Health Policy Brief – Avivas E-Portfolio

To: President Donald Trump

From: Aviva Massihesraelian

Date: January 20, 2020

Re: Banning E-cigarette Advertisements

Statement of Issue:

Use of E-cigarettes has skyrocketed over the past few years, especially in youth, and is now reaching “epidemic proportions,” according to the FDA. In 2017, 11% of high schoolers had used E-cigarettes in the past 30 days, but by 2018, that number had risen to 21%, and by 2019, it rose even more to 27.5% (1). The use of advertisements encouraging people to use E-cigarettes has added to this increase in E-cigarette use. According to the CDC, in 2016, about 69% of US middle and high school students were exposed to at least one form of E-cigarette advertising, including in stores, on the internet, in magazines, and on TV (2, 10). Furthermore, according to another study, teenagers exposed to E-cigarette ads are twice as likely to smoke E-cigarettes within the next few years (3).

Most E-Cigarettes Contain Nicotine and other Toxic Substances. Nicotine is extremely addictive, and can affect brain development of adolescents, even into their late 20’s, which is why it is particularly harmful for teenagers. E-cigarettes also contain cancer-containing particles, heavy metals like tin and lead, small particles that can be inhaled deep into the lungs, and chemical flavorings that are linked to severe lung disease (4).
Smoking E-Cigarettes Could Lead to Smoking Regular Cigarettes. According to a study, US teenagers are 4 times more likely to try cigarettes if they previously used E-cigarettes, and it is estimated that 22% of new cigarette use is caused by E-cigarette use (1). Additionally, another study showed that more frequent E-cigarette use was correlated with more frequent cigarette use later on in the study (5).
People are dying from E-cigarettes! The extent of the danger of E-cigarettes is not yet fully known. Until recently, E-cigarettes were advertised as a “safer alternative” to traditional cigarettes, since they contain less toxins. However, new evidence is proving that this may not necessarily be the case. Between June and August, there were reports of 193 vaping-related illnesses across the US, mostly in adolescents, and a few deaths were reported as well (3, 6). Other studies show that E-cigarettes could have potential negative effects on cardiovascular health, can be toxic to cells, and may even cause some forms of cancer (lung and bladder) (1).
E-Cigarette Advertisements are Increasing the Usage of E-cigarettes in Adolescents. E-cigarette advertisements generally contain content that appeals to youth, such as emotional appeals and animation (7). As stated above, almost 70% of adolescents are exposed to E-cigarette advertisements (2, 10), and this exposure causes a 2 times greater chance that they will smoke E-cigarettes (3).
Traditional Cigarette Advertisements are Banned from TV and Radio, but No Such Ban Currently Exists for E-Cigarette Advertisements. In 1969, under President Nixon, Congress passed the Public Health Cigarette Smoking Act, which banned cigarette advertising on television and radio (8). However, this law does not take into account E-Cigarette advertising, and E-cigarette companies are taking advantage of this advertising opportunity. Juul Labs, a major E-cigarette market, recently launched a $10 million TV advertisement campaign titled “make the switch,” which has influenced many adolescents to use E-cigarettes (9). 9.6 million youth have been exposed to E-cigarette advertisements through TV (12).

Key Stakeholders

Advertisement Companies– advertisement companies will want these products to be advertised because they will get more business if the E-cigarette companies pay to advertise their products through these companies. Thus, they will most likely be against a ban on advertisements.
E-Cigarette Companies- E-cigarette companies, such as JUUL, will want these products to be advertised because advertising leads to more people using their products (as demonstrated above), and if more people use their products, they will get more business. Thus, they will be against the ban (9).
Public Health Organizations- organizations such as Truth Initiative, a non-profit tobacco control organization, are against E-cigarette advertisements as they are encouraging and increasing the use of e-cigarettes, which contain nicotine and are dangerous towards health (1).
The Food and Drug Administration- the FDA regulates the sale of tobacco and e-cigarettes, especially to youth. It also is launching advertisements against E-cigarettes. Thus, it would be against advertisements which encourage E-cigarette use (11).

Policy Options:

Ban the advertisement of E-Cigarettes from TV, radio, magazines, internet, and stores. Just like advertising tobacco is banned, E-cigarette advertisements should also not be allowed.

– Advantages: This would guarantee a decrease in use of E-cigarettes, particularly in adolescents who are more susceptible to advertising.

–Disadvantages: It could weaken business for E-cigarette manufacturing companies as well as companies who advertise E-cigarettes. Also, as long as E-cigarettes are still being sold, youth can gain access to them regardless of whether they encounter advertising about them, especially if they do not understand the dangers associated with E-cigarette usage.

Regulate advertisement of E-cigarettes that have a large youth appeal or youth reach from stores, TV, online, and in magazines. This could include not using themes that appeal to youth, like themes of romance, freedom and rebellion, and not endorsing celebrities or making health claims (2). In addition, regulations could require that stores do not place advertisements at children’s eyes level, require age verification to enter websites with E-cigarette ads as well as those which sell E-cigarettes, and only advertise E-cigarettes within adult TV shows and magazines (12).

–Advantages: This would decrease the appeal for youth, who may be convinced by these advertisements to try E-cigarettes, just because of the social pressure and because it is the “cool” thing to do. Thus, it would limit the spread of E-cigarette usage in adolescents, without completely eliminating the E-cigarette advertising industry. Furthermore, it would still remain an option for adults who want to quit smoking classic cigarettes and are searching for an alternative.

–Disadvantages: Even if these advertisements are not targeted as much to adolescents, they may still be affected and influenced by them if they see them. Moreover, putting them “out of reach” will not really block adolescents from accessing them, and it might even intrigue them more to try them if they feel like they are accessing something which they are not supposed to access. Even more so, since there is no concrete evidence that E-cigarettes are safer than traditional cigarettes, advertising them this way, even to adults, is not such a safe option.

Educate youth about the dangers associated with smoking E-Cigarettes. There should be mandatory education programs in schools to educate adolescents about the dangers of E-cigarette smoking.

– Advantages: Youth could make the choice to not use E-cigarettes themselves, and they might be more likely to stick with it if they remember the dangers. Additionally, if it is delivered effectively, this could convince adolescents who already use E-cigarettes to quit, once they understand all the harms associated with what they are doing.

–Disadvantages: It might not be effective for all adolescents- some are more easily influenced by marketing tactics and social norms than by any real hard facts they will hear. Thus, many are still bound to be convinced by these ads to smoke E-cigarettes, regardless of hearing about all the dangers. Even more so, this might backfire, because some teenagers might be more intrigued to try E-cigarettes after hearing more about them.

Policy Recommendation:

The most effective form of lowering the increasing usage of E-cigarettes in adolescents would be to juxtapose the elimination of E-cigarette advertisements with teen education on the dangers posed by E-cigarettes. An alarmingly large percentage of adolescent interest in E-cigarettes is due to lack of education and awareness. If teenagers are unaware of the harmful and dangerous consequences of their actions, then they will have no reason to resist this enticing concept of so publicized “safe” smoking. Furthermore, even with proper education, advertisements have proven to nevertheless be an alluring culprit of public health issues such as E-cigarette usage. While an immediate, effective elimination of E-cigarette advertisements may seem outrageous, a gradual decrease in their presence appears much more likely. Removal of all E-cigarette advertisements should be demanded to conclude no later than a one-year deadline. This gradual reduction coupled with the appropriate education will guarantee decreased adolescent usage of E-cigarettes, hopefully combatting this rapidly growing “epidemic.”

References:

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