Alex, a 17-year-old Grady High School student, started smoking cigarettes his freshman year but switched to vaping when the liquid nicotine craze swept among his peers.
Alex never had a problem purchasing either nicotine product from local retailers — despite being underage.
Now, the federal Food and Drug Administration is cracking down on retailers who sell vaping products to minors, tightening regulations on e-cigarettes and publicizing the health risks of vaping to teens.
The FDA recently cited over 1,300 retailers across the country for selling vaping products to minors, including two in southeast Georgia. A few weeks ago, the FDA required all e-cigarette retailers to include a health warning label on vaping products that describe the addictive qualities of nicotine, similar to warnings that have been required on cigarette packs for years.
But erratic enforcement and gaps between federal and local regulations hamper initiatives to curb vaping among minors, according to a review of teen smoking data and interviews with public health experts.
Under Georgia law, vaping products are not yet classified as tobacco products so the Department of Revenue, which regulates cigarettes, does not regulate them. Unlike tobacco, retailers do not need licenses to sell the products, and the sales are not taxed.
The revenue department has the authority to inspect retailers for selling to minors, but essentially leaves enforcement to the FDA.
Enforcement gaps
Roughly two out of five Georgia high school student smokers — about 20,500 students — were able to purchase cigarettes despite being underage, a 2017 report by the state Department of Public Health found. The study didn't address e-cigarettes but suggested that illegal tobacco sales to minors in Georgia is widespread.
Alex said he was able to purchase vaping products from smoke shops, and he did not have to show identification.
The Atlanta Police Department has not cited any minors for possession or smoking of e-cigarettes since 2015, said police spokesman John Chafee.
E-cigarettes are battery-operated, slim devices that heat pods of oils or liquids into vapor. Most frequently, the liquid contains nicotine; however, it can be purely water or other substances such as the drug found in marijuana. Users don't inhale carbon monoxide or tar dangers of cigarettes.
It’s been illegal in Georgia to sell electronic cigarettes to minors since July 1, 2014, said Nancy Nydam, spokeswoman for the Georgia Department of Public Health. But it’s unclear how many inspections the state does.
The state Department of Revenue, which also regulates alcohol and tobacco products in Georgia, is tasked with preventing such sales. It also has authority to conduct "underage investigations," according to state law.
When The Atlanta Journal-Constitution asked how many inspections the department has performed recently, William Gaston, press officer for the Department of Revenue, instead said in an email that such questions should be posed to the FDA.
“Vaping devices and vaping liquids are not tobacco products (under Georgia law), so they are not regulated by the Department,” Gaston wrote.
Brenda Davis-Rowe, another spokeswoman of the Department of Revenue, said, “I am not at liberty to discuss FDA’s work in jurisdictions.”
FDA spokesman Michael Felberbaum in turn directed the question to the state department of public health.
But Nydam, at the health department, shifted the burden to the revenue department, saying it “would have regulation over the sale of tobacco or tobacco-related products.”
Regulatory holes
There are other gaps. No policies either on the federal level or in Georgia limit nicotine levels, monitor ingredients used in e-cigarettes, or regulate advertising or packaging for vaping products.
Some states, such as California, have taken steps to implement regulations such as prohibiting e-cigarettes where smoking is not allowed or restricting advertisements near schools.
Jean O’Connor, adjunct associate professor at the Rollins School of Public Health at Emory University, recommended that local communities take steps such as banning tobacco products from schools and places where children gather, like sporting events and after-school programs. She also recommended that retailers put e-cigarettes behind the counter or out of sight.
“There are things that can be done at the local level in addition to what’s being done at the federal level,” O’Connor said. “Yes, the FDA work is a step in the right direction, but it really needs to take action at multiple levels to really curb the epidemic.”
Georgia has been taking similar steps over the past few years, with a majority of school districts and more than two dozen park and recreation associations adopting tobacco-free policies, according to Nydam.
The continued use of e-cigarettes by minors, however, is not only sustained by retailers.
“Anyone contributing to the marketing or the normalization of use of these products by minors is contributing to this epidemic, which includes things like advertising … to adults looking away when they see youth using these products,” O’Connor said.
E-cigarette companies have made their products available in candy flavors like vanilla, chocolate and gummy bear, and created packaging that resemble foods like juice boxes, candy and cookies, prompting warnings from the FDA. Critics argue that these designs are marketing to younger populations.
“Whatever hope we had that the e-cigarette manufacturers would behave better than cigarette companies has been eliminated by their behavior,” said Matt Myers, president of the Campaign for Tobacco-Free Kids.
Teen smoking on the rise
Meanwhile, the number of teen smokers is increasing. A report issued earlier this year by the Georgia Tobacco Use Prevention Program said that more than one in four Georgia high school students used electronic cigarettes at some point, and three out of 100 high schoolers used them daily.
That would put the percentage of Georgia teens vaping daily on the same level as the percentage of all adults vaping in a month, according to a Centers for Disease Control and Prevention study two years ago.
This rise in teen vaping is not exclusive to Georgia. More than 2 million U.S. middle and high school students have tried e-cigarettes, according to the same CDC study, a development that has sparked concerns in public health experts and education leaders.
"The disturbing and accelerating trajectory of use we're seeing in youth, and the resulting path to addiction, must end. It's simply not tolerable," FDA Commissioner Scott Gottlieb said in a speech last month. "I'll be clear. The FDA won't tolerate a whole generation of young people becoming addicted to nicotine as a trade-off for enabling adults to have unfettered access to these same products."
If current trends continue, the rates of e-cigarette smoking are likely to increase as students get older. There was a 65 percent increase in teens who had tried e-cigarettes from freshman to senior year, the same Georgia Tobacco Use Prevention Program report found.
The use of nicotine can lead to addiction and health consequences, and the drug can do additional damage to the developing brains of young people. But e-cigarettes — which deliver nicotine to the body without the other harmful contaminants of lighting tobacco — do offer a less risky alternative to cigarettes.
“The delicate balance here is protecting kids and also paying attention to smokers and their desire to quit,” said Michael P. Eriksen, dean of Georgia State University’s School of Public Health.
Some students believe the vaping trend will pass like the fads before it. Already, as many high school seniors disapprove of vaping with nicotine on a regular basis as other substance abuse such as alcohol or marijuana, according to the data.
“I think people will stop,” said Grady student Aldian, 17, “but it will take time to find the next big thing.”
Vaping regulations in Georgia
It’s illegal to sell or distribute e-cigarettes to anyone under 18.
Minors may not purchase, attempt to purchase, possess, sample or use e-cigarettes.
E-cigarettes may not be sold within 500 feet of a school or playground.
Stores and vending machines selling e-cigarettes must have a sign saying they do not sell to customers under 18.
Source: Georgia code.
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