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INTRODUCTION
While public perception of the tobacco industry has slowly deteriorated as social culture and research has condemned the consumption of their product, the new upstart e-cigarette industry is quickly taking its place without the same degree of public scrutiny. Specifically, this paper seeks to understand the ethical implications of the introduction of e-cigarettes, otherwise known as vaping products, to an isolated demographic: the youth market. Through our findings, we believe that the introduction of e-cigarettes to the youth market has ethical concerns due to its predatory marketing, societal trends and inherent health effects.
MARKETING TO YOUTH
E-cigarette usage almost doubled from 11% to 21% from 2017 to 20181 in 12th grade American students becoming the greatest increase in substance consumption in the history of the American National Adolescent Drug Trend survey. Other forms of tobacco consumption from this demographic either decreased or stayed the same, clearly indicating the prevalence of e-cigarettes as the preferred method of tobacco intake. Many e-cigarette companies advertise themselves as a healthier alternative to smoking with the leading e-cigarette company JUUL going as far as saying their mission statement is to improve the lives of the worlds one billion adult smokers and that their product is meant for adult smokers only 2 however their intentionally devious marketing techniques signal otherwise. The issue with framing their products as being healthier than cigarettes without mentioning other effects is that it is deceptively misleading youth to believe that they are overall safe and harmless.
With JUUL making up more than half of the e-cigarette market in America3 and becoming the fastest start-up to achieve a $10 billion valuation4 they serve as a representative proxy on how they and their competitors built this billion-dollar industry off the naivety of youth. The 2019 systematic study on JUULs promotional efforts by Stanford Universitys School of Medicine found that their advertising imagery in its first 6 months on the market was patently youth oriented 3. The study analyzed the companies Twitter, Facebook, Instagram and customer directed marketing emails and found that JUUL primarily used techniques to appeal to the youth demographic. The company leveraged the growth of social media to target the mediums most active users, the youth5 through a campaign known as organic social media marketing where social media influencers , people who have large followings on social media serve as promoters of the product. These influencers have been shown to be more effective in promoting products than traditional celebrities with 70% of teenagers saying they relate to influencers more than traditional celebrities and 60% stating they would purchase products recommended by influencers6. Studies have shown that social media exposure from e-cigarettes evoked positive impressions of smoking from youth7, indicating that JUULs promotional techniques were highly effective on this demographic. Furthermore, the study found that the company advertisements prominently featured sweet and fruity flavours , which could suggest that they were specifically promoting products that appeal to the younger generation. Regardless of the company’s intent, it has been proven8 that youth believe that flavoured e-cigarette liquids (similar to the ones marketed by JUUL) are targeted towards them rather than older adults contradicting claims made by the company.
JUUL advertised itself as a start-up seeking to disrupt the tobacco industry by helping save the lives of the adults addicted to cigarettes with their revolutionary sleek product. In reality, by marketing themselves as an adversary to big tobacco , and a champion of revolutionary change , they likely attracted the youth market to their product. JUULs advertising techniques drew a lot of inspiration from past tobacco marketing strategies9, making it likely that they were attempting to replicate big tobacco’s past success with the youth. While newspaper articles and billboards have been replaced with Facebook and Instagram posts, the intent of their promotion remains; to promote their product to the youth to groom their next generation of customers for years to come.
Although JUUL maintains that they dont market their products to the youth, their actions speak otherwise, with the majority of their incriminating social media history being wiped from the internet3. Their attempt to hide their wrongdoings along with their past promotional strategies provide close to irrefutable proof that their past actions had forceful intent and their demographic dominated by the youth10 was not created by accident. After all, if there was nothing wrong with their social media activity, why would they bother to wipe evidence?
One of the most prevalent reasons why corporations like JUUL were able to recreate the success they saw in tobacco products among youth is due to the lack of effective legislation upon introduction and the delay in updating laws. Existing legislation at the beginning were out-dated on the grounds that vaping products did not meet the existing definition of tobacco and it would take time and debate to classify the products. For example, the United States did not rule them as being treated as tobacco products until 2010 19. In Canada, the Tobacco and Vaping Products Act (TVPA) defines tobacco and vaping products separately, and vaping products have their own separate rules within the act 20. In particular, marketing is one of the legal areas where there were holes that paved the way for e-cigarettes. Just because an act is not explicitly illegal does not mean that it is ethical to do it, especially if laws change to assess it as illegal.
As at the time this report is written, Health Canada has proposed but not yet enacted additional limitations of e-cigarette marketing 21. Their four propositions are as outlined below. One major change is that Vaping product advertisements would not be permitted at any point of sale where youth is allowed access, including online 21. To capture even more advertising, there may also be a broader limit to prohibit vaping advertisements in any public areas available to youth, such as parks, malls, etc21. Heavy restrictions may be added to effectively prohibit broadcasting of commercials during youth programming across every channel 21. The last proposition is that entities are to be prohibited from digitally or physically promoting vaping in youth publications, including social media 21. As these propositions have not yet been implemented as at the time of this report, its clear that marketing regulation around e-cigarettes is significantly less restrictive from traditional tobacco, which has more bans on media and restrictions 22. In the past few years, the industry took advantage of these holes in Canadian laws by blasting vaping advertisements across broadcasted television, social media, and other media outlets 23. One article describes these advertisements as slick, edgy, glamorous and it can be easy to see that the industry is aggressively trying to rope in new consumers, including the youth 23.
With the youth marketing industry expanding more than 20 times between the 90s to 2000s11, it has become apparent that marketers are putting a strong emphasis on this demographic. Marketing to youth creates an ethical dilemma as it emphasizes the cognitive imbalance between adult marketers and the youth target. For marketing to be deemed as ethical, it must follow the power balance principle; that is the scale must not be tipped to favour the marketer nor the consumer12. In reality, this scale often favours the marketer given that their objective is to sell the product through any means possible. These power imbalance issues are further exacerbated by the advertising practises of the e-cigarette industry to the youth. JUUL specifically targeted social media mediums where youth would have no parental oversight, a strategy which is deemed unethical12 as the youth are unable to recognize the manipulation behind the advertising. By promoting their product with themes such as pleasure , relaxation , romance , and holidays 3, the e-cigarette industry preys on the developing cognitive abilities of the youth and leverages the spikes in dopamine levels to entice them to purchase their product.
With traditional tobacco companies being phased out in favour of e-cigarettes, there are striking parallels between the marketing of the products to the youth demographic. The ethical issues that traditional tobacco companies used to face are clearly re-emerging in the promotion of e-cigarettes. The rampant marketing of the product to the youth has led to an incredibly high uptake of e-cigarette consumption and has thus created a false positive notion of the product in society.
PUBLIC PERCEPTION AND SOCIETAL TRENDS
With the e-cigarette industrys use of predatory marketing in combination with poor youth education programs on the impacts of smoking to health, youths perception of e-cigarettes remains substantially at risk.
E-cigarettes have been proven to reduce the cigarette consumption of smokers without causing significant side effects as opposed to abruptly stopping13. As a result, the youth public perceives e-cigarettes as a healthier alternative to traditional tobacco use. Data from the 2012 National Youth Tobacco Survey, consisting of a sample size of around 25,000 students ranging from Grade 6-12, revealed that approximately one-third of students viewed e-cigarettes as less harmful than traditional cigarettes 14. Even among the more recent studies conducting analyses from 2015-2016, youths perceived e-cigarettes as the least harmful and addictive of tobacco products15. Youth perception of relative harm from cigarettes and e-cigarettes is heavily based on frequency and intensity of cigarette smoking. According to the 2012 National Youth Tobacco Survey, 88% of participants believed that daily use of 10 or more cigarettes was correlated with a large amount of cigarette-related harm, while only 30% responded that non-daily use was associated with the same amount of harm 14. These findings are highly concerning as low-dose cigarette consumption has been shown to substantially increase the risk of cardiovascular disease, cancer, and addiction potential 14. This perception of frequency and intensity being correlated with harm, in conjunction with the perception that e-cigarettes are less harmful than cigarettes, lead adolescents to be highly susceptible to e-cigarette/tobacco use.
Contrary to their image as a solution to tobacco addiction tobacco consumption for students in grade 12 increased from 23.7% to 28.5% between the years 2017 and 201816. This increase is a startling change from the anti-smoking trends in lawmaking and public perception and seems to indicate that smoking may be renormalizing amongst youth. Education and social progress had replaced the image of smoking and nicotine consumption being cool with an association with disease and addiction, but vaping has become seen as the new and exciting trend amongst youth. This could even potentially undermine the work done to reduce consumption of traditional cigarettes, as the younger generation becomes more accustomed to smoking.
To put in perspective the renormalization of vaping into society, we dont need to look much further than the classrooms of schools, which has become ground zero for JUUL adoption. Due to its indiscreet form factor and lack of visible smoke trail, students have been able to use the product in various public areas; areas where smoking cigarettes has become taboo. When high school staff members were polled about JUUL consumption, they found that 48% of them have heard or seen students using JUUL in the bathroom and 40% has had heard or seen them using them beside the building or in the parking lot30. The consumption of JUUL has become so rampant in schools across America, schools have began taking extreme measures to the point where a school in Arkansas has resorted to removing main entrance doors to student bathrooms to dissuade students from vaping inside of them. The normalization of using their JUUL product in washrooms has led to the youth calling their washrooms the JUUL room indicating how pervasive the product has become in youth culture31.
In a specific case in North Carolina, a young high school student who became intrigued by vaping as a hobby ended up getting addicted to the nicotine, which began to adversely affect his life (Cite). The young teen was attracted to JUUL due to its approachability, attributable to the variety of interesting flavours and lack of smoke being produced when used(cite). The flavours that could be added made smoking much more enjoyable than it would be with normal cigarettes, and the small device was easily concealable (cite). The popularity of this product amongst older students also drove this interest, as if vaping had earned credibility for its image as hip and trendy. In reality, the nicotine content made it similarly addictive and harmful, and this misperception ended with the teenager in rehab for substance abuse (cite). This is just one of the many cases where youth have been enchanted by e-cigarettes and roped into a slippery slope of addiction.
Evidently, the youth have been significantly affected by the societal craze over e-cigarettes with many of them being un-aware of its harmful effects, being fooled by public perception. Schools have become a breeding ground for e-cigarette users as students promote the product to each other leading to an environment where peer pressure leads to an uptake in consumption. This renormalization of e-cigarette consumption is especially concerning due to the well-studied negative health-effects and its addictive properties.
HEALTH EFFECTS AND ADDICTION
E-cigarettes have been a huge success with adolescents, especially with 12th grade students, showing an increase in vaping from 11% to 21% in 2017 to 20181. However, with e-cigarettes being a relatively new product, studies around the effects of e-cigarettes on health, particularly the cardiovascular system, are only an emerging area of research. As smoking has been a common practice for many years, the effects of nicotine on the body are already known. Nicotine has been known to increase adrenaline levels, heart rate, and blood pressure in the body, and many new studies findings have been suggesting that e-cigarettes could be bad for health17. In a recent 2019 study posted in the Journal of the American College of Cardiology18, researchers tested ho w blood vessel linings (endothelial cells) reacted when exposed to six different e-cigarette liquids (e-liquids) of varying flavors and nicotine levels. Their findings revealed that any exposure to any of these e-liquids would result in cells being damaged and accelerating a process called endothelial dysfunction which is a preceding symptom to cardiovascular disease. Additionally, the findings showed that the cinnamon-flavoured e-liquid, which could debatably be marketed for youth, produced the largest amount of cellular damage of all six e-liquids.
This is especially concerning because of the lack of regulation around nicotine. The addictive property of nicotine is what drags youth down the slippery slope of continued smoking, whether that be through tobacco or e-cigarettes 25. Within Canada and the U.S., one major issue with e-cigarettes and tobacco products is that there is currently no legal limit for the amount of nicotine allowed within them 26. This is especially concerning because more than a decade ago, tobacco companies were found guilty for purposely designing their products with high amounts of nicotine to foster addiction 27. In the trial, U.S. Judge Gladys Kesslers comments the following on their unethical practices, ‘profits from selling a highly addictive product which causes diseases that lead to a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss and a profound burden on our national health care system’ 27. Not surprisingly, some e-cigarettes have nicotine levels close to traditional cigarettes, with JUUL going as far as advertising that their e-cigarettes nicotine level is the same as cigarettes 28. To make matters worse, pre-mature use of nicotine at early ages alters a persons addiction threshold, thus making youth more susceptible to being addicted to other drugs 25. Overall, the industry has shown that without a restriction to stop them from doing so, they will manipulatively design their products to be addictive to the core.
The U.S. Food and Drug Administration (FDA) has recently proposed setting limits on nicotine, reducing it to 80 percent of its current levels 26. The FDA has calculated that this proposal could cause 5 million individuals to stop smoking cigarettes within the first year of the legislations implementation 26. However, this proposal applies to just traditional cigarettes 26. While this may be a step in the right direction, it may unintentionally push vaping further to youth to satisfy their nicotine desire 26. Overall, it may be wise to also consider setting nicotine limits on vape products, given their addictive nature, negative health effects and how the industrys manipulative practices impact youth.
CONCLUSION
While it is currently a popular product with many youth and adults, there are significant issues with the marketing, regulation, and effect on user health of e-cigarettes that strongly parallels that of the traditional cigarette industry. From a macro level, its interesting to see how quickly the youth have became accepting of the same sin-industry product; easily deceived by its new shiny packaging. Although they have been educated on the negative implications of consuming tobacco-based products, through the power of targeted marketing on an impressionable demographic, e-cigarette companies have been successful in creating a market in a space which before seemed dwindling with big tobacco . With JUUL being acquired by Altria, Americas preeminent cigarette company in 2018 for $12.8B, this is likely the first of many acquisitions done by big tobacco in the e-cigarette space 29. As more integration between the old and new occur, it becomes more and more likely that the up-start e-cigarette industry becomes a front for big-tobacco and allow them to continue with their unethical business practises. There is a reality where todays youth allows history to repeat itself and subject themselves to the harmful effects of tobacco; except this time through e-cigarettes. The growth of this new industry is a concern to the youth in society, and it is strongly advised that work continues to be done by lawmakers, researchers, and the general public with regards to e-cigarettes to prevent what happened with cigarette companies from happening again.
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