I Was Addicted: TN High School, College Students React to FDA Ban on Flavored E-cigarettes

Backpacks filled with empty nicotine cartridges, hallway sales of e-cigarettes and bathrooms clouded with vapor — this is a typical day at Bearden High School in Knoxville, two students say.

"Almost everyone in the school has a Juul (e-cigarette)," said John, a 16-year-old junior at Bearden who would only agree to be identified by his first name. "They're doing it every day, every minute, every chance they get."

In order to combat nicotine use among youth, the FDA is implementing a partial ban on the sale of flavored e-cigarettes, which Knoxville students say are frequently and heavily used in both college and high school.

The ban will prevent most retail locations from selling e-cigarettes in all flavors other than tobacco, menthol and mint. Other flavors will be available online and in age-restricted locations, such as tobacco stores and vape shops.

Juul, the most popular e-cigarette brand, sells vaporizing devices with interchangeable, pre-filled "pods" that contain a high concentration of nicotine and a variety of flavors. The company voluntarily stopped accepting orders of its mango, fruit, creme and cucumber pods from more than 90,000 retail locations, including tobacco stores, this week ahead of the FDA's announcement Thursday.

"JUUL Labs is committed to improving the lives of the world’s one billion adult smokers, with the ultimate goal of eliminating cigarettes," the company said in its announcement. "While we have been working to solve that problem, another unintended and serious problem has developed – underage use of e-cigarettes, including JUUL."

'So many things' kids like about Juul

The FDA believes certain flavors have led children to use e-cigarettes. John, the Bearden High student, believes online trends have also played a part.

Currently, in Tennessee, only people 18 and older can purchase devices like a Juul. The problem, John said, is that seniors in high school are often 18 and sell them to their underage friends at an increased price.

"It's very easy to sneak it anywhere — backpacks and even your pockets," he said. "You can get away with doing it in class and cover it up under your shirt or up your sleeve."

Juuls look a lot like flash drives and can even plug into your computer to charge, John said. He doesn't use e-cigarettes, but his friend Capen believes the majority of students at Bearden do.

According to the 2017 Knox County Youth Risk Behavior Survey, nearly 15 percent of Knox County High School students use e-cigarettes, which is higher than the rate of traditional tobacco use.

From 2017 to 2018, e-cigarette use in the United States increased 78 percent among high school students —from 11.7 percent of students using them in 2017 to 20.8 percent in 2018 — according to data published by the FDA.

A Juul device used to inhale nicotine-infused vapors, on right, is shown next to a standard USB or stick drive at left. School and law enforcement officials say the Juul devices that came on the market only recently are easy for minor students to conceal because they are small and resemble the stick drives commonly used to store computer data. (Photo: Bart Pfankuch / South Dakota News Watch)

Daniel Mayer, an 18-year-old freshman at the University of Tennessee, suggests an even larger percentage of students use these devices in college.

"I would guess that one out of two people (on campus) have them — maybe one out of three," he said. "The reason I kept doing it was the nicotine buzz but, really, a lot of people do it just to watch smoke come out of their mouth."

Barstool 5th year, an Instagram account documenting college Greek life and party culture, declared Juul's recent announcement an "emergency." It has also posted photos of students dressing up as a Juul for Halloween, having Juul-themed birthday cakes and wearing Juuls as earrings.

Students use their Juuls in class, Mayer said, and some professors know it. His friend recently told him a story about a professor designating one corner of the class as the "Juul corner" because of the amount of students using their devices there.

Dimitris Agrafiotis is the executive director of the TN Smoke Free Association, an advocacy group for independent vape shops. He believes there are many reasons Juuls are more popular with students than larger vapes.

He agrees with John when it comes to the online trends and the ability to conceal. But the devices are substantially more affordable than larger vaping systems more commonly used by adults, which can cost around $70 for a starter kit plus $25 for liquid.

Adults who use these devices typically use liquid with an average nicotine content of 0.6 percent, Agrafiotis said. But for around $15, a person can purchase a four-pack of Juul pods, which each have 5 percent nicotine and equate to 20 cigarettes.

"I think that the attraction here is that little (nicotine) buzz that they’re getting," Agrafiotis said. "It’s easy, quick, concealable, it gives you that jolt. There’s so many things that would make it desirable to the younger generation."

But despite the FDA findings, Agrafiotis does not believe flavors are a factor among youth.

A new smoking trend is shaking up the e-cig industry, but it's trickling down into area high schools. Video by Jessica Saggio, FLORIDA TODAY Wochit

'They need that flavored product'

FDA chief Scott Gottlieb said he sees the benefits of devices like e-cigarettes keeping people from using combustible products.

However, the use among teens has become "nothing short of an epidemic," he said in a conference call.

"Any policy accommodation to advance the innovations that could present an alternative to smoking – particularly as it relates to e-cigarettes – cannot, and will not, come at the expense of addicting a generation of children to nicotine through these same delivery vehicles," he said. "This simply will not happen. I will take whatever steps I must to prevent this."

Students at Bearden High School say Juul e-cigarettes are easy to conceal due to their flash-drive appearance. The device's USB charger even plugs into computers. (Photo: JUUL Labs)

One of the reasons he believes children are attracted to the devices is the flavors. But flavors are also the reason people decide to stick with vaping instead of smoking, Agrafiotis said.

“(Adults) need that flavored product to stay off cigarettes,” Agrafiotis said. “Kids are not attracted to the flavors. You can’t tell me the cucumber or mango is an attractive flavor to kids.”

Each high school student, college student and convenience store worker interviewed by Knox News agreed that cool mint and mango Juul pods are the most popular sellers.

Mark Orr, the manager of Rocky Top Market on Cumberland Avenue, said it's college students who typically buy Juul products from his store.

"They've been very big, and it accounts for a large percentage of sales," he said. "Stores are trying to get (fruity flavors) from wholesalers but it's difficult because stores are all ordering them because of (the ban)."

Mayer said mango is his go-to choice.

"Honestly, when I turned 18, I just kind of bought one," he said. "I didn’t know what it was going to be like because I never tried one. I was addicted for a while. ... (The ban) definitely will slow me down if I can't get mango all the time."

The flavor will be available online, but only for people 21 and older. While some people could get older friends to purchase them, Mayer said it's smarter to cut back than deal with the hassle.

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A figure smokes a Juul e-cigarette in this photo illustration. (Photo: Photo illustration by Calvin Mattheis/News Sentinel)

Cool mint will still be available in convenience stores and gas stations. The FDA chief said the flavor, along with tobacco and menthol, are more popular with adults.

The FDA did not want to ban flavors offered in traditional cigarettes, Gottlieb said, because this would prevent smokers from having the option to purchase a healthier version of what they already use.

However, Agrafiotis believes the FDA's move is doing more public harm than good.

Businesses and smokers 'will hurt'

"The truth is that kids start smoking," Agrafiotis said. "If vaping was not available, they'd continue to start smoking. ... The fact that kids are not smoking should be celebrated, not punished. I think kids are smarter than adults making a lot of these laws — choosing a vapor product rather than a combustible product."

Scott Gottlieb (Photo: FDA)

But with fewer choices available in gas stations, he said, the choice might not be so easy. Most smokers buy cigarettes from gas stations but will be limited in the number of alternative products they can buy from stores once the ban fully rolls out over the next couple of months.

"It’s great to have these products there available because maybe on an impulse or because they’ve heard about it they’ll pick it up and try it and quit smoking," he said.

The FDA argues that children who start with vaping are more likely to turn to combustible cigarettes.

"Who wants to go from a Juul to a burning, ashtray, combustible tobacco flavor?" Agrafiotis asked. "Nobody wants to do that. ... The only data to back it up is that if you limit the accessibility to these products, you’re going to have to get nicotine somehow. So the delivery method that’s left is the delivery method that’s killing 440,000 Americans every year, unfortunately.”

The moves made by Juul and the FDA could also affect Tennessee businesses.

The JUUL vaporizer have become very popular with kids. Now Juul plans to pull back their flavors and advertising ahead of possible FDA regulations. USA TODAY

Sam Salloukh estimates that flavored pod sales outpace "regular" flavors four-to-one at his Tobacco World Smoke Shop in Arlington, Tennessee, but he's unable to order them.

"Who stands to benefit is Juul because they can continue to sell these products on their website," Agrafiotis said

Full restrictions from Juul and FDA

In addition to stopping retail orders from all stores, Juul has implemented a third-party identification system on its website.

The system will only allow people 21 and older to purchase Juul devices with multiple verification methods and product restrictions. Only two devices and 15 pod packages can be purchased per month, and no more than 10 devices can be purchased per year.

Juul also will increase a secret shopper program, reduce its social media presences and crack down on people violating Juul's terms when reselling products.

Although Juul made these announcements voluntarily, the FDA has since announced it will make some of these practices mandatory.

FDA Commissioner Scott Gottlieb announced Thursday that he will “advance” a new rule to ban menthol in cigarettes and begin a separate process to ban menthol and other flavored cigars. (Photo: Mark Lennihan/AP)

Flavored e-cigarette products, other than tobacco, menthol and mint, will only be available in stores with age restrictions. Online sales must have stricter policies for age verification.

Gottlieb said he also seeks to ban menthol in combustible tobacco products and flavors in products like cigars and cigarillos.

An official, updated e-cigarette policy is in the process of being implemented, Gottlieb said. The FDA expects a couple of months to pass before the public is notified, the market transitions and the policy goes into full effect.

https://www.knoxnews.com/story/news/2018/11/18/fda-juul-ban-tennessee-ecigarettes-teens-business/2001867002/