Eugene weekly., January 03, 2019, Page 13, Image 13

HEALTH
in the first few puffs, Ashley and Pankow say.
Juul was the first major retail e-cigarette brand to use
social media in a big way. A combination of hashtags,
celebrity endorsements and artsy images of hip young
people flew under the radar of public health tracking
systems, Huang and his colleagues reported in March.
Quarterly sales of Juul tracked the skyrocketing number of
tweets and retweets in 2017.
In April, the FDA announced a crack down on youth
sales and marketing. In July, Juul added a lower nicotine
pod (3 percent compared with 5 percent) to its lineup in
mint and Virginia tobacco flavors. In November, Juul
announced it was closing its Facebook and Instagram
accounts and stopping distribution of certain flavors of
pods that critics called appealing to teens. Juul maintains
that it never intended youth use and instead aims to provide
a less dangerous alternative to combustible cigarettes.
In December, one of the world’s largest tobacco
producers and marketers, Altria (formerly known as Philip
Morris), purchased a stake in Juul Labs for $12.8 billion in
a deal that gave the 1,500 Juul Labs employees $2 billion
in cash, the Wall Street Journal reported. On Jan. 18, the
FDA will hold a hearing on reducing youth e-cigarette and
other tobacco use, including the role for drug therapies to
support quitting.
The tobacco industry has seen numbers of U.S. adult
users steadily decrease since the mid 1960s and youth
users drop since the mid 1990s. The drop is attributed
in large part to prevention efforts to discourage smoking
among teens. After all, nine out of 10 tobacco users say
they began before age 19.
Of course, tobacco companies also lose customers to
quitting and premature death.
As preventive health professionals like Brian King at
the U.S. Centers for Disease Control in Atlanta are fond
of saying, “When used as directed, tobacco kills half of
its users.”
Heated tobacco is the next wave, King says. The FDA is
reviewing an application to allow marketing of a tobacco-
warming product called iQos (“I quit ordinary smoking”)
that plugs into a device that looks like an iPhone, plus a
claim that it’s safer than cigarettes. The device is popular
in other countries, King says, but “a similar device failed
miserably” in the U.S. earlier.
E-cigarettes may be not be as bad as smokes, especially
for secondhand smoke, but the vapors still expose users
to known harmful levels of certain chemicals, such as
formaldehyde and ultrafine particles, Stanton Glantz,
a long-time foe of tobacco use, said in an online lecture
in August. Preliminary surveys and molecular studies
implicate daily e-cigarette use with nearly double the risk
of heart attacks and with increased risk of chronic lung
disease. Dual users — people who both smoke and vape
— have even higher risks.
People often associate smoking with cancer, Glantz
said, but it accounts for only one-third the premature
deaths, with heart disease and lung disease the major
killers. “The risks are substantial,” he said. “No one knows
yet how it compares to cigarettes, but they’re getting closer
and closer.”
So what do you tell smokers who want to quit? “Always
support a quit attempt,” Glantz said, but they need to know
that “for most people, using e-cigarettes makes it harder to
quit.” When used properly with counseling and support and
a disciplined quit plan, as with FDA-approved cessation
products, e-cigarettes may be effective in quitting, he said.
Prevention works better than trying to recover from
a nicotine addiction. Nationally, policies to limit youth
tobacco use have tended to start locally. In Lane County,
“there’s evidence that use of e-cigarettes may be leading
to use of other tobacco products,” says Christy Inskip,
coordinator of the Lane County Tobacco Prevention and
Education Program. In 2014, she and her colleagues
documented tactics proven to target youth and vulnerable
populations, such as people of color, those with lower
incomes, disabilities and rural residents. They include
varied pricing of cigarellos, flavored little cigars that can
be sold individually, which cost 69 cents in Florence, with
higher tobacco use rates, and $1.18 in Eugene.
In another tactic, local stores get $10,000 a year to
allow the tobacco company to place and advertise its
products where it wants, such as near candy and at a child's
eye level, Inskip says. “The industry is exploiting local
retailers,” she says.
The county and its cities are fighting back. In 2014,
Lane County was the first in Oregon to require a license
to sell tobacco and, in 2017, to raise the tobacco sale age
from age 18 to 21. The state of Oregon followed within
months. Cottage Grove was the first city to ban sales of
e-cigarettes to minors. Eugene recently passed a smoke-
free downtown ordinance, with ways for businesses to
opt out, as well as ways for other organizations to opt in
outside the prescribed smoke-free boundaries.
One of the most effective strategies is raising the
price. In Oregon, the state Governor’s Budget includes a
proposal to increase the price of tobacco by $2 per pack of
cigarettes and also for the first time to tax inhalant delivery
systems, which include e-cigarettes, says Delia Hernández,
spokesperson for the Oregon Health Authority. ■
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