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The future of vaping depends on how regulators act now

ARI SHAPIRO, HOST:

Within the past decade, e-cigarette companies created a brand new market and a new generation of young people addicted to nicotine. More than 14% of high schoolers say they currently vape. Some states, most recently California, are banning flavored tobacco products that are popular among kids, including e-cigarettes. The Food and Drug Administration also recently removed some vaping products from the market. NPR's Yuki Noguchi reports the future of vaping will depend on what regulations come next.

YUKI NOGUCHI, BYLINE: Samuel Rose's mother warned her seven children to avoid drugs, alcohol and cigarettes.

SAMUEL ROSE: My mom - she did a tremendous job of raising us to not like that stuff and to not do that stuff.

NOGUCHI: But initially, Rose thought vaping was different. It became wildly popular at his high school in Gaffney, S.C. Carolina. E-cigarettes were billed as healthier alternatives to cigarettes.

ROSE: I would've 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. You know, it's not dangerous.

NOGUCHI: But soon, he felt it was. It 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. He bought new e-cigarette supplies from young adults at church old enough to buy them. The device and its vapors were easy enough to hide. But Rose didn't like who he'd become.

ROSE: You know, I didn't really like the idea of lying to my mom. She's a single mom. She's been to hell and back for me. And it really hurt our relationship because I was hiding this from her. Since I'm lying to her and I'm using that much, I didn't want to be around her.

NOGUCHI: He realized he was addicted. 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., repopularizing it after a dramatic decline. Regulating e-cigarettes has been slow and painstaking. Brian King directs the FDA's Center for Tobacco Products.

BRIAN KING: Everything that the FDA does, particularly Center for Tobacco products, gets litigated.

NOGUCHI: Two years ago, his center required all e-cigarette products to be authorized for sale. It received nearly 8 million applications. King says those with the largest market share among teens were reviewed first. But...

KING: We're also dealing with a very sheer, high volume of products, and we have to make sure that we do it right.

KING: And, King says, e-cigarettes might also improve public health by helping adults avoid more harmful cigarettes. This month, the FDA removed menthol products made by e-cigarette maker Logic from the market. Last summer, it made a similar move against JUUL, the company that popularized vaping, though that's tied up in legal appeal. Matthew Myers is president of the Campaign for Tobacco-Free Kids. He wants to see the FDA take more products off the market.

MATTHEW MYERS: I think we will see a relatively rapid removal from the market of the products that had been the primary cause of the youth e-cigarette epidemic. The greatest immediate effect will come from cutting off the spigot.

NOGUCHI: That might sound simple, but Robert Jackler says regulators have always played cat and mouse games with the tobacco industry.

ROBERT JACKLER: By the time they implement something, the industry's already figured ten ways around it.

NOGUCHI: Jackler is a professor at Stanford Medical School and researches tobacco marketing. He notes the FDA's 2020 ban on flavored cartridges had zero impact on youth vaping. That's because plenty of alternative technologies, like disposable devices and refillable pods, were still on the market.

JACKLER: It left an eight-lane highway of escape because you can still buy 30cc things of liquid in whatever flavor, chocolate or butter rum, that you want. And the disposable's notably Puff Bar.

NOGUCHI: Sam Rose, the vaper from South Carolina, agrees. He says when the FDA banned his favorite mango flavor, he and his friends shifted.

ROSE: Mango JUUL pods were banned. Pretty much everybody that was doing it was addicted, so they just moved over to the menthol flavors and mint flavors.

NOGUCHI: That drives parents like Meredith Berkman crazy. Berkman co-founded Parents Against Vaping E-cigarettes. She says until this month, the FDA seemed reluctant to regulate or ban menthol.

MEREDITH BERKMAN: It makes the poison go down easier. 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 protect younger kids from starting.

NOGUCHI: So Jackler, the Stanford researcher, says state and federal regulators need to act on the three things that make vaping attractive to youth.

JACKLER: One is flavors. Two is nicotine. And three is price.

NOGUCHI: Jackler says companies have steadily increased the concentration of nicotine in their e-cigarette fluids, from about 1% to about 6% or higher. That makes them more potently addictive.

JACKLER: And it also becomes really cheap. You know, a teenager for 20 bucks can buy the equivalent nicotine dose of multiple cartons of cigarettes.

NOGUCHI: To combat that, Jackler says states should tax e-cigarettes at the same high rates that have made cigarettes largely unaffordable for young people. Cost was a big factor in making Sam Rose want to quit. He estimates that over 3 1/2 years, vaping a cartridge and a half a day cost him more than $10,000.

ROSE: Every time I think of that number, I almost gag.

NOGUCHI: Rose says his attempts to quit failed until he and his younger brother came clean with their mom.

ROSE: She was surprised, but, you know, she was also - her attitude was, let's move forward. That was 100% a game changer.

NOGUCHI: Feeling accountable to them helped him fight the cravings until they subsided about a month after quitting. 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 mentors teenage staff.

ROSE: 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.

NOGUCHI: He says he seldom sees people vaping anymore. And he feels closer than ever to his mom.

ROSE: After I get off the phone call, I got to tell my mom thanks one more time just because I know how much I don't deserve her and how much she did for us.

NOGUCHI: Yuki Noguchi, NPR News. Transcript provided by NPR, Copyright NPR.

Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.

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