In the wake of last year’s EVALI lung injury outbreak and a raft of legislative and media reactions to perceived threats to youth, an intriguing question is being asked about one potential cause of the exaggerated-but-real rise in nicotine vaping among teens who don’t smoke.
Are anti-vaping advertisements inadvertently promoting product recognition and uptake among youth?
In a December report for the Competitive Enterprise Institute, Senior Fellow Michelle Minton argued that anti-vaping campaigns portraying e-cigarettes as a deadly youth epidemic have the opposite effect to that intended. She noted that after an early surge in youth vaping, there was a decline from around 2015-2017—but that a 78 percent increase in high schoolers who tried vaping in 2018 followed a proliferation of anti-vaping media campaigns.
“You don’t need a degree in child psychology to realize that message was doomed to backfire,” she wrote, citing the concept of “psychological reactance”—as well as evidence that media content warnings may entice youth, for example, and that some groups of students showed an increase in drug use after participating in the abstinence-only DARE program.
Minton is not the only person to suggest this. My conversations with tobacco harm reduction experts in the past several months have pointed in a similar direction.
“It encourages the behavior. Like telling a three-year-old not to stick peas up his nose.”
David Sweanor, a professor of law at the University of Ottawa, Canada and industry expert, told me last fall that stigma-focused advertisements could drastically backfire in the long run. Regarding “moralists” who are “yelling about young people,” Sweanor said, “It encourages the behavior. Like telling a three-year-old not to stick peas up his nose.”
One noteworthy example of the kind of messaging to youth that we’re talking about is provided by the US Food and Drug Administration’s “The Real Cost” campaign. Last summer marked the beginning of a new series of advertisements under that moniker, showing street magician Julius Dein performing magic tricks for random teens who say they vape. The ads depict youth surrounding Dein in various settings where he “magically” turns their vapes into cigarettes and warns, “Vaping can lead to trying cigarettes.”
As critics have pointed out, even if the likelihood of trying vapes and trying cigarettes may be correlated, that does not demonstrate that the former causes the latter.
Just like other anti-vaping advertisements pushed by public health organizations around the world, the slick presentation of The Real Cost generates a predicament of inadvertent product recognition among the youth these campaigns are designed to warn. The props used resemble closed-system devices like those made by Juul* or NJOY.
“We now have the absurd situation where anti-vaping activists blame Juul for glamorizing vaping with youth-appealing ads,” Clive Bates, a tobacco harm reduction expert and former director of Action on Smoking and Health (ASH UK), told Filter. “Yet the most likely place you will see these ads today is on anti-vaping campaign websites—they are long gone from Juul’s marketing, which is now boring to a fault.”
A lawsuit against Juul brought this month by Massachusetts Attorney General Maura Healey is one of many that accuses the company of the “glamorizing” that Bates referenced. It addresses a series of digital marketing campaigns that reportedly used models and influencers on social media to draw in new youth customers. Healey also cites the vape manufacturer’s purchase of advertisements on websites focused on youth entertainment.
The lawsuit will take its course. But for our purposes, the media coverage of the lawsuit is interesting. The lawsuit’s evidentiary exhibits feature the marketing samples that Healey says are illegal. In turn, news organizations’ reporters and editors have used the images as headline photos, examples in articles, and clips in local and national news broadcasts.
Youth are thereby further exposed to the marketing that has ceased to be published in its original contexts—and the media’s negative framing of such marketing is unlikely to dampen its effects.
“What do these anti-vaping groups expect to happen when they inform every kid in the land that vaping is something they absolutely must not do because other kids are finding it awesome and upsetting to adults?” asked Bates.
“Anti-vaping campaigners are stimulating curiosity by making vaping the most widely discussed youth issue in the US.”
“We know vaping is driven by curiosity and the wider social environment,” he continued. “But that is exactly what the anti-vaping campaigners like the Truth Initiative and the Campaign for Tobacco-Free Kids are doing: stimulating curiosity by making vaping the most widely discussed youth issue in the US, even though there are many more pressing youth concerns such as opioid use, drink-driving, bullying, guns and mental health.”
The Truth Initiative is a major player in US anti-vaping messaging. It conducted a 2019 study, published in the journal Tobacco Control, which found that “Juul-related” content on Instagram had proliferated.
The study focused on keyword research to determine the popularity of hashtags related to Juul, other products and vaping in general, analyzing thousands of posts from March to May 2018. The researchers found that out of 14,838 Juul-related Instagram posts made by 5,201 users, about one-third were promotional in nature; only 11 percent contained nicotine and addiction information, and over half reportedly appealed to a definition of what they consider “youth culture.”
Keyword hashtags like #juulbuzz and #nichead were used more often in anti-vaping content than in promotional content. One “spoof” account called @nicheadnation accounted for hundreds of posts found under the #nichead hashtag. The posts all promoted negative messages about vaping—alongside images depicting cartoon characters and children using Juul products.
No sensible harm reduction advocate would support the promotion of nicotine products to youth who do not smoke, and a continuing crackdown reflects this. The FDA recently ordered, for example, that the manufacturer Eonsmoke cease deploying social media influencers to promote its pod systems. Adult film star Mia Khalifa and reality television star Scott Disick had promoted Juul-compatible Eonsmoke pods and other products, the FDA determined.
Yet while the justified reduction of promotional materials available to youth continues, the anti-vaping content that has flooded social media to compete with the pro-vaping content remains.
It is important to note that the case I’m making is not proven. It is, however, highly plausible that widespread depictions of the behavior of vaping, regardless of their anti-vaping intentions, could normalize vape brands, devices and flavors for minors who consume these media.
Using fear, misinformation and stigmatization to promote public health messages is fundamentally disempowering. But how strangely helpful it would be for anti-vaping groups if these tactics were to be fueling the very youth uptake that supports their own, well funded existence.
*In 2020, Juul provided an unrestricted grant to The Influence Foundation, which operates Filter. Knowledge Action Change, from which the author received a scholarship, also provided a restricted grant to The Influence Foundation through a scholarship in 2018. Filter’s editorial independence policy applies.