Vaping: Recent Developments and Emerging Issues — A TFM Policy Forum

At its September 6th Policy Forum, Tobacco Free Mass brought together national experts to discuss recent developments and emerging issues around vaping. The three panelists gave real-life examples of the newest trends, talked about their broader impacts, and gave thoughts on impactful policies.

The newest nicotine products on the market are members of the pod mod family, explained Youn Ok Lee, PhD, from RTI International.  Pod mods are a group of products that use a disposable pod with a reusable electronic device (“mod”).  The most popular pod mod is Juul, a device that looks like a flash drive and is nearly undetectable when used.  The appeal of Juul and similar products is that they use nicotine salts, which deliver a buzz at an addictive level of nicotine without any harshness. The pods are available in a range of sweet flavors. They are also designed to be so discreet that they can be used nearly anywhere without detection.  Because of these factors, the majority of young people who experiment with JUUL continue to use it.

JUUL’s success is the result of a sophisticated marketing effort aimed at young people. As Dr. Lee explained, although JUUL’s official marketing content is aligned with public health objectives, JUUL is also being promoted by retailers, affiliate marketers, and users on social media. This content glamorizes youth use of the product and rarely mentions using the product to quit smoking.  It is likely that much of this content is paid for by JUUL, but more research is needed to determine how much.

JUUL is an example of a closed pod system. Others, like Suorin, are open pod systems, which means that they can be refilled with any type of e-liquid, including ones that contain drugs other than (or in addition to) nicotine. Some systems, including KandyPens and a product line of JUUL look-alikes called Pax, are explicitly designed for cannabis oils.  As the CDC’s Michael Tynan explained, the overlap of nicotine and cannabis products complicates monitoring these devices and even having conversations about them.

The presence of these products in community-based retailers deserves our attention. According to Lisa Henriksen, PhD, of Stanford University School of Medicine, children who live in a place with a higher density of vape stores vape at a higher rate than peers who live where there are fewer vape stores.  Density of these stores in communities, she explained, is “an environmental risk worth being concerned about.”

Communities across Massachusetts have looked at ways of protecting their young people from these new products.  Many require stores to obtain a permit to sell e-cigarettes, and some cap the number of permits they will allow, which helps with the issue of density. Many municipalities fought the impact of vape products by raising the age of sale of all nicotine products from 18 to 21 and by prohibiting the use of e-cigarettes where the Smoke-Free Workplace Law applies.  These two regulations were included in the youth tobacco prevention legislation that will go into effect at the end of December.  Because part of the appeal of these products to young people is flavor, many communities across the state have restricted the sale of flavored nicotine products. This policy is gaining traction after a speech on the Senate floor this summer.

Tobacco Free Mass is very grateful to the three panelists for sharing their expertise.  We’d also like to thank our Vice-Chair, Lauren Smith, MD, MPH, who moderated the event and gave an overview of TFM’s progress over the past year.  Thank you also to the Massachusetts Medical Society for hosting us and to their president, Alain A. Chaoui, MD, FAAFP, for his introduction.

Slides from the presentations:

See bios of the Policy Forum’s speakers here: