You Have To Be 21 To Smoke In Illinois. Will New Law Affect Teen Vaping?
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So now citizen states around the country are trying to clamp down on vaping by raising the minimum purchasing age for tobacco products from eighteen to twenty one will it work, and what did it entire generations worth of an anti tobacco campaigns? Teach us about affective ways to change teen behavior this hour on point tobacco Twenty-one and teen vaping. And you can join us. Are you a teenager who's tried e cigarettes? Are you will worried parent? What is your story will raising the e cigarette age twenty? One make any difference. And what do you think it will take to curb teen vaping? Join us anytime at on point radio dot org or Twitter and Facebook at on point radio now, Illinois just recently raised its tobacco age to twenty one. So let's listen for a moment to Illinois Governor Jay Pritzker who signed the legislation on Sunday here. He is announcing the rule change. This is about the health of our youth and the longevity of our shits. And if there are young people who will travel over state lines to buy tobacco products because they can legally buy them there than I urge the surrounding states to pass tobacco twenty one to Illinois. Governor Jay b Pritzker on Sunday. Joining us now from Chicago is doctor Julie Morita Commissioner for the city of Chicago's department of public health and under her leadership Chicago raise the age for purchasing cigarettes and e cigarettes tobacco products in general to Twenty-one back into. Thousand sixteen as you just heard the entire state of Illinois followed suit this past weekend. Dr Marito welcome to on point. Hi, mike. Thanks for hosting us. So first of all tell us tell us a little bit about what you saw in terms of changes in teen vaping rates in Chicago over the past couple of years that prompted you to to change the purchasing age back in two thousand sixteen. I think our approach for tobacco started before vaping. Even came onto the scene. We recognize that the best way to prevent problems with tobacco related disease was really trying to prevent young people from smoking. And so we implemented a number of different things starting from twenty thirteen. However when we did start seeing that e cigarettes and vaping was becoming a problem. We really did escalate our effort, and so we could see that the trend was rising rapidly. But more and more young people were experimenting with e cigarettes in vaping. And that the rise was really rapid that helped us really motivate others to move forward with instituting tobacco twenty one. And in two thousand sixteen. Jump in here because some of the numbers around tobacco use usage in teens in Chicago's quite remarkable. I mean, I I see that you've written that that Chicago has reduced cigarette. Smoking rates by high school students from a little over thirteen percent, which it was in two thousand eleven down to six percent today. D do you attribute that to raising the the the purchase age to twenty one? I think we know about tobacco youth on youth is that we make these products less affordable less accessible and less attractive to youth. They will be much less likely to purchase these products. And so two thousand thirteen we created a flavored tobacco ban around schools. So that schools couldn't sell mint flavor or candy flavored tobacco products within five hundred feet of high schools. We also increase the price of regular cigarettes by increasing the taxes, and then twenty four team we made Easter as part of our clean indoor act ordinance, which prevents people from these smoking around or inside of buildings, but then we often included these cigarettes in that in that that ban those kinds of efforts along with tobacco twenty one have contributed to the major reduction at least saw and young people smoking cigarette. But that's what we have. We have a reduction of high school students smoking cigarettes that doesn't necessarily reflect their activity as a relief that they being or juuling. Right. Because you say here in a piece that you wrote that e cigarette use by teens is in Chicago is at six point six percents so higher now now than cigarette use that was in two thousand seventeen minutes that time our percentage of kids smoking high school students smoking cigarettes was six percent. And those reported are admitted to vaping are using these cigarettes loose six point six percent. I know I suspect that the rates of young people using e cigarettes vaping is probably higher than that right now. Because it was just a massive explosion of youth. The manufacturers were unbelievably successful in marketing their products to young people, and that's reasonable. We see many many young people that are using these products and actually addicted actually addicted. Okay. So we're gonna talk a little later in the show about about exactly what's in these e cigarettes and why maybe teenage brains are more susceptible to addiction through them. But but have you what have you heard from parents from teachers? Around Chicago about how much more or if they are seeing more e cigarette usage amongst teens. I am appearance. In addition to being a public health official and a pediatrician and I have a sixteen year old who's in high school in Chicago public school. And so I talked to his peers and his peers parents and the teachers in his school, and I know that the juuling vaping is a major problem. And I it's it's it's not just limited to my son's school. When I talked to parents of kids that age and high school or even in middle school across the board. They are concerned about their children being exposed to being taking on the habit of Julie, and the potential health hazards that really poses. So I guess I heard you say a little earlier Morita that not only did did you raise the the purchasing age to twenty one in Chicago or the city of Chicago did that, but there were all these other efforts as well about play, you know, banning places where cigarettes or even e cigarettes could be used. But now, I'm I'm also wondering given what you just said about. The powerful marketing a vaping. And you know companies like jewel will say that they do not intentionally market to words to minors or teens one acknowledge that that's what you would say. But but it does more need to be done beyond the raising of the purchasing age. Definitely I think again, we increase the age of purchasing. We also prohibit the use of these products in the same places that regular other traditional tobacco products are can't be used. And then we also created a acquire moment for warning signs to be posted in retailers establishment. So that they actually put up signs that indicate that e cigarettes tobacco products are hazardous to health the tobacco industry spends billions of dollars to market their products. And though they may claim that they're not marking them toward youth some of these products, you don't create products that are candy flavored mint creme brulee flavored to appeal to adults, and that's really meant to be appealing to us. We don't have those kinds of budgets in the public sector. And so what we've done is we've required that retailers him the city of Chicago put up warning signs that really make it clear that these products are addictive and harmful to health. Well, Dr Julie Morita Commissioner for the Chicago department of public health. Breath and Chicago back in two thousand sixteen raised the purchasing age for tobacco to twenty one. And this hour, we're talking about the fact that a lot of states are following suit as well, Dr Morita thank you so much for joining us today. Thank you. Let's go straight to the phones. Matthew is calling from Richmond Virginia. Matthew, you're on the air. All right. Thanks for taking my call. I just wanted to express just a comment here. I wanted to speak just briefly on kind of how this affect raising the minimum age to twenty one per tobacco products because we pass a similar law here in Virginia. Just recently. I kind of wanted you to briefly discuss how it affects public health as a whole on the long term as well. Because many of the discussions I with my friends about this. They say, well, we're dope. We can make this choice. But they don't really understand how this benefit society of the whole long term. And I know that the pretty broad question. But I just wanted to express the importance of in see what you think about it. Hang a bit for. So you say when you have discussions with your friends. Do they do they use these cigarettes? Do you? Yes, I do rest assured making plans to quit. However, my I do have friends who use tobacco products e cigarettes cigarettes, and sells and some of them will argue a weakened into the military. We can do the lottery we can do all the thank and adult can do. But we shouldn't be able we can't buy tobacco products. If you're under twenty one, and I try to express them the health benefits, but you know, some people prefer their choice instead. Okay. Matthew from Richmond Virginia. Thank you so much for your call. So let's get an answer to Matthew's question about how does it affect the public health at large? Joining us now is Dr Suzanne ten ski. She is a professor of pediatrics at Dartmouth College. She's a tobacco control expert with more than seventeen years of experience, researching tobacco issues and products and council counselling youth who use those products. She's also the former chair of the American Association of pediatrics tobacco consortium, Dr tan ski welcome to on point. Hello, thank you. So. Much for having me. So we had that great coal asking sort of a big picture question about how does raising the tobacco age or purchasing H two twenty one. How does it affect the public health overall? Well, that's a really important issue. So cigarettes are a defective product that used as intended will kill half of the people who are long-term users. So from a public health standpoint stopping people from using tobacco and helping them to quit. Cigarettes is one of the best things. We can do we're going to lose four hundred and forty thousand people in the United States this year to tobacco related deaths. So yes adults can make their own decisions. But this is a product that would never have seen the light of day. If we put product restrictions on cigarettes. Back in the nineteen hundreds when cigarettes were created this is really a defective product. And really it shouldn't. It's not safe for anybody to use until does that seem logic though, apply for e cigarettes and for vaping it. It's an interesting question so cigarettes, again, if if cigarettes are comparison killing half of their long-term users. I don't really like that comparison, I really prefer the comparison to be healthy air, and if we're comparing e cigarettes to combusted tobacco cigarettes, they really are quite different. There are fewer fewer things that are in e cigarettes, but they are not without harm. And there is equal or higher amounts of nicotine in the various products. The products are really different from each other. And we'll get into that in a moment if we have time. So I can't say that one vape is another, and, but we have not gotten away from the ultra fine particles in some of the other byproducts that happen when you heat up the vape that is in them too. High temperatures things break down you have a different characteristic based on flavors based on. The nicotine and based on the the stuff that makes the what's called the humic dent and those things when they breakdown have harmful harmful characteristics, all by themselves. So Dr task you stand by here for moment because I do want to explore with you more when we come back from a break about exactly what's in cigarette versus a regular cigarette and the effects, especially that that might have on the teenage brain. So we're talking about the fact that more cities and states are trying to raise tobacco purchasing ages to twenty one in order to curb e cigarette use amongst teams. We'll be right back. This is on point. On point is supported by legalzoom who want you to know that if you wanna make twenty nineteen the year, you finally start a business or secure your family's future. Legalzoom can help with their network of independent attorneys. Licensed in all fifty states legalzoom can help you navigate your legal needs from wills and trusts to LLC's trademarks contract, reviews and more. And the best part is legalzoom is not a law firm. So they don't charge by the hour. More at legalzoom dot com slash point. Hey, it's a fear. Is Berg host of NPR's asking me another and this month, we're celebrating women in comedy and this week from the Netflix series Russian doll. We're joined by co creator, Leslie Hedlund and actor grittily. We challenged them to not one, but two games about real nesting dolls and fashionable food trends, listen and subscribe now. This is on point Meghna, Chuck rubarski. We are talking this hour about the increasing number of cities and states who are raising their tobacco purchasing age to twenty one impart to curb the rate of teen vaping in those cities and states one know what you think about teens and e cigarettes, and whether or not you experiencing that in your own life. If you have a teen who vapes. Or if you do it yourself, and if you think raising the tobacco purchasing age to twenty one is going to make a difference in the rising number of teens who were trying out e cigarettes, and let's listen to an ad from the FDA FDA's anti vaping campaign that launched just last fall on YouTube and other social media channels meeting teens where they are the ads depict nicotine spreading through teenagers bodies and disfiguring their faces. There's an epidemic spreading. Scientists say it can change your brain. It can release dangerous chemicals like from L to hide into your bloodstream. It can expose your lungs to a leeann which can cause irreversible damage. It's not a parasite not a virus. Not an infection. It's fading. An anti V being ad from the FDA. Well, how do these ads fall on teen ears Morgan Redford of NBC's today show spoke with a group of high school seniors last fall about why vaping appeals to them and to their classmates? You come for the coolness, but you stay for the buzz. Big thing is the fact that it's just not a cigarette. You know, we're taught from really young age about like not smoking cigarettes in the damage of cigarettes and stuff like that. That's from the NBC today show some teams teens talking to Morgan Radford, we're joined today by doctors, Suzanne tense key. She's a professor of pediatrics at Dartmouth College and former chair of the American Association of pediatrics tobacco consortium. Okay. Dr danske. I would really love for you to take a little further into exactly sort of what's in an e cigarette. And you said before the break that they're all little different. But you know, what effect does it have on teenage brains. So we're going to start narrating out with a little bit of science, and we're. Going to use the analogy of light bulbs. So your your night light is four watts. The light bulbs that are above your bathroom are sixty watts and when you're reading it's probably a hundred or hundred and fifty watts we have that same kind of array of of strengths of wattage of power with e cigarettes as well and the power, plus the nicotine concentration is where you get your nicotine delivery. So all e cigarettes are all vaping devices are not the same. So if we talk about jewel, which was mentioned earlier that's a fairly low watt device seven or eight watts, but it's very high nicotine concentration around fifty milligrams per milliliter. So it's a high nicotine delivery system with relatively low power can just see jewel itself says that one of their their vaping pods could have as much nicotine as an entire pack of cigarettes. That's correct. And and I have patients in young people who are vaping a whole pot today. And I point out. Hey, you know, that's like a whole pack of cigarettes and they're shocked. They really do. Appreciate how much nicotine they're actually getting and Julius is designed for rapid hit of nicotine to your brain. It. It's been been characterized and developed so that really mimics of a combusted tobacco cigarette. Which is what really gets the nicotine levels highest new brain. So these are the highest nicotine addiction potential, these are they hit your brain. They give you that buzz as you heard from the students from there to the NBA an NBC show. So that's what the kids are really seeing. And that's what they like. And that's what makes them feel good is that little bit of a buzz nicotine is a drug that does not make you high. You don't lose your sense of perception, it just gives it that little lift net little buzz. And so it's pleasant at what the problem with that is that it becomes a d be developed dependence, and that leads to to addiction, and you need that drug in your in your blood, and in your brain in order to feel well, and you feel really poor when you don't have that on board. And so it's this it's this vicious cycle that you need it. Otherwise, you don't feel good. For sex is the fall off also relatively quick because we you know, there's all there's always ended anecdotal stories. No that we're hearing about psalm teens who are very heavy ISA grit users like needing to have it a hit from their jewel every half an hour. Right. And again, the characteristics are different. Everyone's metabolism is a little bit different. And the way people vape is different. So so we've talked about Julia's one product. But then there's other products like the single likes kind of disposables or the rechargeable they have lower power, they have lower delivery. And so those have kind of really lower addiction potential because they don't carry that same kind of a buzz and with people who are using those modifiable ones where they can change the wattage so they can tune it down. So it's more like a like your night later. They can crank it way up. So it's like your task lighting, and that changes, the nicotine delivery and that change the characteristics of how it works in your brain. And in your body. So I can't say that any individual. I can't compare three people and say, you're gonna need more. In another one, and you're gonna need another hit in fifteen minutes or three hours because everyone is a little bit different. And that's really why this is a tough thing to tackle. Because if you told me you smoke a cigarette I have a pretty good idea of how much nicotine you're getting. But with these other devices, we need to know a lot more in order to know. How do we treat you? How do we approach you? How do we help you become a non nicotine user, and we're really stuck? Because there haven't been any studies yet. Yes, doctor says he the lemme ask you here is is nicotine regarding teens is nicotine addiction the primary concern here because jewel and other e cigarette companies would say and do say that that for adult smokers e cigarettes are a healthier option because of the lack all the other compounds and chemicals that come with smoking regular cigarettes because you know, you heard in that clip before the other thing that the teen said to NBC was I think the big thing is that it's just not a cigarette. We're taught from. Young age of not smoke cigarettes in the damage cigarettes, do and stuff like that. With the implication there that the teams are saying they don't believe that e cigarettes. Do do them any damage, and that's a big problem we're having so it took twenty to forty years for us to really figure out what harms come from combusted Abaco cigarettes. So back in the nineteen hundreds before the automatic cigarette rolling machines were created people didn't smoke cigarettes. And it was only once though as they became very mainstream and very popular that cigarettes took off and you saw this mirror of lung cancer about twenty to thirty years later that really mimicked the the the curve that you saw with people smoking additional cigarettes. And so it takes a long time for some of these harms to happen in our bodies. And yes, there are not all of the constituents that are present in cigarettes. But there's a lot of things in there that are of concern in particular. We know that there are metals that can come off the coils that's not healthy to breathe into your lungs. Our bodies were not evolved to metabolize propylene glycol or glycerin in our lungs. That's not how. How our lungs work and many of the some of the other things that are in vapes are alter fine particles, and in many of the products that they've looked at the amount of Oltra find particles that are in electronic cigarette. Vapour are the same as in combusted tobacco cigarettes. You can't see these older fine particles. You can see smoke you can see aerosol. But these are things that are that are even smaller and can cross your lung tissue directly and go into your bloodstream, and cause inflammation. And we think that the inflammation is really what's driving heart attacks and strokes. And so we may not be any better off for his heart attack and stroke standpoint by people using vape as compared to combat the tobacco cigarettes, and that would be really harmful. Okay. So Dr Danske, you can imagine we have a lot of callers. Join us Limoges bring a couple of in here. Let's go to Jim who's calling from Omaha Nebraska. Jim you're on the air. Meghna my son vapes. And he aids right in front of us. So I think he really has no concept of the fact that it's bad or that it's harmful to your health or that it's like cigarettes. Thanks, jim. Don't go away to sit get how how do you feel that? He does it right in front of you. I guess he's twenty one. He's an adult. I think he's going to do it regardless. So what we say? And so I mean does it difficult situation. Okay. Well, I mean, but you you, you know, your son pro may be better than he knows himself. I mean it in the past. What is it taken taken to change his behavior when he was doing stuff that maybe you didn't think was good for him? He's been doing it for two three years without us knowing about it. And now that he's older. I just think we don't really have the ability to change his behavior now that he's older. Okay. Well, Jim thank you so much for your call. Let's hear from as land is calling from Arlington, Massachusetts, you're on the air. Hello. Thank you so much for having me. I love your show and to show today. It's so personal my wife, and I we switched over from from cigarettes to jewel about four years ago. And it was honestly the best thing we did. Because you know, they are right. There is much less less product in jeweled and regular cigarettes, and health wise, we feel so much better. But but it's so annoying. Every time I reached for it. I mean, it is I think a little more victim cigarettes just trying to quit both. It's much harder to quit. Ju I feel like, but I think what we need to do is to make uncall-. You know what I hate about? It is not the health, but the financial, you know, drawbacks from it. We we spent about three fifty a month for Joel products. And you know, that's four thousand five thousand a year we could be going towards vacations and other stuff that normal people are supposed to do. But you know, if we got to change with the marketing young. Yeah as length. Thank you so much for your call. Okay. Dr Taskey just respond to it. As and said he he switched over from cigarettes thinking, it would be healthier. Maybe he feels better. But now he's spending four thousand dollars a year on his jewel. So how what what do we know about what it would would take to end the the nicotine addiction that comes through some of these e cigarettes? Well, first of all, let me say, congratulations. I'm so glad that you were able to get off combustive tobacco because that's a huge savor of your life already. And now the next task is going to be too. See how we can get you off of jewel and off of these vaping nicotine products. And the we don't as I said, we don't have a lot of evidence as to what's the best approach because they're such variability. And because we we don't have a lot of studies that are really driving us towards a single answer. But we do know that nicotine replacement products, which are FDA approved. They are clean products. They do not have any breakdown products from being heated to high temperature. There is no metal. There's no carcinogens. They are the safest form of nicotine that we that we know about. And so I would suggest that that using switching to a form of nicotine replacement therapy to try to wean yourself off of jewel would probably be a good approach or just try cutting back on on your jewel usage. It's going to be a process because these products do have high nicotine in them, and you are likely very fizzy physically as well as psychologically dependent on this product. So getting some good behavioral support is helpful. And there are a number of places. They quit lines will help people who are vaping. In addition the truth initiative, which is has been doing a lot of work on helping young people not take up and to quit both cigarettes and vaping products. They have an app that's called this is quitting. And they just released that a couple of months ago, specifically focusing on vaping. And in the absence of of anything else. Let's give that a try for folks who are trying to quit vaping. Dr tan skin wanted them were questioned about jewel specifically because we did we did reach out to them and asked a Representative from jewel to join us today they decline that. But they did offer. This sent us quite a lengthy statement. And it reads in part this is again from jewel, we strongly support raising the purchasing age for all tobacco products, including vapor products to twenty one and have been actively supporting legislation to do this in states across the country and at the federal level. The jewel statement goes on to say we cannot fulfill our mission to provide the world's one billion adult smokers with a true alternative to combustible cigarettes than. The number one cause of preventable death in this country. If youth use continues unabated, and then they talk again about how they support tobacco Twenty-one laws so about that those adult smokers there, I mean, this even from within the public health community. This is where some of the pushback comes that that they say we shouldn't be making it harder to to get access or by e cigarette products because they are helping a lot of adult smokers who may be wanna move towards towards quitting. Does raising the the the tobacco age to twenty one have an impact on that. If you've got I know nineteen or twenty year olds who may want to use e cigarettes to quit, the youth smoking that they started at younger ages. Well, we know that tobacco Twenty-one is very effective. So I think when you were talking with Dr Morita, I don't have to use the statistic, but the the number of initiative initiatives for cigarettes in Chicago decreased by thirty six percent over two thousand sixteen to two thousand seventeen this works, and what it really we're really. Works is in the fifteen to seventeen year olds if you get tobacco products in vaping products out of the high schools kids, don't initiate, the high school kids aren't hanging out with twenty one year olds. But they are hanging out with eighteen year olds an anecdotally. I have an eighteen year old son on his eighteen eighteenth birthday, his friends called and said will you buy me jewel? Thankfully, he said. No, he knows what I do. But this is this is a real problem. We do need to try to keep it out of the high schools the number of cigarettes that are purchased by nineteen eighteen nineteen twenty twenty one twenty year olds is about one percent of the total cigarettes in the United States. So it's a fraction of cigarettes that are sold to this population. If we keep it out of their out of their hands that will have a great impact on both initiation. And cessation if they can't get the products, they're not likely to use them. And with all cases, where they've been tobacco Twenty-one Twenty-one sales restriction that's been affective. So some have not included vaping. But again, if we're preventing both cigarettes and. Ups will be getting closer to keeping kids from having them. But isn't alcohol consumption, the most obvious example of why it doesn't really matter? What legal ages that if kids want to do it or sorry if teens want to do it. They're going to get their hands on it. They will. But every barrier we put in place as Dr Morita was was saying price matters. So taxation matters, a whole lot kids are very sensitive to pricing structure. So if we make it more expensive, there are less likely to use it if you make it harder for them to get it at the at a store at at a convenience store gas station, they're less likely to use it. These barriers actually make a big difference in uptake. And so every single step. We can take is going to help. And as was mentioned earlier. And I think we'll talk about next changing the advertising also matters making this not cool. We've done a great job changing the social norm around cigarettes, and we need to now change the social norm around vaping and make it not cool. So that these young people don't think that it's the next best thing because all we're doing is. Creating a new generation of people who are dependent on nicotine and teens were dependent on nicotine become adults who are dependent on nicotine, and we need to break that cycle. Well, we will we gotta take a break in a couple minutes. And when we come back from that break, we will talk about the advertising around it. But we've got some comments here coming in online. Jason Glaspie says it'll be as affective as all prohibition throughout history has been Jason implying that it will not be effective at all. Let's see what else. Do we see here? Frank. Barton says. Yes, teen smoking vaping is a problem. So is so is any smoking vaping wired tobacco products still sold at at all. And this interesting comment from Jamie Benn's ler who says does treating young adults more like children lead them to make more child is childish decisions Dr tan, what do you think about that one? I'm a pediatrician. I love kids there my population that that I I love the most. So I don't think that's true. And and really the adolescent brain is uniquely susceptible to. Nicotine addiction. So if we prevent and protect an adolescent brain from nicotine exposure until it's well in Gillette brain is well into its twenties, it's less likely to to have a lifetime addiction. So this isn't a this isn't a child thing this developmental brain structure issue. And so really protecting those brains is better and to the point of the of alcohol, we saw a lot fewer. We're seeing a lot fewer alcohol related traffic incidents. Once we raise the alcohol h twenty one that's undeniable. We'll Dr Susan tans ski professor of pediatrics at Dartmouth College damn by for just a second. We are talking about an increasing number of cities and states raising their tobacco purchasing age to twenty one in order to curb teen vaping rates. We'll be back. This is on point. Hey, it's here. And on the latest episode of how I built this. How Alice waters pioneered the farm-to-table movement and revolutionized American cuisine along the way check it out on how I built this from NPR. This is on point magnitude already. We're talking this hour about the fact that more cities and now states are raising their tobacco purchasing ages to Twenty-one impart to curb teen vaping rates and teen e cigarette smoking rates joined the sour by Dr Susan ten ski. She's a professor of pediatrics at Dartmouth College in a former chair of the American Association of pediatrics tobacco consortium Golota comments coming in online here. MD Vecchio says my friend was a smoker and used vaping to dial down his nicotine delivery until it was next to nothing, then he stopped altogether. Thus vaping helped him quit smoking. USA Celt said says why are there? No vaping advocates on well, USA Celt. We did ask jewel. They are the dominant company in this market right now to join us, and they declined but offered a statement again. I'll just read a part of it saying that they strongly support tobacco Twenty-one initiatives in states and also at the federal level. But again. Declined. However, let's go to Ed who's calling from Ithaca New York edged you're on the air. Hello, thanks for taking my call. I smoked for fifteen almost twenty years pack and a half a day. My wife is well, we both switched vaping. And it's helped my life for mendaciously. I just want to point to the Royal College of physicians who say that e cigarettes are safer alternative almost ninety eight percent to smoking combustible tobacco. And I I agree that we should do something about the age underage vaping as a problem, but the Vilnai's vaping into ban flavors. I don't think is the right way. I think as a vape ING community all the advertising, the, you know cartoon like logos. And, you know, advertising something as specifically candy flavored is a problem, and we could do more. But I think the FDA needs to do to work more with the vaping community. So that we can come up with better guidelines for how these things should be marketed rather than to just villain is the entire, Ed. Thank you so much for your call. So let me bring Ryan Kennedy into the conversation. Now Ryan joins us from Baltimore Maryland. He's a professor of public health. At Johns Hopkins, Bloomberg school of public health. His reach research focuses on tobacco control in the US and internationally including health warnings cessation support and advertising as well. So professor Ryan Kennedy. Welcome to you. Hello magna. Okay. So you just heard our caller they're saying that he thinks the vaping community overall getting a bad rap now. And that there are better ways of working with the community to take serious efforts on curbing teen e cigarette use usage rates, where do you think about that? Now, it's always been a hard pass the walk here. We are getting more and more evidence to suggest that e cigarettes or other bay vaping devices are helpful for some people to transition away from combustibles of. We want the evidence that they can transition completely not remain. What we call a dual user. So dialing down a little bit of your smoking. But still smoking several cigarettes a day as the devices have become more mature more sophisticated. They seem to be doing a better job the ability for a device like jewel to deliver nicotine to an adult smoker. Like, we heard earlier the nicotine blood cousin traction can mirror or even exceed that of a cigarette with an experience user. So we have this device that seems to hold promise. It's certainly not safe. It's not something that I'm naive nicotine user should initiate on. But we're we're really challenged in. How we mesh message very clearly to young people just the the relative danger of these devices, we had the analogy earlier of the light bulbs. The forward the sixty one it's almost like that with tobacco products as well. When we measure by constituent buy constituent there. Are different levels of risk e cigarettes, not risk-free. They're quite dangerous. And and like, Dr ten ski was saying there's probably things we just don't know about the health effects, given the longevity of the disease manifestation. Right. So so help us understand than this core question. I mean, we're looking at the raising of the tobacco purchasing Asia Twenty-one and whether or not that's affective in curbing team e cigarette usage, but we do have a generation of advertising surrounding reducing teen cigarette or tobacco use more broadly. So there's a great amount of data here that we can we can look to to figure out what works so what does work in changing team behavior, regarding smoking or tobacco. Sure. So the the what we've learned from public health is that we typically need a very comprehensive approach we need to be using all the tools that are available to us. And that includes things like restricting marketing that includes things. Like ages purchase it includes taxes. It includes things like product regulation. We we probably should require any ISA grit manufacturer to allow consumers to purchase products that have different levels of nicotine different concentrations to help those that couple that we heard that switch. But now they want to get off. How do we do that? There's probably a role in terms of how we design these products as well jewel has been a really interesting rise for us to watch in public health, and as a product there are aspects of its design that are just so appealing to young people. It's a small kids can hide them in their hand. They're easy to share. They don't make a mess. It's not like a cigarette where you have asked and things like that the kids would have to contend with. We can probably use levers to require specific design considerations to make them in to quote, one of the callers, less cool. And so but. But then you'd have to you'd have to ask jewel to change a core aspect of their product. I mean that seems to be a lot of people would see that as as government overreach. It might be or if they're being consistent with that. What they say in that they're trying to target to adults and adult that's really motivated to quit using combustibles should be motivated to try a product that is going to work not one that's gonna be, you know, indigo blue. Well, I I wanna talk more specifically. So that's the the the design itself the industrial design of a jewel pod to begin with. But I want to explore advertising a little more here. Because one of the things that people talk about is how even though companies like jewel say they are not directly advertising through social media to teens. Nevertheless, there's a lot of I guess I don't want to say celebration. But but e- cigarette usage in social media. So how does that is there a place there? To to to curb its appeal to teenagers, right? The the marketing field has expanded with the expansion of of social media. And we're now facing sort of is about how to begin to regulate some of this content in similar ways what we've witness with drills and other manufacturers is a real mastery of the use of internet sort of the the people that influence others. They're actually called internet influencers. So if you're an individual on Instagram, and you have one hundred thousand followers companies could pay you to promote their product to use their product to post pictures of your product, and what what we've seen happen. Is this incredible boom of sort of a hashtag promotion of products where influencers might be the first out of the gate to introduce their followers to a product or product features. And then users and other even young people on the internet. Will pick up and create their own hashtags. And in a sense do all the marketing for a company keying into sort of basic branding principles. Well, you're sorry. Ryan to forgive me for interrupting there, but on this point about marketing, I just want to go to a caller really quickly. John is calling from Baltimore Maryland, John, you're on the air. Do you see a lot of ads or marketing for e cigarettes or vaping? Hey, thanks for having me. Actually, he pretty much nailed it. I I really even when I was a lot younger what I was like eighteen I I have not seen a single after vaping everything that I see is my friend that that are VP next to me for stuff on social media where people are are blowing like huge clouds, and that looks impressive. And I think that makes people want to eight more. So do you think the, you know, if we if we wanna curve teenage e cigarette uses that we ought to focus on social media, or are there other places that you would look. I I mean, I think he should focus on the media people book on how cool it looks. And the other is extremely important is the eight shops that are selling them to underage people. You know, that aren't karting and just giving it to you know, for goes in there. Well, John thank you so much for your call. Dr tan ski this has come up a couple of times that it looks cool. Right. I mean, Ryan Kennedy was just saying even this the design of a jewel itself looks cool. That's exactly the same thing that people used to say about cigarette smoking, right? It was it looked cool like movie stars were doing here. So how do we how do we change that to message that maybe it might look cool, but it isn't cool to do. Sure. An an actually if you look at some of the vaping advertising that's been out. They really took some lessons directly from big tobacco's playbook, and you look back, and you can see really mirrors of old ads in the fifties. And sixties kind of coming up again with some vaping ads. And I'm surprised that the previous caller said he hasn't seen ads because I've definitely seen them. They've been on the Super Bowl. So. So there are ads that are now on television tobacco ads been banned from TV since nineteen seventy and now there are vaping out. So there are vaping ads out there. They're in magazines there in print, they are all over social media. It's difficult to tell if something is a social media social influence, or that's been paid by an industry or is this just word of mouth, and you really can't tell the difference between those. So I completely agree. It's important for us to make these less cool, and it is going to take some peer influencers to change that conversation either in the high school, or in college is just where the young people are making this less attractive. Well, I wanna play an anti-smoking. Ed anti-smoking cigarette smoking, Ed four television made by the CDC. This is from two thousand twelve and you're going to hear someone named Harry offering tips on getting ready in the morning after Terry had throat cancer, which caused her to have allergic to me and lose her teeth in her hair. And I you. I wanna to give you head getting ready in the morning loan, noon me. And me. And made the mine. Two thousand twelve anti-smoking television ad from the CDC Ryan Kennedy do ads like that work for teens. I mean that one's kind of when I guess to designed to scare you about the effects of cigarette smoking detains get that message or they're better ways to to reach them. What we've learned in public health messaging is basically what works for an adult will work for a teen. Sometimes when we get to segmented, we're really run the risk of speaking down to the audience. Teens like to consider themselves as very sophisticated. I think something like that. With Terry obvious in marketing different messages are going to appeal to different people at different times, but her series of PSA's were super powerful and very personal. And she was very brave, and I think regardless of your age, you can appreciate that. By the way, Dr tan ski actually I'm gonna take a slight tangent here because we're getting a lot of questions about second hand smoke and vaping an e cigarettes. Is that an issue? It is a, but it's difficult to measure because again, the the changes the difference in the product characteristics. There are some vapes. As as actually Ryan was just mentioning where you have a huge, actually, the guest was signals these huge plumes, and there's a tremendous amount of aerosol that comes off of them. And when you have some of those large plumes with lots of aerosol, they do deposit more kind of particulates into a space, and in in vaping competitions and in in various locations. They've tested the air quality. And vape can make the air quality harmful, and it violates the kind of public health standards for air quality. So yes, it does introduce particular into a space depending on the product it may not actually release as much nicotine as a traditional combustion tobacco cigarette. But we do know that the vape that comes off can actually trigger asthma it can trigger respiratory complaints. So so it's not benign by itself. Ryan Kennedy here someone a little earlier a census a message on Facebook. Chris Tucker says the real story the actual story is that ultra owns thirty five percent of jewel ultra is a huge company. And a believe the end of last year. They bought this thirty five percent stake in jul- for twelve point eight billion dollars in December. And just for folks who may not know of Altria, they actually also owned, for example, they have major stake in Heuser Bush and Philip Morris as well here. So how much of the story is that these these huge companies are moving into. The the cigarettes space if I could use that phrase. I think it's exactly the story. We we need to understand that every major close system e cigarette on the market today is owned by a major tobacco company JTI Altria British American Tobacco the each have either developed or purchased e cigarettes businesses and the witnessed what we're seeing in terms of the marketing strategies the positioning it's right out of their their play books from decades ago. This is this is really concerning the the stake and jewel from Altria that kind of an investment sets up jewel, very well to take their product globally, Dr Tennessee, what do you think about that? Ryan's dead on. This is this is really concerning. And there are some different laws that are present around the globe for for kind of concentration of nicotine. And so so it'll be interesting to see what happens as time goes on and how jewel and some of these other products will change the characteristics. So that they can abide by the laws in each of these countries where they probably want to expand their market share. So I'm to the point that they can change their products. They I'm sure they will change their products to change the market and get a global footprint room. Rent will Ryan Kennedy. We've got a minute left to go here. And I want to circle back to where we started about this idea of raising the purchasing age for tobacco products to twenty one. I mean, given how popular it's teams he cigarettes are increasingly becoming amongst teens. Do you think it's an effective step or just a first step? I think it's an important step. I think the the meme that the my kids shared with me this morning was why are there toilets and the drool room? I think we need to do what we can to get these products out of the schools the access to products from older kids is a known pathway if kids don't have those products, if we don't have the social norms created in those important settings for young people. We won't have people addicted to nicotine, well, Ryan Kennedy is a professor of public health. At Johns Hopkins, Bloomberg school of public health with us today from Baltimore professor, Ryan Kennedy. Thank you so much for joining us. Thank you, Dr Susan tan ski professor of pediatrics at Dartmouth College and former chair of the American Association of pediatrics tobacco consortium, Dr tan ski thank you so much. Thank you very much. Folks. You can always continue the conversation and get the point podcast at our website on point radio dot org. Also, follow us on Twitter and Facebook on point radio. Our program is produced by antebellum and Brian Hartson ski Eileen Amata Imada, Stefan Sonus Ellison poli James Ross and Alex Schroeder with help from Matt hoesch Alex Payne and Cindy Wertheim. Sydney. Sorry, Sydney, our executive producer Karen Shiffman. I'm Meghna Chuck regard. This is on point. On point is a production of W B U R, Boston and N P R. Support for on point comes from college fine using data to provide personalized college guidance admissions advisors help high school students apply to college based on their chances of getting accepted and receiving scholarship awards. More at college mine dot com and fracture, creating frame Lewis photo decor and Gibbs by printing digital photos directly on glass. A fracture is image. And mount in one available in this election of ready to display sizes. Learn more at fracture me dot com slash on point. I made a talk RA bardy coming up on the next point President Trump wants his allies, Stephen Moore and Herman Cain to join. 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