State Directs Money from Tobacco Tax to Fight Teen Vaping ‘Epidemic’

Lilo H. Stainton | November 15, 2018 | Health Care
NJ tries to curb rising use of flavored e-cigarettes among youngsters as FDA cracks down on manufacturers at national level

Credit: Vaping360
Vaping with a JUUL device
New Jersey has joined a growing national movement seeking to curb what experts consider the epidemic increase in “vaping” among young people, investing about $7 million to reduce the use of these electronic tobacco-delivery devices in the Garden State.

The state Department of Health announced Wednesday it will use money from taxes on cigarettes and other tobacco products to fund a youth education campaign, with peer-outreach teams in each county, a network of 11 regional “quit centers” to support smoking cessation, and efforts to reduce tobacco use on college campuses and in workplaces that employ a large number of young people.

The campaign is particularly focused on vaping among teens. Vaping is the inhalation of mist from an electronic device, or e-cigarette, which vaporizes nicotine-infused liquid. Studies by the federal Food and Drug Administration show the practice has escalated 77 percent this year among high school students nationwide, and 50 percent for those in middle school, according to The Washington Post. Many brands of e-cigarettes lace their products with flavors, like mango and cotton candy, which are particularly appealing to kids.

“Every year, smoking kills more Americans than alcohol, AIDS, car crashes, illegal drugs, homicides and suicides combined. These deaths are preventable,” state health commissioner Dr. Shereef Elnahal said; nearly 12,000 New Jerseyans die of smoking-related issues each year, federal statistics show.

Decline in cigarette smoking

“Engaging our youth and young adults in this education campaign is crucial,” Elnahal added, noting the timing coincided with the American Cancer Society’s Great American Smoke Out, an annual event to help people kick the habit held on November 15.

While vaping is rising in popularity in New Jersey — with one in five high school students trying a e-cigarette device last year — smoking of cigarettes has declined in recent years and remains below the national average, the DOH notes; less than 14 percent of adults and nearly 17 percent now light up regularly. The state has prohibited smoking in public buildings for more than a decade and banned tobacco use at public parks and beaches last summer. It also expanded Medicaid coverage for smoking cessation.

The new DOH campaign follows a similar public outreach effort by the FDA, announced in September, to ensure young people are aware of the dangers of vape products. It also launched what it called “critical and historic” enforcement actions, targeting more than 1,300 retailers nationwide — both physical stores and online vendors — with warning letters and undercover visits designed to stop them from selling these products to minors. (In 2016, the FDA banned e-cigarette sales to minors nationwide, but in New Jersey, state law requires people to be 21 to be allowed to buy any tobacco products.)

In addition, the FDA is starting to crack down on the companies that make vapes and
their “flavor pod” inserts. The agency sent letters to leading manufacturers — including JUUL, a brand particularly popular with kids — calling for them to do more to stop youngsters from accessing these products. The 2016 rule change gave the industry two years to convince federal regulators vapes were no more dangerous than traditional cigarettes, and The Washington Post and others have reported the FDA plans to announce additional restrictions any day.

JUUL announces sales restrictions

Earlier this week, San Francisco-based JUUL announced it would stop selling flavored pods in more than 90,000 retail stores in an effort to reduce the uptick in use among youngsters. (Tobacco and menthol flavors will remain.) The company said it would also end its presence on Facebook and Instagram, but will continue to post to Twitter.

Credit: Vaping360
JUUL "podmods"
“JUUL Labs is committed to improving the lives of the world’s one billion adult smokers, with the ultimate goal of eliminating cigarettes. While we have been working to solve that problem, another unintended and serious problem has developed — underage use of e-cigarettes, including JUUL,” CEO Kevin Burns said, adding that the company shared the FDA’s goal of preventing youth from getting addicted.

“We don’t want anyone who doesn’t smoke, or already use nicotine, to use JUUL products. We certainly don’t want youth using the product. It is bad for public health, and it is bad for our mission,” he said.

E-cigarette makers argue that their products are safer than traditional cigarettes because they do not contain tobacco and don’t involve combustion, the process believed to release cancer-causing toxins. (Some types of devices are also used to vaporize cannabis-infused oils, sold through medicinal marijuana vendors and in states where pot is not prohibited.)

Nicotine and other chemicals

“However, (e-cigarettes) contain nicotine, which is an addictive substance, and can harm development of the adolescent brain,” explained Olivia Wackowski, an assistant professor at Rutgers School of Public Health’s Center for Tobacco Studies. The devices also emit trace amounts of other chemicals, she said, and there are few studies on the long-term risks of inhaling the chemical flavorings involved.

“While they shouldn’t be considered safe, some public health experts believe e-cigarettes can play a meaningful role in reducing harm for smokers who switch to them instead of continuing to smoke traditional tobacco products,” Wackowski added. “A concern, however, is that non-smokers and youth might start using these products for fun, enticed by the flavors or by a cool product design.”

To reduce the temptation among teens, the DOH will provide $2 million to the nonprofit New Jersey Prevention Network to launch a new statewide public awareness campaign on the dangers of e-cigarettes. The network will also create “youth action teams” in each of the state’s 21 counties, or peer groups dedicated to tobacco cessation efforts in their schools and communities.

Credit: Vaping360
In addition, the NJPN will use nearly $2 million more to create 11 regional “quit centers” where smokers can get individual and group counseling, nicotine replacement patches, and peer support, the department said. These will be based in areas with the highest incidence of lung and bronchial cancers, chronic obstructive pulmonary diseases and heart disease and will be operated by local healthcare providers, including the RWJ Barnabas Institute for Prevention & Recovery, Hackensack Meridian Health, Inspira Health Network, Atlantic Prevention Resources, and Cape Assist.

Trying to help people quit

The network will invest another $400,000 to improve vaping and smoking prevention and cessation policies in workplaces that hire many young adults, and it will use $300,000 to expand smoke-free policies on college and university campuses in New Jersey. Some 15 of the state’s 19 community colleges are already smoke-free, the DOH said, and 24 of the state’s universities strictly limit the practice. Only St. Peter’s University is 100 percent smoke-free.

“With 99 percent of smokers reporting they began before age 26, our schools, colleges and universities play a critical role in addressing this growing public health issue,” said Elnahal, who met with college leaders to discuss these policies last summer.

The DOH will use the remaining funds to boost services at the NJ Quitline (1-866-657-8677), a telephone counseling service, which will be expanded to include electronic referrals, and to evaluate, monitor and support the new programs implemented by the prevention network, officials said.

Revenue for the new programs came from a 2017 law that required the state to dedicate to the DOH’s cessation and prevention programs 1 percent of the money collected through the state’s tax on cigarettes, cigars and wholesale tobacco. In 2016, this tax amounted to $695 million.