production, programming, traffic, operations and news. She produces the Vermont Public Choral Hour, with host Linda Radtke. Karen recently worked with co-producer Betty Smith on a national collaboration with StoryCorps One Small Step, connecting Vermonters one conversation at a time.
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