A Popular Product
The Tobacco Atlas Team is based in the United States, but we hail from all parts of the world and perhaps consequently, we tend to think about tobacco control from a decidedly global perspective. Recently, one of the liveliest topics in tobacco control has been about a specific e-cigarette brand that has become dominant in the US market, Juul.
Juul is a USB-stick sized e-cigarette that turns a highly-concentrated nicotine salt solution into an aerosol in a discreet manner. The device has soared in popularity in the United States, comprising more than half of e-cigarette sales in US convenience stores in 2018. The reasons for this commercial success may include its branding, design, nicotine delivery effectiveness, and the inconspicuous nature of the device. The company that developed Juul, Pax Labs, was not affiliated with any of the major international tobacco company though it sold one of its original products to Japan Tobacco. In 2017, Juul was spun off into an independent company from PAX Labs and to date remains independent from the large transnational tobacco companies. As its popularity has increased rapidly, concern has been raised by health groups in the US that widespread adolescent use of Juul is a potential public health disaster in the making.
Public Health’s Concern
E-CIGARETTE UPDATE: Today, @American_Heart joined five leading public health and medical organizations urging the US Food and Drug Administration to take strong and immediate action to address the dramatic rise in teen use of Juul e-cigarettes: https://t.co/HGXBKs0RqN pic.twitter.com/S0O1WFCAeR
— American Heart Advocacy (@AmHeartAdvocacy) April 18, 2018
Exact figures of just how many teens are using Juul vary, but numbers are probably similar to those using combusted cigarettes, if not a little higher. The reason that health groups are worried about Juul use is that the product is only available in high concentrations of nicotine, which may be causing some teens to develop nicotine addictions. To make matters worse, many teens appear to believe that Juul does not contain nicotine. The same survey suggested teens seem to consume the product because they think it is a bit rebellious to do so and/or contains flavorings they enjoy.
If some portion of those teens migrate to smoking who otherwise would not have done so in Juul’s absence, then we would be observing the much-discussed but difficult to identify “gateway effect” between e-cigarette and cigarettes that so many in the public health world fear.
Juul has Global Ambitions
Job postings have appeared on Juul’s employment webpage indicating that the company intends to grow beyond the borders of the United States, as any ambitious company does. They indicate they are planning to open an office and base a team in London that will seek to expand sales into countries in Europe, the Middle East, and Africa which allow the sales of nicotine-containing e-cigarettes.
Juul arrived in Israel in May 2018 and by June sales appeared to have been banned. The company’s first foray outside of US borders ended in acrimony. Consultations between the company and the government prior to the start of sales appear not to have taken place. The Health Minister balked at the idea of introducing a product with three times the legal maximum limit of nicotine permitted in the European Union. Instead, legislation was introduced by the government that will steer the unregulated e-cigarette sector in the country towards the rules of the European Union, known as the Tobacco Products Directive.
#JUUL WARNS IT WILL FIGHT #ISRAEL OVER POTENTIAL E-CIG BANhttps://t.co/l1KDFa11Df#publichealth #harmreduction #reducedrisk #stopsmoking #smokefree #vapingsaveslives #vapefamily #vapecommunity #quitsmoking #vapeon #vapelife #ecig #ejuice #eliquid #smokeless pic.twitter.com/j62rXqPmxE
— HealthCabin (@HealthCabin) June 15, 2018
Within the countries of the EU, we do know that Juul will have to reformulate its products which contain a liquid 5% nicotine concentration in the US, to comply with the European Union Tobacco Products Directive’s requirement that e-liquids contain no more than 2% nicotine. Outside of the EU, they may not have to reformulate. Whether Juul will be able to successfully sell its product in the EU with that nicotine concentration cap is an open question, and one that policymakers ought to pay attention to. Notably, no combustible tobacco product sold in the EU is subject to a nicotine concentration limit. This is an interesting policy decision by the EU because though Juul may be attractive and addictive, the preponderance of research suggests that using e-cigarettes is less harmful than using combustibles.
Policy Implications of Juul
Juul’s popularity in the US has led health groups to cry out for regulation of the product. The company has taken steps to address some of regulators’ concerns, for example, by selling e-liquid in a tamper-proof child-safe disposable pod which prevents unwanted contact with, or consumption of, the liquid inside. The issue of its nicotine content, however, is complex. The product provides as much nicotine as a pack of cigarettes in a pod that is claimed to last for a day of use. On one hand, this is a feature of the product as the company implicitly suggests that it helps smokers to quit cigarettes more effectively, while on the other, it may addict never-tobacco users—especially youth—more effectively. Further, the issue of its social marketing strategy suggests that youth are one of its target audiences, not as much the adult smoking population.
Policymakers should find ways to keep all tobacco products out of the hands of minors by raising excise taxes on tobacco products to make them less affordable and by raising the minimum age of sale. However, if raising taxes causes the prices of significantly less harmful tobacco products to increase to the point that it increases demand for combusted products, then the net public health could turn out to be negative.
By Alex Liber
Photo Source: Wikimedia Foundation