A Tale of Three Countries: Teen Vaping in the US, UK and Australia

What has been framed as a teen vaping epidemic in the US poses an existential threat to the e-cigarette industry. But is this issue unique to the US? UK based E-Cigarette Direct recently completed a survey of national data on teen vaping that has been compiled by the regulatory groups in the US, UK and Australia. Most of the graphs below are courtesy of their report, which we recommend checking out.

Teen Vaping an Existential Danger to E-Cig Industry

E-cigarettes are threatened with restriction and even extinction in the US because vapers are not heavily represented in the circles where regulatory decisions and laws are made. This contrasts sharply with alcohol. Drinking rates are highest among educated, high income adults.

The number of US high school students who binge drink, 13.5 percent, is far higher than the number who use electronic cigarettes daily, 2.4 percent. But no one is calling for national restrictions on liquor sales and manufacturing, despite the grim toll exacted annually by underage drinking.

The interests of vapers are sorely underrepresented and this has created an unusual dynamic. Liberal bastions like San Francisco, and Congressional representatives who claim to champion LGBTQ rights, such as Diane DeGette (D-Colorado), are leading the charge for strict e-cig restrictions that harm marginalized groups.

DeGette’s SAFE Kids act, a national ban on vaping flavors, is the ultimate example of the fruit flavor fallacy. This fallacy is predicated on the misguided belief that sweet fruit and dessert flavors exist to entice children to vape.

Teen Vaping in the UK, US and Australia

The state of vaping internationally adds another layer of complexity. E-Cigarette Direct dissected this subject expertly. The graphs below are from their report. Their deep dive into the difference between daily e-cig users and occasional use is particularly enlightening.

The UK a Beacon of Hope for Vapers

In the UK, the National Health Service (NHS) promotes vaping as a cigarette alternative that is 95 percent safer than smoking. A government funded website titled “Using E-Cigarettes to Stop Smoking” would be unthinkable in the US, but is a crucial resource for residents interested in their harm reduction policies.

Public Health England (PHE), an executive agency in the UK’s Department of Health and Social Care, rejects the idea that vaping is a gateway to smoking cigarettes.

The NHS and PHE have no special agenda, just a lot of skin in the game. As part of a publicly funded, single payer system, they rely on tax dollars to stay afloat. They are ruthless when it comes to cutting measures that do not make financial sense. In 2017, the NHS pulled the plug on homeopathic and herbal treatments as a misuse of resources. Whatever your thoughts are on alternative medicine, this move makes it clear that the UK is not afraid to act if it means saving money.

Vaping in the Land Down Under

Australia has adopted the opposite course, there is little national guidance to speak of and e-cigarettes are regulated on a state-by-state basis. Some of these states have very strict rules. You are allowed to own vaping supplies, but most Australian vapers rely on ecommerce websites for their ejuices. Nicotine free e-juices are more widely available.

Australia's center-left Labor Party continues to erect road blocks that deny Australian smokers access to ash and smoke alternatives. As reported in The Guardian last autumn, the Federal Labor party was upset that Phillip Morris is lobbying to loosen the rules.

Health Minister Greg Hunt continues to fight hard for an e-cig ban. Whether the concerns or ideological or personal, he showed few scruples when parroting talking points that at best are misleading, and seem to be lifted verbatim from the hackneyed anti-vaper playbook. “The overwhelming medical advice and evidence is that it’s likely to lead to the uptake of smoking and we cannot support that.”

This outburst was made in response to a year long inquiry into Australian e-cig laws resulted in a split opinions, and no action on the Federal level.

The chairman of the committee assigned to investigate e-cigarette legalization, Trent Zimmerman, strongly disagrees with this assessment and wrote a dissenting opinion that was strongly in favor of e-cigarette legislation.

"International examples indicate that smoking rates among younger cohorts continue to fall in many countries where E-cigarettes are widely available.

For example, Cancer Research UK stated that despite the availability of E-cigarettes in the UK there has been ‘no increase in youth smoking of tobacco, which is another important measure in terms of establishing the gateway effect.’

Restrictions on the sale and marketing of E-cigarettes to younger people can help to alleviate this risk. The risk of a ‘gateway’ effect needs to be weighed against the benefits of people quitting smoking via E-cigarettes.

As one UK witness succinctly put it: ‘the gateway in is much, much smaller than the motorway out [of smoking].’

Trent Zimmerman MP & Tim Wilson MP,

Committee Member Andrew Laming MP submitted a historically short dissent of the national e-cig ban:

Life is short and shorter for smokers. Just legalise vaping.

Andrew Laming MP

E-Cigs Under Siege in US

Vapers are waiting for the FDA to drop the hammer on e-cigarettes in the US, and harsh restrictions are already being enacted at the state and local level. There are rumblings of an FDA vape pod ban, and previous scape goats for the uptick in teen vaping include: retro ejuice packaging, sweet flavors and gas station sales to minors. None of these last three hold any water and are discussed in detail below.

US vs UK Teen Vaping

The UK’s approach to vaping is more liberal than the US, but they are not encouraging teenagers to vape. Sale of vaporizers and e-liquids to individuals under the age of 18 is prohibited. But they have looser rules regarding the advertising of e-cigarettes, and fewer restrictions on where you can vape. Following the logic of anti-vapers, they must not care about children and the teen vaping epidemic should be far worse than in the US.

Apparently, it did not work out that way. The number of UK children who vape at least weekly is less than half the US rate.

Here is where it must be noted that there is a limit on nicotine strength in the UK. Unlike in the US, ejuices are limited to 20mg/ml on the other side of the pond. This is less than half of a standard US Juul device’s 50mg/ml.

Could it be that nicotine content, and not Fruity Pebbles flavored vapor, is what high school students are after? This simple explanation may complicate the issue of e-cigarette regulation, especially if it turns out higher nicotine levels are beneficial for smoking cessation. But it is the elephant in the room and must be addressed.  

Vaping Accelerates Decline In Smoking Rates?

Australia has by far the most restrictive e-cigarettes laws of the three countries examined. Their success in the snuffing out smoking has also been more limited. Correlation does not mean causation, but the numbers fly in the face of the outmoded theory that vaping is a gateway to combustible cigarettes.

The US, whose teen vaping rate has led to an endless stream of alarmist editorials and new FDA regulations on e-cigs, has the largest decline in the “Having Ever Smoked” category. Five percent of Australian youth have smoked in the past week, compared to 2.4 percent in the US and 3 percent in the UK. The US also had the largest decline in regular smokers, and Australia by far the smallest drop.

This prompts an interesting question: Could the higher nicotine levels available in the US facilitate smoking cessation but also lead to more teenage vaping. The data is not present to draw this conclusion, but it is a subject that deserves further examination.

This winter, a study published in the New England Journal of Medicine found that vaping crushed nicotine replacement therapy as a smoking cessation tool. The device distributed for that study was not a trendy Juul, a sleek refillable pod system, a sturdy AIO or a mighty 220w box mod with a subohm tank. It was a basic, high resistance, stick battery powered cartomizer e-cigarette.

Teenage High Risk Behaviors

Pursuing alcohol prohibition to reduce teenage drinking is not on the table in the US. Drug use remains a serious concern. Proponents of marijuana decriminalization have won some notable victories in the last 20 years, most notably in the state of California. Unfortunately, a virtual e-cig prohibition in San Francisco is under consideration. How does the US stack up to the UK and Australia in terms of teen drug use and vaping? In a word, poorly.

US vaping and drug use rates in minors are twice that of Australia. Drug use among minors is almost double the UK rate, and the percentage of teen vapers is three times greater. The fact that vaping is less common than other risky behaviors in US youth is not cause for celebration. But it does suggest regulators have taken their eye off the ball and are obsessing over teen vaping.  

Youth alcohol use in Australia is the highest of the three countries examined. At 27 percent, it easily outpaces the US rate of 19 percent and the UK rate of 21 percent. In all three countries, teen alcohol use measurably higher than vaping. This does not even factor in the comparative risk of these behaviors.

You may have read passing references to the dangers nicotine poses to the developing brain, and we certainly have no interest in selling our products to minors, but alcohol use is a certified scourge in the US. Underage drinking killing 5,000 teens annually.

The State of Vaping In United States

E-Cigarette Direct's compilation of national data provided fascinating international insights into what has been framed as a teen vaping epidemic. What the numbers do not capture is the anti-vaping climate in the US. Politicians are searching for scape goats. Their explanations would be laughable if the stakes were not so high for smokers and former smokers who vape.

Fruit Flavor Fallacy

The Fruit Flavor Fallacy needs to be laid to rest once and for all. Data is available, in the form of a survey of 69,000 adult vapers by Dr. Konstantinos E. Farsalinos, that clearly illustrate adult vapers prefer sweet flavors. But the FDA and politicians across the US remain fixated on the idea that dessert and fruit ejuices were designed to hook children.

Retro E-Juice Packaging Targets Nostalgic Adults

Another bankrupt theory was acted upon when the FDA cracked down on e-juice packaging. They were concerned that e-juice boxes resembled processed foods and junk food snacks that peaked in popularity decades ago. The authors of this intense enforcement program probably weren’t marketers. Retro e-juice packaging targets nostalgic adult vapers, but a terminal disconnect from modern trends has blinded lawmaker’s like Rep. DeGette to this reality.  

In her press release announcing the SAFE Kids Act, a national flavor ban, she cited Tutti Frutti and Cotton Candy as examples of a “kid-friendly” nicotine flavors. If by kids she meant children who grew up during the Eisenhower-era, she is correct about this Tutti Frutti business.

The FDA’s example in the retro packaging crackdown was Nilla Wafers. Today this cookie is generally used in pie crusts, but it made a great dunkable treat for kids watching the moon landing. Seriously. I’m pushing 40 and those things were demoted to Grandmother’s cupboard long before I was born.

Critics are correct in assuming that sugar-coated cereal themed e-juices target a younger generation. That generation is Generation X.

It probably is wise to refrain from designing ejuice packaging that looks like edible food items and to steer clear of any trade dress violations. But these creative designs exist because the sweet flavored ejuice market, for adults, is booming.

It is difficult to stick out when there are thousands of flavors to choose from, and sampling is barred at most vape shops. The fastest way to get an adult customer’s attention is an attractive box that evokes delicious and sweet flavors from childhood. This is not the same as targeting children.

Vape Pod Ban

It appears the FDA has decided to look at the role that closed pod systems play in the uptick in teen vaping. There are even rumblings of a ban on vape pods systems. Although we advocate age verification and education, the exact measures that slashed cigarette smoking to record lows, a new class of devices whose release coincided with the uptick would appear to be a more likely culprit than fruit flavors or Sour Patch Kid themed bottle labels.

Put yourself in the shoes of teenager today. You probably don’t care if Elvis or Little Richard had the superior studio cut of Tutti Frutti. You probably aren’t basing your buying decisions on which breakfast cereals were most heavily advertised during Reagan-era Saturday morning cartoons. But a device which is discrete, easy to use, and provides a quick nicotine fix might be appealing.

Strict E-Cigarette Bans Harm Marginalized Groups

E-cigarette restrictions punish smokers, and marginalized groups are disproportionately impacted. This fact is completely overlooked in most discussions on teen vaping and e-cig bans. At least Commissioner Gottlieb acknowledges this reality, lawmakers and anti-vaping activists rarely demonstrate this nuanced of a view. In an interview on Fox News, Gottlieb stated:

“We believe these products are less harmful than smoking and for a currently addicted adult smoker who can quit cigarettes by migrating onto an e-cigarette they are probably having a positive impact on their health, and maybe a significant impact on their health.”

In their pursuit of a virtual statewide e-cig prohibition in California, failed to consider how vaping can serve as a cigarette alternative. This was glaring in its omission was intentional. These politicians do not want to promote cigarette smoking. They have embraced a puritanical mindset where total nicotine abstinence is the only desirable outcome. This approach is a relic of a bygone era.

Rural America Punished By E-Cig Sales Restriction

 Iowa Attorney General Thomas Miller blasted the new FDA e-cig restrictions last fall. He immediately realized that targeting gas stations and convenience stores would create serious obstacles for rural vapers. His letter to the FDA argues that the health of adult smokers, especially those in rural areas, should not be disregarded.

Gas stations and convenience stores are right to be concerned. They have been singled out for blame. There are legal concerns about this strategy and the FDA’s decision to differentiate between vape shops and convenience stores may face its day in court.

A National Association of Tobacco Outlets (NATO) editorial run in CSP News outlines a number of issues with the FDA’s decision to target certain classes of brick and mortar stores. In a letter to Scott Gottlieb, their director Thomas Briant argued that 96.7 percent of convenience stores passed FDA sponsored compliance checks this summer and that the FDA’s own 2016 Tobacco and Health assessment found that nearly 90 percent of underage users of e-cigarettes relied on “social sources” (read legal buyers) to obtain these products.

Briant also questioned the legal basis of the FDA’s declaration. The congressional authority given to the FDA to control all aspects of tobacco and e-cigarette sales is limited. The congressional mandate, “Prevents the FDA from restrictions that would prohibit the sale in a face-to-face transaction by a specific category of tobacco outlet.” Gas station and convenience store owners are likely to challenge the FDA’s power to limit the sales of e-cigarettes for a specific class of retailer.

Denying Smokers Access to Cigarette Alternatives

Rural Americans are not the only group that will suffer if denied access to cigarette alternatives. There is a serious danger that many urban, African American and LGBTQ vapers will be funnelled back onto cigarettes by heavy handed regulations.

A CDC survey found that census identified LGBT individuals were nearly 3 times more likely to use e-cigarettes than the population as a whole, 7.4 versus 2.5 percent. They also smoke at a higher rate, 20.3 percent versus 14 percent. Tobacco kills 30,000 members of the community annually.

Smoking rates among the transgendered have been estimated at over 80 percent and studies have tied this to structural discrimination. Bisexual women are over twice as likely to smoke as heterosexual women.

A study by the International Journal of Environmental Research and Public Health found African Americans are more likely to embrace e-cigarettes alone, rather than engaging in dual use and continuing to smoke cigarettes, than any other group.

This study did not view their uptake of e-cigarettes in place of cigarettes to be of any benefit. It is long past time to revisit that view.