Behind the Vaping Epidemic: The Art of Deceptive Marketing

By Alicia Kline, MS, CPS, and Marcia Goodman-Hinnershitz, MSW

Words. Are. Powerful. Words provide the vessel for our communication with the world. Words help to formulate and articulate our perceptions of the world. Therefore, the intentional selection of words to provoke specific thoughts or feelings, becomes a very powerful weapon towards manipulating desired behaviors or the motivation to engage in certain behaviors. Unfortunately, words often create unrealistic, untrue, and misguided understanding of our environment. Choosing the correct words persuades consumers to ignore science. Choosing the correct words builds billion-dollar companies and can maintain a public health crisis for almost 100 years.

The tobacco industry, selling its deadly addictive products, has mastered the art of using words through marketing manipulation and advertisements. Before the ban on cigarette advertisements on television, tobacco companies marketed cigarettes during Saturday morning cartoon shows. Winston created an advertisement using the popular youth cartoon characters the Flintstones, suggesting that smoking helps you to relax and have fun. In the late 1980s, Camel introduced their cartoon mascot, Joe Camel. Joe Camel was cool, and you could earn cool Joe Camel merchandise by collecting points off a box of cigarettes. During this time, Marlboro also began their “miles” program where smokers could earn miles from each pack of cigarettes they purchased and convert those miles into merchandise. Tobacco companies offered coupons, to help with the growing price of cigarette taxes1

Surprisingly, the battle between science and tobacco dates to the 1600s. Many countries banned its use and even churches have excommunicated anyone caught smoking in holy places. In 1912, American physician Isaac

Adler wrote the first comprehensive research study on the correlation between smoking and lung disease. By the time the United States Surgeon General Luther L. Terry released the Surgeon General’s Advisory Report on Smoking and Health in 1964, over 7,000 articles were published related to smoking and lung disease2. Despite releasing 34 additional reports over the last 50 years including thousands of scientific studies, cigarette smoking remains the leading cause of preventable death in the United States. Nearly 500,000 Americans die each year from lung related-diseases due to smoking and while tobacco use continues to decline each year, over 30 million American continue to smoke. Why? Why do people start or continue to use tobacco products? People use tobacco products for numerous reasons, and we cannot suggest or list every reason for their use. However, we can examine the extensive role the influence of tobacco marketing strategies played as a significant reason for tobacco use in the United States.

Simple magazine advertisements first appeared in the United States in 1798. Since those first advertisements, tobacco marketing developed into highly sophisticated marketing strategies that skillfully persuaded the public to continue using their products despite scientific evidence. During the infancy stages of lung disease research, when less than a third of physicians were convinced of the health risk associated with smoking, tobacco companies convinced doctors to appear in their advertising. Images of doctors smoking and endorsing the product help to create an illusion of safety in the public minds about using tobacco products3. As another tactic to confuse the public, Big Tobacco funded independent studies to manipulate and highlight specific data in a positive way.

Science continued to fight back. On January 11, 1964, Luther L. Terry, M.D., Surgeon General of the U.S. Public Health Service, released the first report of the Surgeon General’s Advisory Committee on Smoking and Health. The report concluded that cigarette smoking is:

• A cause of lung cancer and laryngeal cancer in men

• A probable cause of lung cancer in women

• The most important cause of chronic bronchitis

By the late 1960s, most physicians understood and supported current lung disease research and refused to endorse tobacco products. Furthermore, as scientific research expanded, Big Tobacco could no longer use the excuse that the evidence was inconclusive. Big Tobacco also faced several government regulations which removed all television and radio ads. However, tobacco companies adapted and shifted focus to print ads and created ads that made tobacco look young, sexy and fun. Phillip Morris pushed their Marlboro man ads, the ruggedly handsome cowboy that every man wanted to be, and every woman wanted to be with. Despite any regulations Big Tobacco always marketed their products to youth.

Berks County Secondary School Youth Tobacco and Vaping 30th day Use (Pennsylvania Youth Survey)

2015 2017 2019

History is repeating itself. Rates of youth smoking continue to decrease due to successful prevention efforts and enforcement of federal tobacco control regulations. However, the tobacco industry marketing practices targeting vulnerable youth has resulted in a new health epidemic.

A disturbing fact is that it required forty years of concentrated public health efforts, supported by the first Surgeon General’s report, before we started to see a decline in adult cigarette use. But Big Tobacco doesn’t stay down for long. There is too much profit from the sale of products containing addictive chemicals such as nicotine. With cigarette smoking on the decrease, the tobacco industry quickly regrouped and turned its energies to the promotion of other forms of nicotine delivery. In 2007, enter the electronic cigarette and vaping into the United States. Electronic cigarettes created a new and lucrative revenue stream for tobacco companies with unregulated products to market to the generation of technology-loving youth.

Electronic cigarettes emerged under the guise of a “harm reduction” strategy. The tobacco industry promoted electronic cigarettes as a “safer” alternative to smoking and thus created a marketing buzz that would seek to legitimize this product. The fact that vaping products contain addictive nicotine was never revealed. Thus a new means of the delivery of nicotine to unsuspecting consumers was born.

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The tobacco industry, with its previous successes in targeting youth, recognized that billions of dollars of new revenue could be realized from the youth vaping market. Therefore, the tobacco industry was not satisfied in directing its marketing solely to the adult consumer as an alternative to smoking. Rather the industry put in motion sophisticated marketing strategies directed at youth. Juul Labs, the maker of the most popular U.S. e-cigarette, launched its aggressive youth campaign in 2015. This campaign utilized social media influencers and launch events to glamorize vaping. While Juul Labs fervently denies its marketing campaigns target youth, the Federal Drug Administration, and academic researchers, such as the Stanford Research into the Impact of Tobacco Advertising, have found clear evidence of a JuuL-driven youth nicotine epidemic.

According to the National Youth Tobacco Survey (NYTS), the dramatic increase in high school e-cigarette use coincided with the JuuL marketing promotions. Youth use of this dangerous substance increased by 135% from 2017 to 2019 (from 11.7% to 27.5%)4. Researchers at the University of Michigan who conduct another national youth survey, the Monitoring the Future Study, found that the increase in youth nicotine vaping from 2017 to 2018 was the single largest one-year increase in youth use of any substance in the survey’s 43-year history5.

Public health studies have clearly demonstrated the dangerous and addictive chemicals contained in electronic cigarettes. Nicotine used during adolescence can harm the developing brain. Other chemicals found in electronic cigarettes, such as acrolein, can cause irreversible lung damage. As the most popular electronic cigarette used by youth, one JuuL pod contains as much nicotine as a pack of cigarettes. A JuuL pod contains nicotine salts that do not produce vapor or visible emissions. This cartridge-based delivery system may make the product more addictive than cigarettes6. Therefore, the promotion of electronic cigarettes by the tobacco industry as a safer alternative to cigarettes, is a misrepresentation of a far deadlier product.

The need for more stringent controls of electronic cigarettes by the Federal Drug Administration (FDA) is critical to the health and well-being of our youth. On Aug. 8, 2016, all e-cigarettes and other electronic nicotine delivery systems (ENDS) products became subject to the FDA’s tobacco authorities, including the premarket authorization requirements in the Federal Food, Drug, and Cosmetic Act (FD&C Act). All electronic cigarettes and other ENDS products on the market at that time needed to have authorization from the FDA to be legally marketed.

However, the actual enforcement of its regulations is at the discretion of the FDA. All ENDS products currently on the market can be considered illegally marketed since no products have been authorized by the FDA. Priority enforcement by the FDA is directed to the following:

• Any flavored, cartridge-based ENDS product (other than a tobacco or menthol-flavored ENDS product).

• All other ENDS products for which the manufacturer has failed to take (or is failing to take) adequate measures to prevent minors’ access; and

• Any ENDS product that is targeted to minors or likely to promote use of ENDS by minors7.

By setting these priorities, the FDA is responding to the public health concerns related to youth use of ENDS (vaping) products while not specifically countering the rationale of the tobacco industry that ENDS products assist addicted adult cigarette smokers in transitioning away from smoking. The FDA regulations represent an important step in curbing youth use of addictive vaping products. Any delays or inconsistencies in comprehensive enforcement of ENDS regulations could have catastrophic health impacts as more youth turn to vaping.

The tobacco industry’s marketing strategies and lobbying power with respect to electronic cigarettes provide a harrowing example of profit versus public health. For prevention advocates, taking on Big Tobacco is like David fighting Goliath but our dedication to protecting our communities and our youth provides the motivation to keep searching for the triumphant sling shot that takes down the giant. Empathy and understanding provide the foundation for developing effective strategies to attempt to end the youth vaping crisis. We must remove the blame we often place on youth for their decision making with respect to vaping. Rather, we must direct our efforts to address the impact of tobacco’s powerful marketing, advocate for comprehensive enforcement of government policies regarding the sale of vaping products, and most importantly, understand that nicotine addiction fuels the vaping epidemic. We must join together with our youth to find the “sling shot” needed to counter the dangerous and deadly strength of the “Goliath” tobacco industry.

Sources:

1 “The History of the Discovery of the Cigarette,” Tobacco Control 2012; 21:87-91.

2 Warning: Surgeon General Finds that Cigarette Smoking Is Even More Dangerous to Your Health | Blogs | CDC.

3 When Cigarette Companies Used Doctors to Push Smoking - HISTORY.

4 Wang, TW, et al., Tobacco Product Use and Associated Factors Among Middle and High School Students—United States, 2019, MMWR, 68(12): December 6, 2019, https://www.cdc.gov/mmwr/volumes/68/ss/pdfs/ss6812a1-H.pdf.

5 University of Michigan, Monitoring the Future Study, 2018. http://monitoringthefuture.org/data/18data/18drtbl3.pdf.

6 The Disturbing Focus Of JUUL’s Early Marketing Campaigns (forbes.com).

7 Enforcement Priorities for Electronic Nicotine Delivery System (ENDS) and Other Deemed Products on the Market Without Premarket Authorization | FDA.