San Francisco voted Tuesday to ban the sale of e-cigarettes that do not have FDA approval, a legislative first for a major U.S. city. The FDA specification is effectively moot, observes The Verge, as no e-cigarettes (which are touted as tobacco cigarette alternatives) currently bear FDA approval.
Though pending executive signature, Mayor London Breed’s public statements voicing concern over the rise of teen vaping suggest she will put the bill into law. (Beverly Hills voted to ban the sale of cigarettes, chewing tobacco, and e-cigarettes earlier this month, leaving hotels as the only legal sellers of cigarettes in the city.) San Francisco is also the site of the country’s leading e-cigarette producer, Juul Labs.
Juul spoke out against the legislation, arguing that criminalizing e-cigarettes would “create a thriving black market” and encourage a return to “deadly cigarettes,” as reported by the Washington Post. Cigarette sales are still legal in San Francisco.
City leaders, for their part, remain unfazed by Juul’s admonitions and have even been openly hostile toward the company. As board of supervisors member Shamann Walton told the New York Times, “I would not lose any sleep at all if Juul left. I would help them pack up.”
Sales of Juul products jumped more than 600 percent within one year, says a 2018 letter from the Centers for Disease Control and Prevention, citing an increase of 2.2 million products sold in 2016 to 16.2 million sold in 2017. In December, the privately held company, then valued at $38 billion, sold 35 percent of its stake to Marlboro manufacturer Altria, allegedly seeking overseas investment to boot. In June, Juul bought a 29-floor skyscraper at 123 Mission Street in a record-breaking deal, effectively making Juul the only San Francisco company not in real estate to make such a massive real estate purchase to date. The building is estimated at $400 million. Juul told Business Insider a month earlier that its staff had ballooned from 200 to 2,000 employees within the past year. Most of Juul’s employees work in San Francisco.
The FDA has characterized teen use of e-cigarettes as an “epidemic,” highlighting Juul as a chief culprit. In 2018 the government agency mandated that Juul Labs and other manufacturers “submit important documents to better understand the reportedly high rates of youth use and the particular youth appeal of their products.” The FDA issued instructions for seeking government approval ahead of San Francisco’s decision. As the Verge reports, the FDA will look at e-cigarettes’ marketing and ingredients, plus whether e-cigarettes affect the likelihood that tobacco users will quit smoking and the likelihood that nonsmokers will smoke.
So do e-cigarettes put teens at greater risk for picking up cigarettes? According to an investigation earlier this year out of Boston University in collaboration with the University of Louisville and USC, e-cigarette use can in fact “initiate” cigarette use, as the study puts it. Last year, the University of Michigan found among 10th and 12th grade students surveyed about vaping, “the largest year-to-year increase in substance use ever recorded in the US.” The New York Times reports on an advisory from the US Surgeon General of a 78 percent increase in high school students’ use of e-cigarettes, but adds that only occasional use marked the majority of teen vaping.
Juul, for its part, insists that teens are not its demographic. In a statement to the Atlantic, the company wrote, “We do not want non-nicotine users to buy JUUL products and that is why our marketing is aimed at adult smokers age 35 and up.” As the Atlantic reports, Juul’s ads attempt to follow this directive, even going so far as to list the ages of their spokespeople. Anti-smoking activists and e-cigarette enthusiasts share a common enemy, argues Juul’s marketing: cigarettes. Their mission reads that they aim to, “Improve the lives of the world’s one billion adult smokers by eliminating cigarettes.”
The purported risks of e-cigarettes suggested by some scientists are not universally recognized. As BBC News reports, the UK’s National Health Service recommends e-cigarettes to help people quit smoking. When people vape, they’re consuming nicotine, not tobacco — the latter, says the UK government, is 95 percent more harmful than nicotine, which is not carcinogenic, and arguably useful in getting smokers off tobacco. Advocates of e-cigarettes compare them to nicotine gum and patches.
There’s no data, however, on the long-term effects of e-cigarettes. University of California San Francisco professor of tobacco control Stanton Glantz tells the New York Times that e-cigarettes may not be as safe as other experts believe. In an editorial for the Journal of the American Medical Association published in March, Glantz writes that e-cigarettes may increase risk of heart attack, stroke, and respiratory disease, perhaps because of the “toxicants” that e-cigarettes’ aerosol delivery introduces. To put it more succinctly, look to Glantz’s paper from last December: “Using e-cigs increases exposure to toxic chemicals for most users; they would be better off just smoking.”
On a global scale, BBC News reports that, according to the World Health Organization, estimates on e-cigarette users increased from 7 million to 35 million in five years. Meanwhile, the decrease in smokers worldwide has dropped subtly over the past 20 years, from 1.14 billion in 2000 to 1.1 billion last year.
While the debate on e-cigarettes’ safety and utility rages on among anti-tobacco activists, e-cigarette producers, scientists, and legislators, e-cigarette users in San Francisco will soon need to change their habits. Whether they’ll quit altogether or shop outside their city remains to be seen. As the New York Times includes in its coverage, some argue that the e-cigarette ban may disproportionately affect low-income smokers seeking another option. In the absence of e-cigarettes, they, and others, may just smoke.
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