Blame Anti-Tobacco Advocates for Youth Vaping “Epidemic”

Like most teenage crazes, youth interest in e-cigarettes once seemed a passing fad. In the early years youth vaping skyrocketed, but by 2016 began to plummet. Teens remained uninterested in e-cigarettes in 2017. But, the following year, something suddenly rekindled their interest. In 2018 the number of high school students who vaped jumped by 78 percent. According to the results of this year’s national survey, released this month, that number only increased in 2019. The question is: what renewed adolescents’ interest in e-cigarettes and what can policymakers do about it?

Anti-vaping advocates blame e-cigarette companies for targeting youth with “kid friendly” flavors and say more restrictions and bans will curtail youth vaping. They’re wrong on both counts. It wasn’t e-cigarette makers that made vaping appealing to teenagers: it was anti-vaping advocates. 

Just as adolescent interest in e-cigarettes waned around 2015, anti-tobacco groups in and outside of government launched a barrage of media campaigns aimed at youth. Their intent was to discourage young people from using e-cigarette use, but the ads showing young people communicated the idea that vaping was widespread, rebellious, and cool. 

• One 2015 ad from the California Department of Public Health (CDPH), showed eight images of young people vaping in the 30 second spot.
• A 2016 ad from CDPH showed adolescents vaping along with statements that kids who vape “tend to be more popular,” that they do “cool tricks,” and that “if you don’t vape you’re looked at as an outsider.”

• A 2016 spot titled “Don’t Get Hacked” made by the Food and Drug Administration (FDA) mimics the style and feel of a slasher film, implying that teenager vapers shown skateboarding, bowling, and with friends at a diner are engaged in dangerous behavior. One video aired in 2018 pits images of sweet-faced infants eating strawberries and cereal against what is meant to look like a self-made video by an obviously underage boy (likely an actor hired by CDPH) reviewing a “pebbles donuts” flavored e-cigarette: “It’s like donuts and cereal…no burn or anything, this is so good.”
• The Centers for Disease Control (CDC) ran warning ads as early as 2015 portraying e-cigarettes as a dangerous gateway for youth smoking and an ineffective smoking cessation tool. CDC also teamed up with local health departments to fund dubious advertising.
• The Truth Initiative used puppets and YouTube stars to message to kids. One ad featured a rapper vaping a Juul-like device as he records a song about how annoying it is to maintain his vaping habit. In another, particularly embarrassing entry meant to look like a GWAR-style heavy metal music video, Truth conjures the supposed environmental impact of e-cigarette waste to deter youth vaping.

The common theme running through these advertisements and repeated in countless media headlines, was the idea that—as Gottlieb announced—teen vaping is an epidemic and that while all their friends might be using e-cigarettes, they shouldn’t. You don’t need a degree in child psychology to realize that message was doomed to backfire.

Nobody likes being told what they can’t do, especially teenagers. Adolescence is defined by a growing desire for independence and frustration with authority. Freedom becomes highly prized, and any threat to that can spur resistance and a desire to re-assert autonomy. In other words, teens will do the exact opposite of what they’re told just to prove they can.

Psychologists call this phenomenon “psychological reactance” and it’s particularly potent in teenagers. Accidentally triggering reactance is among the reasons well-meaning public health campaigns, like anti-smoking ads and anti-smoking policies, anti-drug education programs, warnings to drink responsibly, and even anti-littering campaigns, backfire and cause more smoking, more drug use, more drinking, and more littering.

Those initiatives focused on the message they wanted to send, not the message people might take away. For example, showing a behavior—even in a negative light—can make it seem attractive or socially acceptable. Marketing against a product, just like ads for a product, increases awareness of its existence, making people more likely to try it.

Explicit content warnings, for example, have been shown to entice young people, while anti-drug campaigns, like the “My Anti-Drug Initiative,” increased young peoples’ stated intention to smoke marijuana. If the goal is to discourage behaviors, the worst message a public service announcement could send is that “everyone is doing it.”

Analysis of 2018 survey data demonstrated that while more high school students reported vaping once in the last month, most of this was experimentation—infrequent use unlikely to lead to dependence. Of those who did report vaping frequently (20 or more days in the last month) only about half a percent were not already tobacco users; meaning that for more than 99 percent of the high school who were vaping were likely being diverted away from far more deadly forms of nicotine consumption.

But even before that information was publicly available, Scott Gottlieb (former commissioner of the FDA) declared youth vaping an “epidemic.” Days later, the FDA unveiled its “Epidemic Campaign” accompanied by a commercial titled “Vaping Is an Epidemic.” Since then, the message that all the teens are vaping has been repeated in press releases, news reports, and marketing materials aimed at teenagers.  

The constant scare-mongering convinced many, understandably, that “something” needed to be done and lawmakers across the country scrambled to look like they were the ones doing that something. As of December 2019, eighteen states have raised the minimum age limit for tobacco sales to 21. San Francisco banned all e-cigarette sales (though combustible cigarettes remain fully legal). And billions of dollars—government and private—have been allocated for anti-vaping marketing campaigns aimed at adolescents. Yet teen vaping has increased.

While the 2019 National Youth Tobacco Survey shows that teen smoking has continued to decline sharply, and is now lower than ever, past-month use of e-cigarettes increased concurrent with talk of the youth vaping “epidemic.” This has only compelled those who view any form of nicotine consumption as immoral, even if it might displace a deadlier version, to demand stricter regulations, outright bans on products, and more funding for anti-vaping programs. Lost in this moral panic is why teens experiment with e-cigarettes.

The data from the 2019 survey provide a possible answer. When asked why they used e-cigarettes, the number one reason—by far—adolescents provided was curiosity. It wasn’t Juul, which removed all but three flavors from retail and halted all social media promotion last November, who reignited teens’ interest. It was the well-funded anti-vaping advocates who repeatedly told teens that everyone around them is vaping and made e-cigarettes rebellious and cool again. If anyone is to blame for the recent rise in youth vaping, it’s the anti-vaping industry.