At 17 years old, Samantha Domingo was the youngest speaker at an informational legislative briefing on vaping and e-cigarettes on Thursday.
The Farrington High School student and Tobacco Free Hawaii Youth Council member told Hawaii legislators that many of her classmates have become addicted to nicotine by vaping e-cigarettes.
“I’ve seen the effects their nicotine addiction has, and it’s not good,” she said. “E-cigarettes and other tobacco products are very accessible to youth in my community and it must stop.”
Since 2016, it has been illegal in Hawaii for anyone under the age of 21 to purchase e-cigarettes. But her peers easily find ways to get their hands on vaping devices, primarily by purchasing from friends, she said.
Vaping has been rapidly adopted by Hawaii youngsters. The vaping rate among Hawaii high school students is twice that of their mainland peers, and students in middle and elementary schools have been caught with vaping devices. On neighbor islands, as many as 34% of public high school students are vaping, according to the Department of Health.
Heavy marketing on social media and flavors such as mango, lilikoi and li hing mui have enticed young people, according to the state Department of Health.
The e-cigarette industry has received renewed national attention following an outbreak of lung injury among vapers.
As of Oct. 15, more than 1,400 lung injury cases associated with the use of e-cigarette products have been reported to the Centers for Disease Control and Prevention. In 24 states, a total of 33 people have died, all of whom reported having a history of vaping. Many of the products patients used contained THC, the CDC reported.
The CDC has maintained its recommendation that people should refrain from vaping since the ongoing investigation has not identified one compound or ingredient that has caused the illnesses. In response, several states have placed temporary bans on the sale of flavored products.
Bryan Mih, a pediatrician and medical director for Kapiolani Smokefree Families, also spoke at the briefing. He said toxic effects of the high levels of nicotine in e-cigarettes include seizures and gastrointestinal disorders, such as stomach pain, diarrhea and vomiting. It also can severely impact the lungs.
“The flavorings are artificial chemicals, and when you get those in conjunction with propylene glycol, you end up with these chemicals called acetals, and those are found to be airway irritants,” he said.
Mih told lawmakers that younger people are particularly vulnerable because nicotine addictions can change receptors in their brains.
“For the younger folks, 25 and younger, when their brain is still developing, it does negatively impact the behavior and impulse control,” he said. “A vast majority just start using them because of the flavors. They don’t realize that nicotine is in them, and unfortunately by the time they figure it out, they’re hooked on the nicotine component.”
E-cigarettes can carry double the amount of nicotine as traditional cigarettes, sometimes even more.
And because e-liquid solutions that flavor e-cigarettes are not regulated by the U.S. Food and Drug Administration, labeling of their ingredients is not reliable, Mih said. They can include not only nicotine, but carcinogenic ingredients. The solvent propylene glycol has been approved by the U.S. Food and Drug Administration for ingestion, but not inhalation.
“The issue with the e-cigarettes is how they’ve formulated it as well, because they’ve taken regular nicotine and mixed it with an acid to create a solution that’s more neutral, so you get less of a throat burn,” Mih said. “When that happens, you take a much deeper inhalation and you get a huge spike in nicotine and that actually gets you more addicted.”
In light of the growing alarm about the vaping epidemic, President Donald Trump suggested in September that a federal ban of most flavored e-cigs could be in the works.
And on Thursday, Juul Labs announced that it would stop selling most of its flavored products, including mango, fruit and cucumber. The American electronic cigarette company has come under fire for marketing to young people and is currently under investigation by the FDA, as well as the Federal Trade Commission, and federal prosecutors in California, among others.
When e-cigarettes first emerged on the market, they were often advertised as safe alternatives to smoking and even cessation devices. The FDA recently chastised Juul for using such language without its authorization.
In anticipation of such a flavor ban, which has been considered by the Hawaii Legislature in the past, Hawaii retailer VOLCANO eCigs issued a public statement in opposition.
“A Hawaii ban on legally purchased nicotine vape flavors is irrelevant to the outbreak of lung disease,” VOLCANO eCigs said in a statement. “Eliminating flavored nicotine e-liquids will not prevent further cases of lung disease because those products have not been proven to be the sole cause of the outbreak.”
VOLCANO eCigs continued to say a flavor ban would not only hurt its business and an industry that employs about 5,000 people in Hawaii, but also hinder the ability of its adult customers to use flavored products they like.
“Store-bought nicotine vape flavors, especially fruity ones, are a key element of the appeal of vaping to adult smokers,” the release said. “Over 95% of the liquids we sell are flavors other than tobacco because that’s what our adult customer base demands and wants. Enacting a flavor ban would certainly put us out of business and push the tens of thousands of local consumers who use these products as an alternative to cigarettes back to the tobacco market or worse, to the illicit black market where there is no oversight and incalculably higher risk.”
Prior legislative attempts in Hawaii to ban the sale of flavored tobacco products and tax the e-cigarette industry like the tobacco industry have failed.
Sen. Roz Baker, chair of the legislative hearing Thursday, told Civil Beat she is considering various legislation for 2020 to address the growing number of young vapers.
“E-liquids, whether they have THC in them or not, are not the kind of thing intended to be in your lungs,” she said. “The industry is just looking at ways to dupe kids, to make them think it’s cool, that there’s no problem with it, and they ought to be able to enjoy this new product.”
Baker said she plans to discuss the possibility of taxing e-cigarette products like traditional tobacco products.
“E-cigarettes are not a cessation device, they’re an addiction device,” she said. “I grew up when the industry was going into menthol because they couldn’t get into the black communities. We really don’t want our kids in that same predicament.”
At the Capitol, Domingo described her work as a volunteer with the Hawaii Department of Health’s Alcohol and Drug Abuse Division and the FDA, participating in recent compliance checks at e-cigarette and traditional cigarette retailers.
She said the sting operation experience is “always nerve-wracking.”
“Not every store sold to me,” she said. “Some did the right thing and said ‘no.’ But in the end, it was not that difficult to purchase a Juul or cigarettes. I was able to make several purchases on the Big Island and on Oahu.”
She concluded her speech with a proposal for legislation during the session that will begin in January.
“I think the best way to stop access to youth of tobacco products is to end the sale of all flavored tobacco, including vapes and including the online sale of vape products,” she said.
Eleni Gill/Civil Beat