Winner of the Fall 2019 StMU History Media Award for

Best Article in the Category of “Public Health & Medicine”

Within recent years, many college students have discovered a “healthier” alternative to smoking: e-Cigarettes. Although e-cigarettes have been around since the early 2000s, they seem to have evolved over time. Almost twenty years after their conception, new e-cigarette products now provide the desired effects with less effort, come in various styles, and include many different flavors. The modernized product has become increasingly popular in recent years among teenagers and young adults. While college students are among the majority of consumers of these products, a surprising number of high school and middle school students are using (and abusing) this product as well.¹

Adam Hergenreder is one of many adolescents who fell under the influence of vaping. Adam, an eighteen-year-old high school student from Gurnee, Illinois, was an active athlete on the varsity wrestling team. He began vaping at sixteen years old, and, at that time, Adam claimed he was unaware that e-cigarette devices contained nicotine and assumed the product was simply safe to smoke. In an interview, Adam stated that the initial reason he started vaping was to simply fit in with his friends, as everyone else was doing it too. Aside from peer influence, Adam also claimed he was drawn to electronic cigarettes by the various flavors offered to enhance his smoking experience. Adam reported to the interviewer that, “It didn’t taste like a cigarette. It tasted good and it gave a little head high.”² Along with the appealing flavors, Adam claimed that the product was rather easy to obtain: he bought vaping products for his Juul from a local gas station, and when he approached the retailer to purchase the items, they did not ask for his identification to verify that he was of age.³

While e-cigarettes have become an increasingly popular trend for youth across the United States, their rising influence has been followed by an increase in injury among those who use them. To put it bluntly, vaping has become an epidemic among underage teenagers. State and federal health officials are investigating over 100 cases of mysterious lung injuries that have been linked to vaping, and many of these cases involve teens and young adults.⁴

But what is it about vaping that so intrigues young adults and teens? The answer is quite simple: peer influence plays a critical role in a young person’s decision making. A snowball effect begins when one teen out of the group picks up the habit, typically from a parent or older sibling, and then encourages his or her friends to give it a try as well.⁵ As the number of teens who vape grows, the more common it becomes, which makes serious health conditions appear generally less harmful. If everyone is doing it, then what’s the worst that can happen, right? Wrong. Young teens are not aware of the circumstances that come with smoking and have little to no understanding of nicotine’s addictive qualities. Eventually, as smoking habits intensify, young teens often begin to experiment with the use of other drugs and combine them with vaping products.⁶

Each month, about 10 million adults vape nicotine without any reported injuries. However, it is commonly observed that the primary products behind lung damage are vape products that contain Tetrahydrocannabinol (THC), which is the chemical responsible for marijuana’s psychological effects on the mind.⁷ Continued and heavy THC use has been directly associated with a wide range of negative health effects and is highly addictive.⁸

Aside from added ingredients, we can thank advanced technology for the high concentration of nicotine in e-cigarettes compared to traditional cigarettes. In fact, a single JUUL pod is equivalent to an entire pack of cigarettes.⁹ If the nicotine and peer pressure are not enough to sell the product to young consumers, the added variety of flavors assists in heightening the smoking experience, misguiding teens into thinking that e-cigarettes are harm free. To make matters worse, because the average JUUL pen resembles the size and shape of a flash drive, high school students can easily keep their vaping devices on them 24 hours a day, which makes them perfectly capable of smoking an entire pod in a single day. The end result of these combined pressures is a nicotine addict in the making.

Adam’s mother, Polly Hergenreder, shared with a local reporter that Adam would always be smoking his Juul. He would reportedly smoke it several times throughout the day and would go through a pod and a half daily, which is roughly equivalent to a pack of cigarettes a day. At this point, Adam had become addicted to the act. He eventually grew tired of vaping over-the-counter e-liquids and decided to experiment with Tetrahydrocannabinol (THC), which is the primary ingredient used in marijuana, in order to add the psychoactive component to his vaping experience in an attempt to get high. This is where Adam’s health began to fail him. He started suffering from physical symptoms and developed constant shivers, a high fever, and began throwing up non-stop for three days straight. After several days of this, he was admitted into the hospital and was there for six days, connected to IVs and wearing nasal tubes that provided oxygen to his starved lungs. While Polly Hergenreder described Adam as a very healthy and a “typical eighteen-year-old boy,” she also described her experience with her son to be “every parent’s worst nightmare.” Even after receiving medical treatment to stop nausea, it continued, and the doctors were puzzled at what triggered these symptoms. After consulting several physicians, one doctor finally linked it to smoking e-cigarettes and using THC.¹⁰

Adam had bought the THC through a drug dealer who was a complete stranger off the streets. When the reporter asked Adam if he thought that was dumb, Adam responded, “Yeah. When you’re addicted like that, I don’t think that goes through your mind.” The doctors saw the full damage done to his lungs after taking X-rays of his chest and informed his mother that if she had not taken Adam to the hospital as soon as she did, his lungs could have collapsed and he could have died. The doctors told Adam that he now had the lungs of a seventy-year-old, and that they would never return to normal. Now, Adam struggles with everyday tasks and activities, such as going up a flight of stairs. While some of his conditions are improving, he may never fully recover.¹¹

The initial purpose of electronic cigarettes was to provide a less harmful device that could reduce the number of adults who smoked tobacco cigarettes. In this regard, they have succeeded: e-cigs have proven to be a somewhat better alternative to traditional tobacco smoking for adult smokers. Young teens who have no prior nicotine addiction, however, were not the initial target audience. As a result, they should not be using vaping products.¹²

While electronic cigarettes are advertised to be harmless, there have been many hazards associated with the accidental ingestion of the fluids and chemicals, and controversy over the high concentration of nicotine that they offer. The U.S. Food and Drug Administration (FDA) currently only regulates e-cigarettes that are sold for therapeutic purposes, which contradicts the overwhelming number of consumers who are utilizing these devices for recreational means. Because e-cigarettes meet the legal definition of a tobacco product, the FDA is proposing a new rule that enables tobacco retailers to categorize e-cigarettes as a tobacco product.¹³ Due to a critical lack of research on the potential health effects of exposure to aerosolized vapors or the ingredients and chemicals found in the flavorings, researchers do not currently have a full understanding of the long-term effects of e-cigarettes. Ironically, the device made to help make a positive change in the lives of smokers has circled back around, and now endangers the lives of those who had no prior smoking experience.

Aside from the unknown long-term effects of vaping, there are other factors involved in the product that is undoubtedly detrimental to a young person’s cognitive development and overall health. One of the biggest factors to take into consideration is nicotine. Nicotine is a psychoactive and addictive drug that is the main component of all tobacco products, including e-cigarettes. In fact, the highest use of tobacco products among high school students is through e-cigarette products. Between the years of 2011 and 2015, the prevalence of high school students who used e-cigarettes rose from 1.5% to 16%, and a major factor that has helped inflate the number of young consumers is the deceitfully advertised lack of risk associated with e-cigarettes. However, the use of tobacco products causes long-term diseases, disability, and death. It increases an individual’s chances of getting lung cancer, heart disease, chronic lung diseases, strokes, among many other health issues. However, all these possible illnesses are preventable.¹⁴

Adam, discontent with the outcome of his smoking habits, decided to take matters into his own hands. He filed a lawsuit against the Juul Company, along with a gas station in Waukegan where he purchased his vaping products illegally. The residents of Illinois must be twenty-one or older to purchase tobacco products. Adam, among many other teens in the US, has taken up the habit of vaping while being unaware and uninformed of its content. Adam recognized this, and claimed that most teens lack the understanding of the e-cigarette’s main ingredient: nicotine, and its addictive qualities.¹⁵

The lawsuit alleges that Juul was guilty of deceptive advertising tactics in order to attract young consumers, which has resulted in a widespread addiction to nicotine and has increased their sales of vaping products that contain highly concentrated amounts of nicotine as well as other chemicals that offer potential health risks. The lawsuit claimed that the Juul company utilized attractive models smoking the product to lure the “next generation of nicotine addicts” into buying their product. Adam’s attorney states that he did not stand a chance against becoming addicted. The lawsuit also claimed that JUUL sought to fill the void left from failing tobacco companies by creating a modernized e-cigarette, one so addictive that it has caused a record increase in substance use by adolescents in the United States.¹⁶

Adam is not the only teen to fight against Juul. Many attorneys across the country are scrutinizing the company for the accusation of false advertisement that was intended to lure young teens. However, a spokesperson for the company combats all accusations: “Our product has always been intended to be a viable alternative for the one billion current adult smokers in the world…We have never marketed to youth and do not want any non-nicotine users to try our products.”¹⁷ Another attorney, Antonio Romanucci, disputes this claim made by the spokesperson by stating that the JUUL company advertised at events that attracted a younger audience, such as Lollapalooza. Attorneys like Romanucci claim that for kids like Adam, JUUL e-cigarettes are made out to be simple and cool products.¹⁸

In addition to the lawsuit filed against one of the nation’s largest e-cigarette makers, Hergenreder also pursued a lawsuit against Gas Stop, a gas station located in Waukegan Ilinois. Retailers of this gas station were accused of feeding into the underage consumers, and the lawsuit against them claimed that Adam Hergenreder was never asked for his identification when purchasing vape products.¹⁹

All who use this product should be thoroughly informed of its potential risks. There is a crucial need for increased regulation so that these products do not continue to fall into the hands of young teens who misunderstand the seriousness of drug use. Laws regarding the prohibition of cigarette and other tobacco product sales to minors remain varied, un-unified, and inconsistent, making it easy for teens and tobacco retailers to take the situation relatively lightly. It wasn’t until 2009 that President Obama signed an Act that gave the FDA oversight over tobacco products, and this law also banned deceptive marketing practices by the tobacco industry that included keywords that deceived consumers of the pack’s content, such as “low” or “mild.”²⁰ While this was effective in terms of traditional cigarettes, the more modern dilemma of e-cigarettes must be readdressed in order for the population to see a positive change in the regulation policies nationwide.

One of the most common brands among all e-cigarettes is JUUL, which controls nearly 75% of the e-cigarette market and is the brand most affiliated with the newest generation of smokers. JUUL is known for developing a nicotine-dispensing product that is even more addictive than traditional cigarettes. Nicotine is a dangerous drug, which damages the brain by affecting its development and cognition while raising the risk of potential addiction to other drugs. JUULs innovative nicotine delivery system is the reason why so many teens get hooked on the pen so quickly and have a constant craving for the next hit off of their pen, and has created a new generation of young addicts.²¹

The invention of the e-cigarette has created new challenges for the prevention of drug use. Teens are now more capable than ever to participate in the recreational use of drugs and are misinformed about the harm being done to their bodies through false advertisements. Advertisements significantly influence young adults and have caused e-cigarette sales to increase rapidly among teens from 2011 to 2014. Over the past few years, advertisements have evolved to reach and appeal to a younger audience, and have become increasingly persistent in their presence and influence.²²

Adam Hergenreder admitted to using both nicotine and THC; however, he claims that the majority of his time spent vaping was only with the use of nicotine. Adam regrets his decision to start vaping immensely and urges anyone who is vaping to quit. He suggests that anyone who is considering trying e-cigarettes should take a moment to evaluate their decisions and to educate themselves about the JUUL product first. While Adam is continuously feeling better, he still is facing many challenges imposed upon him from his addiction. Because of the damage that has already been done, Adam is unsure of what his health will be like fifteen years from today.²³

The American Vaping Association claims that it is the black-market THC products that are to blame for these illnesses and not the nicotine. However, vaping is a gateway to drug addiction, considering the high concentration of nicotine present within the vaping products. Teens who are easily influenced are vulnerable to the persuasion of false advertisements of tobacco products and are highly likely to spiral down the drain of addiction.²⁴ As we continue to advance in this new age of technology, the influence of social media has become increasingly powerful. Teens who thrive off the approval of their friends and peers feel they have no choice but to follow the most current trends and are now at risk of drug addiction. E-cigarettes have been around for some time, but are more recently becoming an issue of public health. It is important that those who have heard Adam’s story consider the seriousness of this issue, and take preventative measures to avoid creating an epidemic of a new generation of drug-addicted youth.