Author: Michelle Villar

03 Mar Teens Are Still Vaping Despite Flavor Ban

The partial flavor ban put in place earlier this year has shown to be ineffective at preventing new companies from releasing flavored products and, more importantly, at stopping teenagers ​from ​get​ting their hands on them. The partial ban on flavored e-cigarettes is aimed at stopping adolescents from vaping, however, it focuses mainly on flavored cartridges, such as what Juul uses. This opens up many loopholes in the partial ban and allows industries a way to get creative. For example, when Juul pulled its flavored pods from the market in October 2019, teenagers quickly shifted to smoking disposable vape products instead. These disposable products are made for single-use and do not require charging or filling. Cristine Delnevo, who directs the Center for Tobacco Studies at Rutgers University, described the loopholes as “a bit of a game of whack-a-mole, so when policies are aimed at one product, another product pops-up to fill the void”. Some of the more popular disposable vape brands are Puff Bar, Posh, and Stig, and are all made to resemble Juul.

Due to the sweetness of the flavors cutting the harshness of tobacco, adolescents are inhaling deeper and are taking in higher levels of nicotine. As more bans and laws are put into place, product manufacturers will continue to find a way to appeal to the younger population. Parents and educators need to engage in a conversation about the harms associated with vaping and nicotine-dependency and learn how to assist an individual looking for help. 

26 Feb E-Cigarette Flavor Ban Begins After Minimum Age to Purchase Nicotine Products is Raised

The official ban on flavored e-cigarette products began earlier this month, which affects the sale of fruit, dessert, and mint flavored pods. This ban affects pre-filled pods, also known as cartridges, which are designed for disposal after the pod is fully used and are then replaced with a new pod by the consumer. This ban comes on the heels of an announcement by the U.S. Food and Drug Administration (FDA) in late December that officially raised the legal age to purchase tobacco products, including all e-cigarette products, from 18 to 21. 

Pods are widely used among teens, and probably to thank is the vaping giant Juul which popularized the use of pods in e-cigarettes. Surprisingly, Juul will be unaffected by this recent ban, as the company took the initiative on their own before the FDA announcement and stopped selling nearly all of their pod flavors. Consumers shopping on Juul’s website are only able to purchase two tobacco flavors and menthol, both of which were not included in the flavor ban. However, other popular brands that will be affected by the pod ban include NJOY, Blu, and Logic. The affected products will not be allowed back on the market unless they pass an agency review by the FDA, a process which could take years. 

E-cigarettes come in two forms: closed-system and open-system. Closed system e-cigarettes are the only form affected with this ban, as this model requires the use of pods/cartridges that are pre-loaded with e-liquid. Open system e-cigarettes are refilled manually by the consumers with e-liquids that, like pods, are able to be purchased at any vape shop or online. Although this ban seems to be a step forward, many critics claim this ban is not nearly sufficient enough in order to affect teen rates of use. As this ban only affects pods, flavored e-liquids used in open system e-cigarettes are still legal and available for purchase nationwide. Also exempted from the ban are disposable e-cigarettes, which are meant to be thrown out after the product runs out of the pre-loaded e-liquid. Due to these exemptions, Erika Sward, a spokeswoman for the American Lung association, says “I think it’s a joke to call it a vaping ban at all.” Health advocates like Matthew Myers, president of the Campaign for Tobacco-Free Kids, says “I expect to see the shelves filled with many products that have been exempted,” saying that youth will simply switch to the exempt products now that they can no longer buy pods. 

Surprisingly, this ban will not be the most important event concerning e-cigarettes this year. May 12 is the deadline for all manufacturers of vaping products, including open system e-cigarettes and disposable e-cigarettes, to submit applications to the FDA for review. Until this ban, the FDA has freely allowed the sale of all vaping products without health reviews as authorities continued to push back the deadline for review submissions. Now, manufacturers that file an application by May 12 can leave their product on the market for one year while the FDA reviews it. Those who do not file must remove all products by May 12. 

17 Feb ReACH Lab Rocks Miami International Child and Adolescent Mental Health Conference

The ReACH Lab had many accomplishments to celebrate following this year’s Miami International Child and Adolescent Mental Health (MICAMH) conference. ACE Project co-investigators Dr. Elisa Trucco and Dr. Matthew Sutherland presented their 3-hour long workshop “What Everyone Needs to Know about E-Cigarette Use and Vaping Among Teens” to over 60 attendees, which included clinicians and school officials. Their presentation focused on the most recent information on e-cigarette use among teens, and strategies for speaking with adolescents about vaping.

Additionally, three ReACH Lab staff members presented posters during the conference. ACE Project Research Assistant Benjelene Sutherland presented on her research titled “The Synergistic Effect of Low Self-Control and Internalizing Symptoms on Adolescent Electronic Cigarette Use Intentions”, which examined the synergistic association between low self-control and symptoms of depression on intentions to use e-cigarettes among adolescents, as well as the interaction between low self-control and symptoms of generalized anxiety on intentions to use e-cigarettes among adolescents. ACE Project Senior Research Assistant Brigitte Madan presented “Outcome Expectancies Mediate the Impact of Hopelessness and Impulsivity on E-Cigarette use Intentions”, which examined negative affect and social related outcome expectancies (i.e., negative affect reduction and social facilitation) as mediators of the association between personality characteristics (i.e., hopelessness, impulsivity) and adolescent e-cigarette use intentions. ReACH Lab Manager Michelle Villar presented two posters, the first of which is titled “Internalizing Pathways to Adolescent Substance Use from Adverse Childhood Experiences” that examined anxiety, depression, and somatic symptoms as mediators of the association between adverse childhood experiences (ACEs) and adolescent substance use. The second poster titled “Anxiety mediates the association between neural emotional responsivity and problem alcohol use in adolescence” examined whether depression and anxiety symptoms mediate the association between neural activity to an emotional reactivity task and problematic alcohol use in late adolescence.

Looking forward to seeing what the ReACH Lab does next!

07 Feb The ACE Project Highlights the Importance of their Community Partnerships

It’s a new year and it’s off to a great start for The ACE Project! On February 3rd, Co-Principal Investigators, Dr. Elisa Trucco and Dr. Matthew Sutherland, took to the stage and presented at the FIU-RCMI 2020 Health Equity Symposium. The Symposium is dedicated to helping enrich health disparities research in the local community and to encourage the development of new collaborations between researchers and community organizations. Dr. Trucco and Dr. Sutherland provided a presentation on their community events and school partnerships to educate students, school personnel, and parents on the consequences of vaping/e-cigarette use. ACE Project staff, Nasreen Hidmi, Brigitte Madan, Benjelene Sutherland, and graduate student, Katharine Crooks held an information table during the event.

In reference to community events, the ACE Project has given educational presentations to several schools throughout January. On January 10th, the team split up and visited two different schools to present on the harms associated with e-cigarettes. Dr. Trucco and Ms. Madan visited Youth Co-op Preparatory, while Dr. Sutherland and Ms. Hidmi visited the student success center (SSC) at Paul Bell Middle School. The SSC serves as an educational setting and haven for referred students ages 11 and up. Later, on January 14th, Dr. Sutherland and Ms. Madan continued their tour of visiting SSC’s and presented at the center in Riviera Middle School. The following week, on the 22nd, Dr. Trucco and Ms. Madan proceeded with their community outreach efforts at Henry S. West Laboratory School. The team then finished off January with presentations at the SSC at Dorothy M. Wallace Cope Center on the 24th, the SSC in North Miami Beach Senior High on the 28th, and finally at Mater Academy Middle High Charter School on the 29th. In the past month, The ACE Project has recruited and presented to over 650 students. The ACE Project continues to expand their outreach efforts to educate the youth and the community on the risks of vaping.

31 Jan Surgeon General Reports That Doctors Are Not Advising Patients to Stop Smoking

Surgeon General Dr. Jerome Adams warned in a report released last week that a “shocking” number of smokers are not advised to quit by their doctors, despite the current breadth of knowledge on the dangers of smoking cigarettes. “Forty percent of smokers don’t get advised to quit,” Dr. Adams said in an interview. “That was a shocking statistic to me, and it’s a little embarrassing as a health professional.” Dr. Adams is referencing to statistics from the 2015 National Health Interview Survey, collected through the U.S. Census Bureau to monitor “the health of the nation,” that found that four out of nine adult cigarette smokers were not told by a health professional to quit smoking in the past year. In the same report, the Surgeon General warns doctors and health officials that vulnerable populations, such as “gay and transgender people, Native Americans, and people with mental illness diagnoses,” are not getting the help needed to quit smoking, and that more attention should be devoted to these groups. Dr. Adams urged cigarette smokers to use the wide range of cessation methods that have been proven effective by the FDA…a list which does not include e-cigarettes. He referenced the increasingly popular devices after releasing his report, saying that more research was needed on the effects of e-cigarettes. He did, however, offer anecdotal evidence on the “effectiveness of e-cigarettes as smoking cessation tools”, saying: “We’ve heard powerful accounts from adults out there who tell us that they’ve used e-cigarettes to successfully transition from combustible cigarettes.”

Over 55 years since the release of the first surgeon general report that warned the public that smoking causes cancer, smoking remains the “leading cause of preventable death and disease” in the country. Smoking rates, however, are on the decline, with smoking in the U.S. reaching an all-time low of 14 percent. Still, almost half a million Americans die from smoking-related illnesses every year, and about 16 million people suffer from cancer and heart disease linked to smoking, according to the CDC. 

24 Jan Cornell University Designs Innovative Toolkit to Demonstrate Harms of E-Cigarette Use

The Advancing Secondary Science Education Through Tetrahymena (ASSET) program at Cornell University has developed a new learning module kit where high school students can directly test the effects of e-cigarettes on living cells. The kit contains small quantities of e-cigarette vapor condensate, unsmoked vape juice, and water that has been vaporized and re-condensed in a clean e-cigarette. Using these materials, the students then apply it to a single-celled ciliated protozoan called Tetrahymena. The Tetrahymena is an organism that mimics the functions of a human cell, therefore the students will be able to see the moment when a healthy Tetrahymena cell, which is in constant motion, quickly becomes still and sinks to the bottom once introduced to the substance. 

Dr. Donna Cassidy-Hanley, Senior Research Associate and Program Manager of the ASSET program states that “our module is unique in that… it provides a dramatic and impactful demonstration of the real-life effects of e-cigarette vapor on living cells.” The goal of the module kits is to educate and demonstrate to the youth the impact and risks of smoking e-cigarettes in such a way that the students will not forget.

The kit is free for high school teachers and it is currently being used in 18 schools across seven states.

17 Jan Teen Alcohol and Cigarette Use Decreases, Vaping Nicotine and Marijuana Soars

A New York Times article published last month details new information on youth substance use. The annual Monitoring the Future survey that follows 8th, 10th, and 12th graders showed that adolescents are smoking cigarettes, trying hard drugs, or drinking alcohol at lower levels than the past. However, the use of electronic cigarettes to vape marijuana and nicotine has soared. Rates of e-cigarette use to vape marijuana has essentially doubled over the past two years, with 7% of 8th graders, 19.4% of 10th graders, and 20.8% of 12th graders reporting past year use in 2019. This parallels earlier data released by the U.S. government reporting that about 25% of 10th and 12th graders used e-cigarettes in the past month for vaping nicotine. 

This report comes on the heels of the mysterious vaping epidemic of “e-cigarette, or vaping, product use-associated lung injury (EVALI),” which has resulted in 2,668 hospitalized cases, including 60 deaths. According to the Center for Disease Control (CDC), as of early January, 82% of hospitalization cases have reported using THC in their e-cigarette products. According to the CDC, vitamin E acetate, an additive in many THC e-cigarette products, may be a likely source of the outbreak of these EVALI cases, although officials are hesitant to pinpoint the cases on only one chemical or ingredient. 

Although vaping marijuana is steadily on the rise, overall marijuana use (including smoking or eating edibles) was constant compared to last year’s statistics on use in the past year, although daily use did increase. In sum, the results of the Monitoring the Future survey gives public health officials a hesitant feeling of relief, as rates of alcohol and cigarette use continue to decline. “There has been a whole lot of effort at the community level,” said Dr. Sion Kim Harris, a pediatrician and director for the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. “There are some encouraging trends.” In contrast, it seems that efforts to minimize vaping have yet to take hold, likely due to the steadfast belief among youth that vaping is not harmful. 

The National Institute on Drug Abuse funds the Monitoring the Future survey in order to closely monitor changes in teenage drug use and experimentation, in the hopes of better understanding the constantly changing rates of adolescent substance use. 

13 Jan ReACH Lab Graduate Student Publishes Master’s Manuscript

A big congratulations is due for ReACH Lab graduate student Julie Cristello after her manuscript based off her Master’s project was recently accepted to be published in the journal “Addictive Behaviors”. Please continue reading below to read her abstract, congratulations on this amazing accomplishment Julie! 

The relationship between adolescent sport involvement and later substance use (SU) has been unclear. Understanding the pathways through which sport involvement influences SU may help identify targets for prevention. Using a sample of 535 adolescents from the Michigan Longitudinal Study (MLS; 67.29% male, 78.13% European American), this study prospectively examined whether aggression during late adolescence mediated the association between sport involvement during early adolescence and alcohol, marijuana, and cigarette use during early adulthood. In addition, perceived peer SU during early adolescence was tested as a potential moderator in the association between sport involvement on SU. High sport involvement was associated with more alcohol use. In contrast, the indirect effect of sport involvement on SU via aggression was significant for cigarette use, and marginally significant for marijuana use. Lastly, peer SU was a significant moderator in the cigarette model, indicating low peer SU was somewhat protective among high sport-involved adolescents. Prevention targeting alcohol use and associated consequences, as well as aggressive behaviors may help address future substance use.

13 Jan ACE Project Wraps Up First Wave of Data Collection, Reflects on Two Years of Accomplishments

19 Dec How Juul Hooked a Generation on Nicotine

At a congressional hearing this July, James Monsees, co-founder of Juul Labs, testified that “we [Juul Labs] never wanted any non-nicotine user and certainly nobody underage to ever use Juul products.” But how truthful is this testimony? According to a recent article in the New York Times, Juul’s past shows that this is entirely dishonest. In the wake of an increasing numbers of investigations and lawsuits, Juul has continued to insist that their marketing was never intended to attract teenagers and non-smokers. However, according to NYT interviews with former investors and employees, as well as NYT reviews of legal documentations and social media archives, it seems the company knew exactly what it was doing.

According to the article, Ari Atkins, an engineer that was part of the team that developed the Juul, told The Verge in 2015: “We don’t think a lot about addiction here because we’re not trying to design a cessation product at all. Anything about health is not on our mind.” This point was proven when the company did not include a nicotine warning label on their products until the summer of 2018 when the FDA forced them to do so. In December 2018, the vaping giant continued to raise eyebrows when a 35 percent stake in their company was bought by Altria, one of the world’s largest producers of cigarettes and other tobacco products, uniting Juul with Big Tobacco in an undeniable way. 

Juul has virtually monopolized the e-cigarette industry over the last few year, taking over 75 percent of e-cigarette sales and making more than $1 billion in sales in 2018. The company’s gargantuan growth from 2016 to 2018 occurred at the same time that the number of adult nonsmokers that began vaping in the United States doubled. Also during this time, one in four high school students and one in 10 middle school students became e-cigarette users. Although Juul has only recently been tied to increased vaping among adolescents and young adults, it seems this was part of their early game plan. In 2015 during a campaign called Vaporized, Juul introduced itself to the public with parties in large cities like Miami and New York, and with ads and posts featuring young models. Three members of the company’s sales team recalled confusion regarding this campaign; if the company is supposedly targeting current smokers, why is the campaign so youthful? Scott Dunlap, the chief marketing officer at the time, noticing a sharp increase in adolescents and young adults engaging with social media posts featuring hashtags like #juul and #vaporized. In 2017, employees also began noticing that orders were being made online with clearly fake IDs. Although these orders were not filled, it was an indication that underage teenagers were trying to buy Juuls. This clearly didn’t seem to phase the company, as the company moved forward with filing a patent for a vaping device with a built in “gaming mode” that was seemingly aimed at young vapers. This device, however, was never made. Also in 2017, Juul and other vaping companies were sued by the Center for Environmental Health in order to lower dangerous levels of carcinogenic formaldehyde in their products. The Center for Environmental Health  decided to include a provision in the settlement that required the companies to agree not to market to youth. Juul did not sign this provision until last month.

Following the intense backlash concerning Juul’s role in the current vaping epidemic among teens, the company has taken steps to keep products away from teenage hands, including stopping the sale of most of its flavors and halting all advertising. Late last year, Joshua Raffel, a spokesman for Juul, said “we [the company] fully understand the need to earn back the trust of regulators, policymakers, key stakeholders and society at large and reset our company and the vapor category.” Regardless of these current changes, Juul’s long-term presence in the American marketplace remains uncertain. In May of next year, the FDA will be reviewing whether the benefit of smokers switching to e-cigarettes is worth the drawback of developing a newly nicotine-dependent generation. For now, all there is to do is wait and hear about the company’s wavering future.