Electronic cigarettes (e-cigarettes) have gained increased popularity amongst the adolescent population in the United States. Today, teenagers can access smokeless aerosolized nicotine stored in portable devices resembling USB flash drives or pens from local retail stores, gas stations, or convenience stores. The spike in the use of e-cigarettes amongst adolescents is highly alarming concerned entities, such as the federal and state governments, parents, non-governmental organizations, and the healthcare fraternity. Attempts to initiate a rapid decline in the use of e-cigarettes through 'quit smoking' campaigns, regulation of manufactures, and policy creations have heightened across the country. Anti-e-cigarette use campaigners have a common aim; to end the production of vapes that harm teenagers' health, affect their social functioning, cause low-self-esteem from peer avoidance, and cause addiction. Critical approaches to eliminate vaping products' manufacturing in Europe should encompass two aspects. Anti-vaping campaigners should seek to answer these crucial questions: What strategies do e-cigarette producers use to entice the adolescent population to purchase and consume their products? Which policies can be exploited and enforced in the United States to ban the manufacture and sales of e-cigarettes?
Background of the Problem
Abuse of tobacco has shifted in the contemporary United States use population from smoking combustible cigarettes to electronic nicotine delivery systems introduced in the late 2000s. E-cigarettes, comprising heated nicotine-based flavored liquids heated to extreme temperatures to produce aerosols for inhalation, are the "in-thing" for adolescents today. E-cigarettes enthrall teenagers because of their colorful and sleek pen or USB flash drive-like designs that adults cannot detect easily ( Glasser et al., 2018) . Most e-cigarette devices are battery-operated, while most recent forms are rechargeable and refillable. The primary aim for most e-cigarettes is to stimulate the pleasure of smoking a combustible cigarette while providing the "bliss" of a variety of flavors and lack of irritating lung smoke that traditional cigarettes offer.
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E-cigarette users target young adult consumers for various reasons. The manufacturers of vaping products prey on the impulsivity nature of teenagers who are psychologically prone to make dangerous decisions or indulge in harmful habits without care about consequences. Further, e-cigarette organization owners entice adolescents with discreet models of vaping devices, such as pens or USB flash drives that are easy to carry around and conceal, avoiding parental or guardian backlash ( Jenssen & Boykan, 2019) . Moreover, e-cigarette manufacturers lie that their products are less toxic than nicotine in combustible tobacco cigarettes and conveniently fail to indicate the presence of the addictive substance in vapes. Furthermore, entice young adults to vape by using celebrity influencers to role model the habit. Young adults who use e-cigarettes also tend to acquire harmful practices by imitating parents who are chain-smokers or peers who make the substance appear "cool." Therefore, e-cigarette use in young adults is propelled by many aspects, as discussed.
According to a survey conducted by Truth Initiative, the use of e-cigarettes amongst adolescents in the United States has increased alarmingly. This non-governmental organization helps young adults quit smoking. According to research conducted by the entity, 11.7% of high schoolers used e-cigarettes over 30 days ( Truth Initiative, 2019) . Further, survey results showed that in 2018, 21% of teenagers vaped using e-cigarettes, while in 2019, the population of young adults who used e-cigarettes had spiked to 27.5%. Additionally, the Truth Initiative reports that currently, 4.7% of teenagers use e-cigarettes, a notable increase in use from the 0.6% users reported in 2011 when e-cigarettes were pretty new in the market. Furthermore, the Truth Initiative's study showed that its flavor variety enticed 82.7% of e-cigarette users amongst the young adult population. Preferred flavors amongst the teenagers using e-cigarettes include mint, fruit, candy, menthol, and desserts. In 2020, the National Institute on Drug Abuse's Monitoring the Future Study (MTF) surveyed to check the extent of e-cigarette use in young adults in the United States ( Truth Initiative, 2019) . Results of the study showed that 18% of teenagers in the 12th, 10th, and 8th grades vaped nicotine within 30 days of the research.
Currently, the largest e-cigarette manufacturer in the United States is JUUL. According to Truth Initiative, JUUL's e-cigarette consumers doubled in less than ten months between May 2020 and August 2019. The organization attributes the increase in JUUL's flavored e-cigarette to the Food and Drug Association's (FDA) ban of combustible cigarettes with flavors. JUUL proceeded to exploit the FDA's ban of flavored combustible cigarettes by introducing new flavors, such as fruit and candy, to entice the teenage population more. Truth Initiative notes that JUUL's most loved e-cigarette flavor is menthol, based on its market share of 57.7% buyers reported in 2020 ( Truth Initiative, 2019) . JUUL's large market share has also been reported in other states, such as Mississippi, where the manufacturer is the leading supplier for e-cigarettes in the region. According to Truth Initiative, repeat use of JUUL's e-cigarette was most likely if the user had never smoked any traditional or modern cigarette before. Further, research conducted by Nielsen showed that as of 2019, JUUL owned 64.4% of the e-cigarette consumption market in the United States ( Truth Initiative, 2019) . Truth Initiative also notes that 25% of young adults aged 15-24 recognized JUUL e-cigarettes from being shown its product from its survey. Further, respondents reported the use of e-cigarettes as "JUULing." In 2019, a study conducted by the National Tobacco Youth Survey showed that 59% of young adults in the United States used JUUL's e-cigarettes 2019, with respondents reporting that JUUL was their "go-to" brand ( Truth Initiative, 2019) .
Truth Initiative also noted that JUUL invested up to $1 million to market its e-cigarette to young adults through intensive social media campaigns. JUUL e-cigarette awareness is sold passionately in online platforms that teenagers most interact with, such as YouTube, Instagram, and Twitter. Recently, JUUL reported it would increase its product awareness campaign by using print and broadcast media to reach more potential customers. Truth Initiative says that as of 2018, JUUL's YouTube advertisement had attracted up to 1 million views, and its Instagram platform had up more than 775,000 followers ( Truth Initiative, 2019) . Further, JUUL had posted 336,308 posts on Twitter as of January 2019, with up to 80.6% of the company's Twitter followers being young adults of between 13 and 20 years ( Truth Initiative, 2019) . JUUL's marketing strategies to entice young adults into using e-cigarettes include wrapping products to look like candy, wafers, and child-friendly food. Truth Initiative reports that JUUL has heightened its marketing campaigns by funding target population summer camps, paying visits to young adult learning institutions, and requesting churches to distribute posters advertising their content. Other companies that manufacture e-cigarettes on small-scale bases include
E-Cigarettes in the United States are easily accessible by buyers, considering the lack of stringent regulation laws banning the product in the country. Teenage users of vaping products access e-cigarettes in convenience shops, online retail platforms such as eBay, tobacco shops, and pharmaceutical stores. In 2018, the Food and Drugs Association confronted eBay for selling vaping products on its platform, even to underage users ( Truth Initiative, 2019) . eBay has a policy that bans selling items such as e-cigarettes because they are categorized as harmful drugs. The company agreed to remove its advertisements for e-cigarette devices in adherence to organizational policy and compliance with FDA regulations. However, a quick search on eBay today shows that the e-commerce retailer still sells vaping devices discreetly, hidden in non-suspicious wording, such as JUUL chargers or skins. According to Truth Initiative, the tobacco industry's net worth is up to $2.5 billion, but combustible cigarettes only account for one-third of the market sales. In the United States, vape shops sell 19% of e-cigarettes, while drug, retail, and convenience stores sell 53% of the vaping products ( Truth Initiative, 2019) . Finally, online retailers, such as eBay sell 28% of the remaining e-cigarettes sourced and used by the young adult population.
Continued adolescent use of e-cigarettes has many negative health consequences. Firstly, all e-cigarettes contain nicotine, which is delivered to the user's brain system through inhalation. Persistent abuse of e-cigarette causes the brain to be addicted, as evidenced by user's lack of concentration when they do not dose themselves in a day ( Kandel, Griesler & Hu, 2015) . Secondly, users of e-cigarettes tend to graduate to using other drugs, such as heroin, opioids, or cocaine in the long term. Thirdly, young adults who use e-cigarettes during pregnancy expose the fetus to altered nerve cell functioning. Fourthly, according to research, e-cigarette liquids comprise up to 60 chemicals, which is more toxic than combustible tobacco. Fifthly, e-cigarettes have metal components, such as copper, tin, nickel, and cadmium that are carcinogenic and cause cancer in users. Sixthly, most e-cigarettes have reported oxidative stress acquired from the low-level free-radical elements in the products ( Leventhal et al., 2015) . Finally, e-cigarettes have toxic liquid components, such as propylene glycol and delivery solvents that cause dry mouth disease. Currently, the FDA is investigating to check if e-cigarettes cause lung disease or seizures caused by neurological damage from excessive consumption of vaping products.
Statement of Organization's Interest in the Issue
Campaigns to end vaping in young adults are crucial to help addicted victims recover quickly. Additionally, through intensive action to stop the consumption of e-cigarettes in adolescents, the organization will create increased awareness of the negative consequences of using vaping products ( Perikleous et al., 2018) . Moreover, the organization will save many fetuses from damaged nerve cells acquired before birth by a young adult pregnant mother who uses e-cigarettes heavily. Finally, the organization wants to keep e-cigarette adolescent users from progressing to consuming other dangerous drugs, such as opioids or cocaine.
Pre-existing Policies
The United States federal and state governments have instituted various policies to end e-cigarette use among young adults. In 2016, the FDA introduced the Tobacco Control Act that regulates the cigarette industry by mandating manufacturers to adhere to designed protocols. For instance, the Tobacco Control Act expects all cigarette manufacturers to submit their products for an intensive toxicity preview before release to the public for consumption. In 2019, former President Donald Trump's administration promised to remove all flavored cigarettes from the market to end e-cigarette consumption in the United States. Further, in 2019, the FDA proposed eliminating e-cigarettes to age-appropriate locations and restricting flavors used to menthol, mint, and tobacco ( Centers for Disease Control and Prevention, 2019) . In 2019, the FDA designed the Youth Tobacco Prevention Plan and announced it would penalize heavily any manufacturer who failed to comply with created procedures. Further, the FDA liaised with Scholastic and mandated all schools to increase awareness of the negative impacts of tobacco in e-cigarettes through posters.
Moreover, the FDA finalized its strategy to end e-cigarette consumption in the United States young adult population by banning vaping products in flavored fruit-like cartridges. In 2018, the FDA penalized five major e-cigarette manufacturers and 1300 retailers for failing to comply with the required age-appropriate regulation when selling the product ( U.S Food and Drug Administration, 2020) . Currently, the FDA restricts cigarette consumption to young adults above 21 years in the United States. Therefore, if the FDA apprehends any seller selling e-cigarettes to teenagers, it penalizes the individual or business owner. Further, the United States federal government created the Child Poisoning Prevention Act in 2015 that bans the sale of e-cigarettes to underage children using appealing packaging, such as fruit-shaped devices. Additionally, FDA has started the Real Cost campaign, which educates young adults on the negative impacts of consuming e-cigarettes. Consequences, such as poor health, rejection by non-using peers, addiction, and stealing money to buy e-cigarettes, are addressed by the FDA under The Real Cost campaign. Finally, the FDA has an extensive policy document titled "Comprehensive Plan for Tobacco and Nicotine Regulation" on its website that explains its steps to end e-cigarette consumption.
However, the lack of policy action also promotes the continuous use of e-cigarettes amongst young adults in the United States. For instance, even though the former Trump administration created a policy to ensure the elimination of e-cigarette companies, such as JUUL, no action has been reported against the company to date. Additionally, in 2019, the FDA had created a policy to restrict access of e-cigarette to vendors serving adults above 21 years, but to date, the rule has not been reinforced ( Truth Initiative, 2019) . Furthermore, by 2019, the United States had 220 regions that prohibited the sales of e-cigarettes. However, other states refuse to join the anti-e-cigarette campaign and allow sellers to sell vaping products to teenagers. Moreover, the United States does not have a taxation policy on e-cigarettes, which encourages manufacturing and sales to young adults. Furthermore, other states in the United States mandate vendors to confirm the ID of e-cigarette buyers to prevent sales of the vaping product to young adults. Other states, such as Pennsylvania, do not restrict the sale of cigarettes to age-appropriate users, which dampens the overall campaign to end vaping in young adults. Finally, some non-government organizations, such as Truth Initiative, have programs, such as "Quit Smoking," that help adolescent users end the consumption of e-cigarettes.
Recommendations: Policy Options
The United States may consider other policy options to end vaping in young adults. For instance, after finding evidence that e-cigarette manufacturing companies, such as JUUL, target young consumers below 18, the FDA should de-license the entities ( Centers for Disease Control and Prevention, 2019) . Secondly, laws penalizing sellers should warn other business people who intend to enter the market from targeting young adult populations. Penalties for selling e-cigarettes to adolescents should include not less than 30 years' incarceration periods or lifetime jailing for offenders. Finally, schools that apprehend young adults using e-cigarettes should de-register and expel the child. Every learning institution should mandate all learners to take a mandatory drug test every Friday, and if a child is found to have high levels of nicotine in their blood, they should be released promptly.
Benefits and Disadvantages of Recommended Policy Options
De-licensing e-cigarette sellers and manufacturers who target young adults is beneficial because it sends a message that the federal government values adolescents and prevents a repeat of the habit from other companies. However, denying organizations, such as JUUL operating licensing, may translate to sudden unemployment for pre-existing employees and loss of income. Jailing e-cigarette vendors for long periods stop the cycle of abuse because the supplier is removed, but the economy may collapse if income earned by the jailed individual was used to invest in other profitable aspects. Finally, the expulsion of a teenager apprehended using an e-cigarette from school instills fear in other users within the institution and ends the cycle of use, but the expelled student may have permanent psychological issues, such as anxiety and depression from rejection by peers that may ensue.
Conclusion
E-cigarettes are becoming increasingly famous in the United States, primarily amongst the young adult population. Factors encouraging vaping products amongst adolescents include a natural tendency to engage in dangerous leisure activities, peer pressure, parental influence, and enticing by celebrity advertisements. Negative consequences of using e-cigarettes include developing cancer and respiratory diseases, harming a fetus's nerve cells, and possible graduation from using hard drugs. The FDA has policies to end e-cigarette use amongst young adults, such as the Real Cost Campaign and Child Policy Prevention Act. However, other policies, such as de-licensing e-cigarette manufacturers, could also help end the production of vaping products abused by young adults.
References
Centers for Disease Control and Prevention. (2019). The Call to Action on E-Cigarette Use Among Youth and Young Adults. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_SGR_The_Call-508.pdf
Glasser, A., Abudayyeh, H., Cantrell, J., & Niaura, R. (2018). Patterns of E-cigarette use among youth and young adults: Review of the impact of e-cigarettes on cigarette smoking. Nicotine & Tobacco Research , 21 (10), 1320-1330. https://doi.org/10.1093/ntr/nty103
Jenssen, B., & Boykan, R. (2019). Electronic cigarettes and youth in the United States: A call to action (at the local, national and global levels). Children , 6 (2), 30. https://doi.org/10.3390/children6020030
Kandel, D. B., Griesler, P. C., & Hu, M. (2015). Intergenerational patterns of smoking and nicotine dependence among US adolescents. American Journal of Public Health , 105 (11), e63-e72. https://doi.org/10.2105/ajph.2015.302775
Leventhal, A. M., Strong, D. R., Kirkpatrick, M. G., Unger, J. B., Sussman, S., Riggs, N. R., Stone, M. D., Khoddam, R., Samet, J. M., & Audrain-McGovern, J. (2015). Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA , 314 (7), 700. https://doi.org/10.1001/jama.2015.8950
Perikleous, E. P., Steiropoulos, P., Paraskakis, E., Constantinidis, T. C., & Nena, E. (2018). E-cigarette use among adolescents: An overview of the literature and future perspectives. Frontiers in Public Health , 6 . https://doi.org/10.3389/fpubh.2018.00086
Truth Initiative. (2019, March 19). E-cigarettes: Facts, stats and regulations . https://truthinitiative.org/research-resources/emerging-tobacco-products/e-cigarettes-facts-stats-and-regulations
U.S. Food and Drug Administration. (2020, September 14). FDA's youth tobacco prevention plan . https://www.fda.gov/tobacco-products/youth-and-tobacco/fdas-youth-tobacco-prevention-plan
