Seventeen-year-old Preethika Naveen grew up around people who smoked: grandparents, neighbors, and a smattering of others. Naveen vowed they wouldn’t use tobacco products—and plenty of their friends felt the same way.
Over the last five years, however, the proliferation of vaping has changed that.
“Vaping started being a thing when I was in seventh grade or eighth grade, and it increased in popularity,” said Naveen, a senior at Eagan High School. “I’ve seen a lot of my best friends swear that they’re never going to touch any nicotine products, and now they’re going through two to three vapes a week—and I can see how much it’s impacted their academic life, their interactions with people, their priorities.”
Vaping involves using an electronic device, or e-cigarette, that heats a nicotine-laced liquid and turns it into an aerosol that is then inhaled by the user. E-cigarettes are often enhanced with different flavors, and “can contain other harmful substances besides nicotine,” according to the U.S. Centers for Disease Control and Prevention.
Last year, Naveen joined the Eagan High School chapter of the Tobacco-Free Society to raise awareness among fellow students about the dangers of vaping and e-cigarette use.
That campaign got a significant boost in mid-April, when the state of Minnesota announced that it had reached a landmark settlement with Juul Labs and tobacco giant Altria in the lawsuit it filed over the corporation’s alleged illegal marketing of vaping products to teenagers.
Keith Ellison, the state’s attorney general, heralded the settlement as an example of state leadership holding the tobacco industry accountable, linking it to the state’s $7.1 billion settlement with the tobacco industry in 1998.
“One of my goals in bringing this case was to send a message: We will not tolerate youth marketing of nicotine products in Minnesota,” Ellison said in a prepared statement.
The terms of the settlement are not yet public, but they could include tens of millions of dollars and new restrictions on how Juul and Altria can market their products in the state.
There’s hope that the settlement could be an inflection point in a public health campaign about the negative effects of vaping.
Soliana Berhe, Naveen’s classmate at Eagan High School and a member of the Tobacco-Free Society, said as she conducts workshops on vaping, she’s discovered that middle school students know far more about cigarettes than they do about vapes.
“They always assume that cigarettes are negative right away,” Berhe said. “With vaping, they only see the different flavors, the smells, the colors, the products that vapes come in. I feel like that’s the only part they know.”
The campaign to raise awareness about the dangers of traditional cigarettes is, by some measures, one of the most successful public health efforts in modern American history.
In 1997, more than 36 percent of American youth smoked cigarettes. Two decades later, that number had fallen to just below 9 percent. In Minnesota, even fewer kids are smoking regularly: According to a state survey on youth tobacco use conducted in 2020, the percentage of high school students who said they had smoked within the past 30 days was just over 3 percent.
A more recent survey found that the use of conventional tobacco products by Minnesota students reached its lowest point in 2022. Elyse Levine Less, executive director of the Tobacco-Free Alliance, a St. Paul nonprofit, said young people she’s encountered around the state are largely repulsed by cigarettes.
“I’d say without fail they think cigarettes are gross and disgusting, and they can tell you everything about cigarettes—how gross they are, that they cause cancer, rotten teeth, yellow teeth—they can say it all,” she said. “These are kids who probably wouldn’t smoke. And yet, these are kids who, when they talk about vaping, there’s a lot of giggling.”
It appears middle and high school students in Minnesota don’t perceive e-cigarettes and vapes in the same way they perceive traditional cigarettes, even though a single Juul pod contains roughly as much nicotine as an entire pack of cigarettes.
According to Levine Less, that’s because of how Juul and its successors in the vaping market promoted their products, taking care to differentiate them from traditional nicotine products.
“The marketing around it was—flavors and water,” Levine Less said. “‘It’s not bad for you.’ That’s what set the stage.”
Marketing portrayed vaping as fun and flavorful
According to investigations and a number of lawsuits brought by state attorneys general, these companies aggressively pushed their products to teenagers. A lawsuit brought by the state of Massachusetts three years ago alleged that in its early days as a company, Juul purchased ad space on TV networks geared toward children, including Nickelodeon and the Cartoon Network, and a variety of educational websites for middle and high school students.
The state of Texas wrote in 2022 a news release announcing a multi-state settlement with Juul that the company “relentlessly marketed to underage users with launch parties, advertisements using young models, social media posts, and free samples.”
Minnesota’s lawyers made similar arguments at trial before the state settled its own lawsuit against Juul and Altria.
The result was that the rates of teenage use in Minnesota and around the country spiked several years ago to the point when the Centers for Disease Control began defining e-cigarette use among youth as an epidemic. The marketing, Levine Less said, was effective enough that it “undid 30 years of public health efforts” to reduce rates of nicotine use among American children.
Naveen said they don’t think that their friends would ever have started vaping if not for the flavors the vapes come in—flavors including different types of fruits, candy, and sugar cereals that a number of states have argued were produced and marketed specifically to try to hook kids.
“I doubt any of my friends would smoke if it was just flavorless,” Naveen said.
The Minnesota student survey conducted last year found that fruit-flavored e-cigarette products are by far the most widely used among teenage students in the state, with relatively few students using unflavored or tobacco-flavored products.
Berhe said that the flavors aren’t the only way companies like Juul and its competitors market to teenagers, pointing to advertisements that portray vaping as stress relief even though it can actually lead to increased stress.
“They market it as, it calms you down, it helps with anxiety, it kind of gives you an escape to a different reality,” Berhe said. “That’s great when as a teenager you have different stresses whether that’s school, friends, general life—when someone’s telling you that there’s something out there that can help you and fix all your problems, you’re going to go straight to that.”
According to Sharrilyn Helgertz, a research scientist with the Minnesota Department of Health, there is empirical data to support the notion that a share of teenagers use vaping as a means of escape: Teenagers who have experienced severe economic hardship, trauma, or who identify as LGBTQ+ are all more likely to vape.
The concern for public health officials is that teenagers who started vaping with little grasp of what the long-term health consequences might be are now finding it difficult to stop. Seventy percent of students who vape reported signs of nicotine dependence, including intolerable cravings, and 63 percent are struggling to quit. Those students also reported greater mental health challenges, including anxiety and depression.
Some progress, and a push for more
There are reasons to be optimistic about the state of the public health campaign. The rate of teenage vaping declined between 2019 and 2022, and the state has partnered with organizations devoted to helping young people and members of different identity groups quit.
Still, the Tobacco-Free students believe the state needs to do more.
Berhe and Naveen both support a bill to ban the sale of flavored tobacco products statewide, but the bill is currently stalled in the state Legislature. Without sweeping reform, they argue, it’s only a matter of time before the tobacco industry responds to litigation and changing consumer habits with new technologies and marketing.
“I feel like there’s probably a different product that’s going to be created with different synthetic nicotine that’s now being produced,” Berhe said. “It’s kind of a cycle.”