Highlighting professor in otorhinolaryngology Robert Jackler’s research, the Stanford School of Medicine’s Health Policy Forum held a discussion about electronic cigarettes on Monday. Jackler’s work focuses on whether or not electronic cigarettes (e-cigs) are truly effective in helping smokers quit and why there has been a significant rise in teen use.

Jackler, whose research has charted the behavior of the tobacco industry, believes e-cig companies are manipulating consumers into using their products and taking measures to prevent them from quitting.

The difference between tobacco advertising and e-cigarette advertising is that tobacco is controlled by large companies while the e-cigarette industry is mainly based on startups and smaller businesses, according to Jackler. Because these small companies are not subject to the strict regulations placed on big tobacco, they have more freedom to do and say what they want.

In his work, Jackler examines how e-cig companies advertise their products by claiming they help people to quit, as well as how emerging ad channels, especially online and social media, are targeting young teens.

“These companies have the best copywriters, artists, illustrators that money can buy,” Jackler said. “That’s why [the] tobacco industry pays so well. Their sophisticated advertising is based upon research on consumer perception. It’s all about making money.”

Established in 2007, Jackler’s research group studies the impact of tobacco advertising, marketing and promotion. The team, Stanford Research into the Impact of Tobacco Advertising (SRITA), has created an online database of over 25,000 tobacco advertising images with the hope that its research will ultimately help to inform the future of the U.S. government’s regulatory process.

Jackler points to many factors contributing to the wide use of e-cigs, including accessibility and rise in youth consumption. For instance, people can “vape” in places that they usually can’t smoke — like the workplace or other smoke-free environments.

“It is concerning that among middle and high school students, e-cigarette use tripled last year,” Jackler said. “Teens get hooked on the latest trends because they want to experiment. That’s how companies advertise it — as high-tech and modern. They also increase the appeal with all of these these flavors of e-cigarettes — for example, chocolate, gummy bears — made available.”

By looking at channels of advertising, Jackler has noticed that many companies’ social media outlets are mainly youth-oriented, despite their claims that they do not target kids. According to Jackler, teen brains, while developing, are extremely vulnerable to nicotine addiction, and in fact, studies have shown that nicotine addiction is just as hard, if not harder, to quit than heroin addiction.

“The U.S. Senate is worried that e-cigarettes may be a gateway to a lifetime of nicotine addiction,” Jackler said. “No one really knows what the long term effects of e-cigarette smoking are. It will take 20 to 30 years for effects to really show.”

Jackler explained why the youth market is appealing to the industry.

“Why can’t we create e-cigarettes without nicotine — a less addictive one, for teens and a separate product for adults that were tobacco smokers? The answer lies in the industry’s need for replacement smokers,” Jackler said. “Smokers die young, and this industry needs customers.”

In addition, the rise of e-cigarettes with flavors is potentially health-threatening. The chemical compound diacetyl, used for the buttery flavoring in microwavable popcorn, is also used in flavored e-cigarette juices. A report by the the National Institute for Occupational Safety and Health (NIOSH) published in 2003 showed how workers at a popcorn factory developed bronchiolitis obliterans, a serious and irreversible lung disease, as a result of inhaling vapors from diacetyl. After these findings, protective measures have prevented workers from breathing the chemical.

However, these same protective measures are not set for those who inhale flavored vapors.

As Jackler points out, the image of e-cigs as a healthier alternative has definitely played a role in hiding the evidence of harmful substances and led many to feel at ease with the use of e-cigarettes.

“[Companies] do health reassurance,” Jackler said. “They tell people ‘don’t go to the “yucky” cigarettes; they’re dangerous — our product’s perfectly safe; it’s much better,’” Jackler said. “But it’s not perfectly safe.”

Jackler explained the effectiveness of e-cigarettes in helping smokers quit is controversial. While they may help some people stop, they also make quitting more difficult for others.

“The science isn’t there yet to answer this this important question … but this has not stopped e-cigarette companies from aggressively promoting their brand’s cessation efficacy,” Jackler said.

Although the success of the e-cig ad industry is rising, the positive effects of e-cigs are uncertain. Jackler plans to continue to raise awareness and contribute to developing the future of e-cigarette policy.

“E-cigarette marketers need to stop targeting young people,” he said. “An important step towards this goal would be to make federal advertising regulations which apply to regular cigarettes also apply to e-cigarettes. That means no celebrities, no sports endorsers, no cartoons, no radio, no television, no billboards, no games and no free samples.”

“We also need to align the place-of-use regulations of cigarettes to e-cigs,” he added. “Otherwise, smokers will dual-use and perpetuate their nicotine addiction.”

Contact Isabela Bumanlag at isabela7 ‘at’ stanford.edu.