Vape cloud

As the Legislature is considering a ban on flavors in both cigarettes and e-cigarettes in Vermont, a prevention educator describes how some of these substances are created to hook users from a young age — for life

Rolf Parker-Houghton is program coordinator with Building a Positive Community, which offers programs that serve youth and families, including substance-use prevention, though he has written this piece as a concerned private citizen and not in his official capacity.

Parker-Houghton helps health care professionals get the information they need to help people sign up for smoking cessation classes. He also works with people who are addicted to nicotine to help find the help they need. He also works with interns and volunteers to document how corporations market, distribute, and sell nicotine products to young people.

He notes that he will be working on Wednesdays, starting at 5 p.m., at Brooks Memorial Library in Brattleboro, "tracking down information about sales targeted at children in Vermont." Interns and volunteers are welcome to join in this work.

"Information that we gather can be used to close down internet sellers who sell without age verification and try to ship products to Vermont," he continues. "It's good work, and I hope some readers might be able to join me."

For more information, contact Parker-Houghton at [email protected].

I gather scientific information about nicotine products for the Vermont Department of Health's Tobacco Control Program. I also share the latest research about vapes with elementary and middle school students in Vernon, Putney, Dummerston, Guilford, and Brattleboro.

My responsibilities have expanded. I now offer cessation counseling with children as young as 11 - because that is the age at which vaping is starting in our towns here in southeast Windham County.

The first time I talked to elementary school students about vaping, I asked them what they thought it meant to be addicted to nicotine.

"The vape tastes so good, you don't want to stop," one student replied in what would be a common response to this question.

Laughing, another student said, "My mom says she is a chocoholic."

"It's like that Cheetos ad," said a third, presumably referring to a TV spot where a guy looks at the camera and confesses his extreme addiction to the snack food.

These impressions on young minds are borne out by statistics.

The following text is included in a bill (S.18) passed by the state Senate and under consideration by the House:

• Youth tobacco use is growing due to e-cigarettes. Seven percent of Vermont high school students smoke, but if e-cigarette use is included, 28 percent of Vermont youths use some form of tobacco product. More than one in four Vermont high school students now uses e-cigarettes. Use more than doubled among this age group, from 12 percent to 26 percent, between 2017 and 2019. [This is the language in the bill, but I have to note that many popular brands of vapes have no tobacco in them of any kind, and TFN, or tobacco-free nicotine, is very popular among vapers, who are proud to not be tobacco users. They know you are wrong if you insist that they are using tobacco.]

• More students report frequent use of e-cigarettes, which indicates possible nicotine addiction. According to the 2019 Vermont Youth Risk Behavior Survey, 31 percent of Vermont high school e-cigarette users used e-cigarettes daily, up from 15 percent in 2017.

• Flavored products are fueling the epidemic. Ninety-seven percent of youth e-cigarette users nationally reported in 2019 that they had used a flavored tobacco product in the last month, and 70 percent cited flavors as the reason for their use. E-cigarette and e-liquid manufacturers have marketed their products in youth-friendly flavors, such as gummy bear, birthday cake, candy cane menthol, and bubble gum.

• Mint- and menthol-flavored e-cigarettes are increasing in popularity among youths. Over the past few years, mint and menthol went from being some of the least popular to being some of the most popular e-cigarette flavors among high school students.Evidence indicates that if any e-cigarette flavors remain on the market, youths will shift from one flavor to another. For example, after Juul restricted the availability of fruit, candy, and other e-cigarette flavors in retail stores in November 2018, use of mint and menthol e-cigarettes by high school users increased sharply, from 42.3 percent reportedly using mint and menthol e-cigarettes in 2017 to 63.9 percent using them in 2019.

This bill "proposes to ban the retail sale of flavored cigarettes, e-cigarettes, and e-liquids. It would expand the applicability of provisions relating to the seizure and destruction of contraband tobacco products to include contraband e-cigarettes, e-liquids, and tobacco paraphernalia."

It "would also direct the Office of the Attorney General to report on the extent to which Vermont may legally restrict advertising and regulate labels for e-cigarettes and other vaping-related products."

* * *

Students understand that nicotine addiction can cause a person to have highly unpleasant withdrawal symptoms.

High school students have reported that they have seen friends suffering from anxiety while trying to stop. Those who had parents or grandparents who tried to quit have described how these family members got irritable with them - and anxious.

"It wasn't pretty," one student said.

Nicotine addiction is a harm all by itself - independent of the other harms (and there are many) that come from cigarettes and vapes.

But in another way, addiction is about the flavors. Many of the chemicals that cigarette and vaping companies commonly use - menthol, acetates, and pyrazines - don't just taste good, they are known by scientists to alter neurons in the brain so that the nicotine addiction is potentially much stronger.

As a result, for some people quitting can become that much harder and emotionally painful.

According to the U.S. Food and Drug Administration, menthol's sweet and cool flavor is on the list of the most popular flavors with kids. More than half (57.9%) of students currently using e-cigarettes reported using flavors with "ice" or "iced" in the name.

According to the research of Duke University researcher Dr. Sven Eric Jordt, menthol enhances nicotine addiction in more than one way.

"Menthol reduces the irritation sensed when inhaling smoke (or nicotine in a vape aerosol) and can increase the amount of nicotine a person takes into their system and metabolizes."

Putting it a different way, nicotine causes a harsh feeling in the throat, and menthol blocks that harsh feeling. Menthol and some other synthetic cooling agents allow new users to suck the nicotine cloud deeper into their lungs without coughing.

The deeper down a user - frequently, a child - sucks a vape cloud of nicotine without coughing, the more easily and strongly addicted they can potentially become.

But aside from allowing the deep inhale, there is another way menthol and flavorings can help hook kids before they even know it.

"Menthol and chemical flavors that contain acetates can increase the number of receptors in the brain that bind to nicotine," said Dr. Brandon Henderson, Neuroscience and Developmental Biology Research Cluster coordinator at the John C. Edwards School of Medicine at Marshall University, in an email.

"They contribute to making quit attempts more difficult," said Henderson, who identified four acetates that create nicotine receptors in people who ingest these additives.

* * *

The young people I work with don't know that tobacco companies have a long and well-documented history of adding chemicals to work with nicotine.

Hillel R. Alpert and his then-colleagues at the Harvard School of Public Health analyzed millions of tobacco company documents, and discovered that the tobacco company Phillip Morris - now renamed Altria - found a special group of chemicals called pyrazines.

According to Dr. Henderson, pyrazines connect strongly to specific parts of neurons in the brain that are related to nicotine addiction, and it is not fully understood how they might be promoting addiction. But according to Alpert, the company chemists referred to their mix of additives, including three pyrazines, as "Super Juice."

In this 2015 paper, Alpert called for additives and ingredients that "promote addiction by acting synergistically with nicotine" to be regulated by the FDA.

* * *

A decade later, it appears little to nothing has been done to keep addiction enhancers out of nicotine products.

The FDA has, on paper, banned all flavors in disposable vape products, and the agency has not given market approval to menthol versions of products by the R.J. Reynolds Tobacco Company (which makes Camel cigarettes and Vuse vapes) or Altria (which makes Marlboro cigarettes and sells NJOY menthol vapes).

But those menthol products remain on the shelves of convenience stores and available online, and they will for years, because companies routinely appeal FDA decisions. Litigation can take many years, and the agency has lost cases when pro-industry and anti-regulatory, conservative judges have weighed in.

The makers of Marlboros spent $2.75 billion in 2023 on NJOY, so that company seems pretty confident that they are going to continue selling those menthol pods for a long time.

Meanwhile, the FDA is not requiring vape manufacturers to disclose the chemicals they use on the packages that come into Vermont.

So my University of Vermont college interns, volunteers, and members of the nonprofit organization Parents Against Vaping E-Cigarettes purchased vapes so we could find out what might be in them - and so I could give that information to my students and the public.

* * *

For testing, we chose some of the most popular brands among young people: Vuse and Elf Bar.

Even though Vuse GO vapes are not supposed to be available for sale in the U.S., we included this brand because it comes in many "Ice" flavors, like "Banana Ice." Also, it took my volunteers only eight minutes to find and purchase this product online, where it was available without age verification, from at least one company authorized by Reynolds to sell its products.

We also purchased menthol-flavored devices like Vuse and NJOY and Vuse Solo menthol at stores in Montpelier and in other cities in other states.

Finally, we purchased "Tobacco" flavored NJOY out of curiosity to see what chemical flavorings were actually used.

I gave the devices to the Vermont Department of Health, which shipped them for testing to the laboratory of Dr. Robert Strongin, a former industrial and medicinal chemist, at Portland State University, where among his research interests is the study of electronic cigarettes.

In the Vuse Go products, we were looking for these flavorings and also artificial cooling agents.

Of course, we were not surprised to find menthol in the NJOY and Vuse Solo menthol products, both of which also included an acetate that Dr. Henderson's lab has documented as potentially increasing the power of nicotine..

In fact, all the devices we sent to Dr. Strongin's lab that were tested included one or more potentially addiction-enhancing chemicals, whether acetate flavors of some kind, or menthol, or pyrazines.

Pyrazines were the least common in the devices tested so far, but the "tobacco-flavored" vapes have not been tested yet. Other researchers have found pyrazines in other brands marketed as tobacco, so we will have to see what we find in the NJOY tobacco at some point in the future.

Whether the concentrations of these chemicals were high enough to potentially achieve this effect is a question that merits deeper study. For now, people need to know about this potential risk, especially given tobacco companies' past record of intentionally - and secretly - making their tobacco products more addictive.

As for which coolants are being used in the Vuse Go "Icy Flavors," Dr. Strongin's lab identified only one so far, and that is a synthetic compound known as Wilkinson Sword 23, or WS23 for short. This chemical was in every one of the Vuse Go products and also in the Elf Bar.

Scientific publications by researchers in other labs have already documented addiction-enhancing chemicals in many vape products, but some of these papers don't list the brands and the chemicals that are used, instead anonymizing them with terms like "Brand A."

Neither the FDA nor the industry is sharing this information. I've started collecting it into what will eventually be a large table to match devices with the chemicals that make them potentially more addictive, so I can eventually share that information with my students and with the public.

For now, I merely warn students that many flavorings are actually chemicals that can potentially harm their brain, and can potentially make the painful feeling of addiction stronger.

These results come from a single sample for each type of device we tested, so we cannot be sure that they accurately represent what is in all similar devices from each brand. But since pyrazines, acetates, and menthol increase the potential for addiction, I found their consistent presence in our tiny sample disturbing.

We plan, of course, to continue to test vapes from Vermont and continue to publish which brands are selling vapes with chemicals that potentially enhance how addictive they are.

* * *

I know that the students I talk to are going to hear a lot of false information about nicotine, flavors, and harms after I leave the classroom.

Tobacco and vaping companies pay for some of the research that is published on flavors, though some journals refuse to print their "science."

According to an article in Preventive Medicine by Charlotta Pisinger and her colleagues, "Almost all papers with no conflict of interest found that e-cigarettes had a potentially harmful effect on health, while <8% of studies performed by the tobacco industry reported potential harm." That's an astonishingly strong impact of the conflict of influence.

I show one slide from this article to children, which makes a picture of this fact about the science that they can trust versus supposed science that they cannot.

And I ask them if they understand what the graph means, and most of them do.

"They are lying," one student said.

* * *

Some people talk about how legislation that is designed to fight this epidemic of youth nicotine addiction infringes on the freedom for adults to purchase flavored vapes.

But arguments about freedom leave out how the companies, by selling nicotine products that use these flavors and other additives, get people painfully addicted to products they later want to stop using - but can't.

Corporations that mix the nicotine in cigarettes and vapes with these flavors offer painful chemical dependency, not freedom.

The FDA has attempted to ban flavors, including menthol, from vape products, and the agency says it is going to ban them from menthol cigarettes, but because of appeals and lawsuits, that hasn't come to pass - and maybe it never will.

That leaves state regulation. In Vermont, we made sending vapes in the mail illegal, because that is one way companies like Juul were getting their products to children.

In Vermont, the Attorney General's Office has collected large settlements from multiple online sellers that were selling vape products and sending them here.

That illegal behavior is still practiced by some bad apples, but the Vermont AGO has the power to tackle only that part of the problem because our legislators made such shipping illegal.

As a citizen of Vermont, I believe we need to give our AGO the power to go after any corporation that mixes menthol and other flavors with nicotine. That also goes for the synthetic coolants that allow people to suck the nicotine, along with other toxins, deeper into their lungs.

Then our AGO's office can continue to do the excellent work it has already achieved by stopping many internet sales to children.

We can make a mad world somewhat better, and we should try to do so.

This Voices Viewpoint was submitted to The Commons.

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