Vaping adds another risk in Appalachia

On June 23, the U.S. Food and Drug Administration (FDA) issued a marketing ban on Juul products, a popular brand of e-cigarette. With the prevalence of vaping and smoking in West Virginia, along with high rates of lung disease, experts are saying this could bring change to the state.

The ban states that not only must the company stop selling and marketing its products, but stores carrying them must stop their distribution. However, Juul is attempting to fight back in federal court, arguing that the FDA has overlooked data and therefore reported incorrect information on the products’ adverse health effects.

Juul also felt that it was being held to a different standard than other e-cigarette companies and said that the FDA’s motives are more political than in favor of public health.

Sunil Sharma, section chief of pulmonary/critical care and sleep medicine at the WVU School of Medicine, said in a press release from WVU, “Like other communities nationwide, Appalachia has been hit hard by the e-cigarette-vaping epidemic.

“However, compared to other regions, the Appalachian community has suffered more severe respiratory failure and worse outcomes,” he said. "We welcome this move by the FDA to ban Juul products and hope this translates to fewer of our children and young adults falling victim to this deadly habit.”

Mark Olfert, faculty member of the WVU Center for Inhalation Toxicology, was less optimistic, stating that Juul is only one of many brands in the United States, and other countries have outright banned vaping products.

“One can only hope that similar bans on other brands come soon as their products are reviewed by the FDA, or at least until there is compelling evidence that vaping will not harm Americans’ health – especially the future health of our youth,” Olfert said. "If the only outcome here is the demise of Juul, we can expect history to show it was a futile effort to protect American citizens.”

The FDA has thus far given no indication of banning other products. Other companies such as British American Tobacco and NJOY received approval from the agency. Their pitch was that their products could help adult smokers step away from cigarettes and be less harmful to underage users.

Vaping carries major health risks, and medical experts warn it is not the healthier alternative to smoking some believe it to be. According to Johns Hopkins Medicine, while it is less harmful than smoking, vaping can cause lung damage, which in some cases is fatal. Furthermore, the FDA has not officially approved any kind of e-cigarette as a smoking alternative although they have suggested its benefits as one.

The article also notes that vaping has spread a nicotine addiction among a whole generation that might otherwise not have smoked: “It’s one thing if you convert from cigarette smoking to vaping. It’s quite another thing to start up nicotine use with vaping. And, getting hooked on nicotine often leads to using traditional tobacco products down the road.”

Juul in particular has been accused of marketing extensively to youth. While the company insists otherwise, during its earlier marketing campaigns in 2015 and 2016, it bought ad space on many websites targeting children and teens, such as Nickelodeon, Cartoon Network and Seventeen magazine. 

This was the subject of a lawsuit in Massachusetts in 2020. According to the suit, not only did the company advertise to minors, it also did not verify age for online orders, allowing thousands of customers with school email addresses to make purchases. Other states have sued the company, but Massachusetts was the first to highlight the advertising problem.

There has been much concern for e-cigarette users in West Virginia as well. In 2020, a health department study called vaping an “epidemic” in the state, especially among youth. Thirty-six percent of high school students reported using e-cigarettes, which was 8 percent higher than the national rate.  

The report stated, “Youth vaping has created a new addiction for West Virginia’s next generation with the potential to impair, if not cripple, West Virginia’s future health and economy.”

The state has also seen high levels of cigarette smoking. In 2016, 25 percent of West Virginia adults smoked, which was the highest percentage of any state in the country. In 2021, that number was 22.6 percent, still the highest in the country.

Lung disease has historically been a major health problem throughout West Virginia due to smoking and the coal industry. During a study conducted in 2011, researchers found that Chronic Obstructive Pulmonary Disease (COPD) was the third leading cause of death among West Virginians between 2000-2008. 

West Virginian coal miners make up a large portion of those who suffer from black lung disease, an irreversible condition that can only be cured by a lung transplant.

More recently, data for 2021 shows that the rate of new lung cancer cases in West Virginia is 79, soaring above the national average of 58. 

Considering this information, e-cigarettes might be the next major cause of lung disease added to the list. This is also in the context of the ongoing Covid-19 pandemic, which those with lung disease are especially vulnerable to as Covid-19 attacks the lungs.

In an interview with WV Public, medical specialist Carl Werntz said that those with black lung disease are “going to run out of usable lung much faster than somebody who starts out with healthy lungs,” a predicament that can also be applied to those who suffer from lung disease as a result of smoking or vaping.

While some may see the possible ban of Juul as a step toward lowering the vaping rates, a fear persists that addiction to e-cigarettes may leave West Virginia at the lower levels of state health.