Growing up, I fondly remember the excitement over Baskin-Robbins' “31 flavors.” The slogan originated in 1953 and was a big deal at the time because it was unusual for an ice cream shop to have so many flavor options. Oh how times have changed. In 2019, consumers are now accustomed to and expect variety and instant gratification thanks to programs like Amazon Prime, where you can get a plethora of items delivered to your door the same day.

E-cigarettes are no exception.

Background

By now, most people are familiar with the term JUUL (for those of you who are unfamiliar, no that is not a typo, and I am not referring to a precious stone). The JUUL was introduced to the market in June 2015 as an e-cigarette., see “PAX Labs Introduces Revolutionary Technologies with Powerful E-Cigarette JUUL,” BusinessWire (2015). According to its press release, the JUUL was initially touted as an “alternative smoking product that delivers a nicotine experience truly akin to a cigarette, with two times the nicotine strength and three times the vapor quality of leading competitive products.” Despite there being a multitude of e-cigarettes on the market today, JUUL seems to get the most attention. What is most attractive about e-cigarettes like the JUUL is that they come in a variety of flavors and are widely accessible, drawing in JUUL's most common user, the young adult. As of the writing of this article, the JUUL website sells eight flavors and offer the option for auto-ship, which would have the product delivered regularly on a cycle. By way of example, an on-demand convenience delivery service, goPuff, can have a JUUL starter kit or pack of “pods” (the name for a JUUL cartridge) delivered to your door in mere minutes. However, the similarities between Baskin-Robbins and JUUL stop at the variety each brand offers. Unfortunately, JUUL's e-cigarettes carry far more risks than Baskin-Robbins' ice cream.

Risks Associated With E-Cigarettes

By way of background, the surgeon general suggests that e-cigarettes are the most commonly used tobacco products among youth, with the majority of young adult users between 18-24 years of age, see “E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General,” U.S. Dept. of Health and Human Services (2016). In 2014, the Centers for Disease Control and Prevention (CDC) reported that more than a quarter million youth who had previously never smoked a cigarette had begun to use e-cigarettes in 2013, which is three times greater than those reported in 2011, see  Rimer, Sara, “Behind the Vapor,” Boston University Research. Research shows that the risks of e-cigarettes are directed primarily toward youth.

A recent study found that 2,039 Californians, ages 16 to 20 who used e-cigarettes between 2015 to 2017 advanced to using traditional cigarettes, which are more dangerous, see Dubar, Michael S., “Disentangling Within—and Between—Person Effects of Shared Risk Factors on E-Cigarette and Cigarette Use Trajectories From Late Adolescence to Young Adulthood,” Nicotine & Tobacco Research (Oct. 2, 2018). Electronic cigarettes are a path to nicotine addiction for youth, see Chen, Angus, “Teenagers Embrace JUUL, Saying It's Discreet Enough to Vape in Class,” NPR (Dec. 4, 2017). This is likely due to the fact that about 60 percent of teenagers are unaware that this device contains nicotine—the highly addictive chemical that causes damage to brain development, among other serious health problems, Preidt, Robert, “Many Teens Don't Know Juul Contains Addictive Nicotine,” U.S. News (April 18, 2018).

In addition to being a pathway to increased nicotine intake, e-cigarettes contain more toxins from the flavor additives in e-liquids. What makes e-cigarettes, like the JUUL, so attractive is actually one its biggest risks—studies show that the direct additives in flavorings found in e-liquids have been proven harmful if inhaled. The American Lung Association has highlighted Diacetyl, the chemical used to flavor e-liquids in the cartridges of e-cigarettes, as a chemical responsible for causing serious lung problems. Given Diacetyl's harm, the chemical was banned from being used to flavor popcorn in 2007 and the U.K. banned the use of Diacetyl in e-cigarette liquid in 2016. When inhaled, Diacetyl causes bronchiolitis obliterans—more commonly referred to as “popcorn lung”—a scarring of the tiny air sacs in the lungs resulting in the thickening and narrowing of the airways. This is a serious lung disease that causes coughing, wheezing and shortness of breath, similar to the symptoms of chronic obstructive pulmonary disease (COPD). Acrylonitrile, another compound often found in fruit flavorings favored by adolescents, is also highly poisonous and also used in the manufacturing of plastics, adhesives and synthetic rubber, according to the National Center for Biotechnology Information. Both Eugenol, a compound found in a flavor like clove oil and cinnamaldehyde, a compound found in a cinnamon-like flavorings, have also been linked to the development of asthma. Such findings about compounds contained in common flavor additives show e-cigarettes, even without nicotine, are not entirely safe.

Perhaps what is most disturbing is the unknown as research could reveal even more health risks associated with e-cigarettes as time wanes on. As with many “revolutionary” products, only time will tell as to how impending medical research or the legal implications will affect the e-cigarette market.

Emily B. Ashe is an associate in Anapol Weiss' mass tort department. She concentrates her practice on defective medical devices and pharmaceutical drug cases.