We Still Excommunicate JUUL Labs (Updated)

(Editor's Note:  Twenty-One Debunked has never been affiliated in any way, shape or form with JUUL Labs or any other vaping, tobacco, alcohol, or cannabis company.  And we never will be, either.)

Dear JUUL Labs,

Since you were founded in 2015 as a spinoff from Pax Labs, you have always presented yourselves, at least publicly, as the underdog saving the world in the fight against the evil Big Tobacco.  Little did America know that you were about to pull the wool over everyone's eyes and make fools, and then cynics, of us all.

Why do we hate thee, JUUL?  Let us count the ways:

• You loudly proclaimed yourselves as the sworn enemy of Big Tobacco, but you began to copy their playbook awfully quickly in terms of advertising to young people and cynically implemented your own "anti-vaping", "anti-tobacco", and "holistic health education" progams in schools and youth camps. (You claimed that was just an oversight.  Riiiiiiight.)
• Your sham "educational" programs even told teens that your products were "totally safe" yet for "adults only" (wink wink).  And some of your summer camp programs apparently targeted children as young as eight years old.
• You recruited social media influencers with slick advertising campaigns that at least gave the appearance of deliberately targeting young people in marketing your products.  You also went out of your way to target Native Americans with your addictive poison-peddling as well.
• You chose a much higher nicotine level for your products than other vape brands, by far.  And your patented nicotine salt formulation clearly gives a much bigger "kick" of nicotine as well.  That was most likely to try to edge out the competition, and it worked--at the expense of a new generation of nicotine addicts, that is.
• You lowered your nicotine content when selling JUUL in the European Union and Israel (who by law set the maximum allowable nicotine content of vape products much lower than the American version of your products), but curiously still do not offer such reduced-nicotine products in the USA, or any nicotine-free products.
• You gave your products various kid-friendly fruity, candy, and dessert flavors, because reasons.  Or something.  I mean, we all know that adults need their nicotine vapes to taste like candy in order to help them quit smoking, right?
• Until very recently, you failed to adequately warn users that your products contain nicotine and are highly addictive.  Many young people did not even know that all JUULs contain nicotine, let alone such a high level of it.  And some still may not know yet.
• In fact, if anyone were to deliberately design the most effective and efficient way to surreptitiously get young people hooked on nicotine in the 21st century, it would really look an awful lot like JUUL.
• When the FDA finally blew the whistle on you in late 2018, you responded in the most cowardly way possible.  You decided to throw young adults under the bus by calling for the age limit for vaping products to be raised from 18 to 21, and you banned 18-20 year olds from your website.  And you still made no significant changes to your highly-addictive products, save for the removal of a few flavors in stores.
• And worst of all, you literally SOLD OUT to Altria Group (aka Philip Morris), whose name is literally synonymous with Big Tobacco.  You know, the evil industry you once claimed to be fighting against?  Your deal with the devil may have made you richer and bought you some temporary protection, but everything comes with a price, and your day will come very soon.
• Finally, thanks primarily to you, young people are losing even more rights now.

Thus, in light of the above grievances, we hereby excommunicate you, forever.  Here is your bell, book, and candle, you cowardly quislings.  Now go take your crack nicotine and shove it!

We at Twenty-One Debunked urge everyone to #BoycottJUUL yesterday.  If you don't currently smoke, vape, or otherwise use nicotine, don't start!  You are far better off without this highly addictive poison in any form, period, even if vaping does reduce most of its other toxic chemical satellites and byproducts compared with smoking.  But if you currently do, make it any brand but JUUL, and give 'em a swift kick in the margins!  And best of all, JUULers who switch to other vape brands may find it easier to phase out and finally quit all forms of nicotine for good.

New Tobacco 21 Study Leaves Us With More Questions Than Answers

A new and very preliminary study of recently-passed Tobacco 21 laws appears to find that such laws significantly reduce tobacco smoking (both recent smoking and current and established smoking) by as much as 39% among 18-20 year olds.  The study looked at survey results of 1869 18-22 year old young adults in 2016-2017 in 48 states and DC (excluding New York and Massachusetts), and compared those in states and localities that raised the tobacco age to 21 versus those that did not, and further compared 18-20 year olds versus 21-22 year olds, after adjusting for potential confounders such as cigarette taxes as well as demographics and parental and peer smoking.

However, there are still reasons to be skeptical of these findings:

• Correlation is not causation, and there may still be selection bias, reporting bias, and residual or unmeasured confounding.
• Only a few states and localities had an age limit of 21 for tobacco in 2016-2017, especially when New York and Massachusetts are excluded.
• In some of these few Tobacco 21 states/localities, the number of individuals surveyed was in the single digits.
• Even if these results are 100% due to the hike of the age limit to 21, the study may only be measuring short-term effects since the laws are so recent and only data from 2016-2017 were used.  More longitudinal data are needed.
• Such "early-adopter" effects may not be generalizable or durable, as we saw with the 21 drinking age according to Miron and Tetelbaum (2009).
• Data were collected from November 2016 through May 2017, and yet New Jersey was listed a Tobacco 21 state even though their law didn't go into effect until six months later in November 2017.  Thus, we noticed at least one potential coding error.
• California raised the cigarette tax significantly as of April 1, 2017, within the period of the study.  And Illinois and Chicago have raised their cigarette taxes several times in the years before and after Chicago's Tobacco 21 law that was implemented in 2016.
• Smoking was already on the decline nationwide long before any Tobacco 21 laws were passed, and the data are not adjusted for pre-existing trends.
• Vaping was not examined in this study, and in any case all of the data was from before the JUUL craze came on the scene.
• And most importantly, the study did NOT look at people under 18 at all.

Thus, these results are preliminary at best and need to be taken with at least a grain of salt, if not a whole pound.  Especially since, as we previously reported, according to the YRBSS data there is really no robust correlation between high school smoking or vaping rates and whether the smoking/vaping age is 18, 19, or 21.  And even in this new study of 18-22 year olds, the effects were limited to only those who had already tried cigarettes before, and that typically occurs well before 18.  But wait, isn't the strongest pro-21 argument that Tobacco 21 laws would reduce smoking (and vaping) among people under 18?

And for what it's worth, there is no evidence that Tobacco 21 laws (all of which now apply equally to vape products, by the way) have done anything to reduce the JUUL craze that began in very late 2017 and apparently continues unabated to this day in all states and localities regardless of the age limit.

Also, it just so happens that yet another recent and preliminary study was done, this time longitudinally using BRFSS data of 18-20 year olds from 2011-2016 compared to 23-25 year olds, and comparing the local tobacco age limits by metropolitan/micropolitan statistical area (MMSA).  This study, which was driven by even earlier adopters (mainly city and county-level Tobacco 21 ordinances), did find statistically significant reductions in current established smoking by 18-20 year olds that were not found for 23-25 year olds.  But the devil is really in the details, since the effect size was rather small (1.2 percentage points, and at most 3.1 percentage points in some models) for practical purposes, and may still have been driven by reporting bias, selection bias, and/or differential sensitivity by age to tobacco tax hikes at the same time.  And given how effect sizes for later adopters of any given policies tend to shrink over time compared to earlier adopters, these results do not look particularly encouraging.  Especially since a cursory look at the trendlines in the study finds that the slight divergence in smoking rates that emerges in 2014-2015 re-converges and essentially disappears by 2016, suggesting that the findings are likely driven by short-term effects rather than longer-term effects.

Bottom line:  it looks like the supposed benefits of raising the smoking/vaping age to 21 were, shall we say, all smoke and mirrors, at least for people under 18.  The supposed success of Needham, MA, for example, was likely a statistical fluke and/or a result of endogeneity, much like the "early adopter" effects of the first few states to raise the drinking age to 21 creating that particular mirage in the 1980s.  Or perhaps increased enforcement in general relative to neighboring towns did the trick regardless of the age limit, like it did in Woodridge, IL and several other communities the 1990s with an age limit of 18.  Studies show that whenever vendor compliance exceeds 90-95%, there is indeed a dramatic drop in teen smoking regardless, by as much as 50% compared with previously weak enforcement and low compliance rates, especially for the youngest teens.  More recent research bears this out as well, for teen smoking as well as vaping.   And keep in mind that those who make it to 18 without smoking are far less likely to take up this deadly habit later on.

This all should be food for thought for policymakers debating not just the age limit for tobacco, but also for alcohol, cannabis, or anything else for that matter.  And even if such benefits of the 21 age limit were real, we at Twenty-One Debunked would still not support an age limit any higher than 18, on principle alone.  Old enough to fight and vote = old enough to drink and smoke.  'Nuff said.

New York Raises Smoking Age To 21

Governor Andrew Cuomo of New York had to be a big shot, apparently.  Today on July 16, he finally signed the bill that raises the age limit for tobacco and vaping products to 21, effective 120 days from today.

When the lights went out on Broadway last Saturday, that was certainly an ominous sign.  And lest anyone think there is a consolation prize, Cuomo failed to even get weed legalized last month since he apparently couldn't even muster up the votes in the legislature to pass it.

Many counties and cities in the state, including NYC and now all of its "backyard", already set the tobacco/vape age limit at 21.  That of course includes my home county of Westchester, which raised it from 18 to 21 last year, and even Putnam County too.

The only silver lining is that the new age limit of 21, like the old age limit of 18, will only apply to vendors, as it will still not be illegal for "underage" people to possess or consume tobacco or vaping products.   But that still does NOT mean we should support it one bit!

With the "bookend" states of California and New York now down, plus several other populous and not-so-populous states, not to mention hundreds of localities across the country, and even our nation's capital, is our movement lost for good?  We sure hope not.  It looked like the Tobacco 21 movement had stagnated last year, but now with New York, Utah, Virginia, Washington State, Illinois, and Texas next to jump on the bandwagon, and soon the federal government as well, we clearly got way too complacent last year.  It certainly does NOT bode well for any near-future attempt to lower the drinking and toking ages to 18!

Hindsight is 2020, both the year and the vision.  There is still a slim chance that the America we know and love is not completely lost yet.  But that window is closing very, very fast.

The Smoking Gun? Not Exactly

A recent preliminary study from earlier this year by Catherine Orr et al. seems to be stirring the pot, so to speak.  Adding fuel to the already volatile tinderbox of moral panic around teen cannabis use, this study using brain scans appears to find brain changes in 14 year olds who have used cannabis only once or twice, compared with those who have never used it.  Specifically, those who had used it once or twice showed increased gray matter in various brain regions relative to those who did not, which, counterintuitively, suggests a disruption of the normal "pruning" process that occurs during adolescence (or something).  And of course, the MSM predictably just took it and ran with it.

Of course, correlation is not the same as causation, and there are still reasons to be skeptical of the findings and practical significance:

• The sample size was small:  46 people in each group.  Thus, very sensitive to potential selection bias, reporting bias, and confounding.  (Apparently from a larger brain study of over 2000 people, they could only find 47 individuals who had only tried cannabis once or twice by that age, and one had an inconclusive scan.)
• Another way that size matters is "effect size".  And while the numbers are difficult to interpret, they are also on the small side.
• Some underreporting of cannabis (and other substance) use is always very likely, and can skew results in either direction depending on what is being underreported and by whom.
• Temporality of the initial findings remains unclear (i.e. which occurred first?).
• No other study has ever found long-lasting brain changes from a single dose or two of cannabis, at least not in humans.  And no one has ever replicated these findings yet.
• Previous studies have been quite inconsistent in terms of the effects (or lack thereof) of cannabis use, even regular use, on brain structure, function, and cognition.  Some studies found increases in gray matter, others decreases, still others null.  Ditto for white matter as well.
• Given how the participants were European, it is particularly difficult to disentangle cannabis and tobacco use as the two substances are customarily mixed.  This is important because nicotine is a known neurotoxin to which the early adolescent brain appears to be exquisitely sensitive.
• The study apparently did not look at the brain effects of those who used cannabis but did not initiate until age 15 or older, so even if the effects are real, they may not necessarily be generalizable to people over 15.
• The practical significance of the findings is clear as mud right now.  Even the researchers aren't entirely sure what they mean.  Is it actually bad to have more gray matter, and compared to what exactly?  Is it disrupted brain development, or simply stimulated and enhanced neurogenesis?
• While greater gray matter in the study was correlated with differences in psychomotor performance contemporaneously for whatever reason, the only bad thing correlated with it two years later was generalized anxiety.  No other measures of psychopathology or performance were correlated at baseline or two years later.
• Come to think of it, if these 14 year olds were followed up two years later, why were their brains not scanned again a second time at 16, especially since there admittedly were many who were cannabis-naive at 14 who went on to use it two years later?
• And frankly, it really doesn't even pass the straight face test that a mere single dose or two of such a relatively mild psychoactive substance would be enough cause a long-lasting disruption to brain development, a process that occurs over several years.  To quote Paracelsus, "the dose makes the poison".  That, and Occam's Razor too.

Of course, the cliche that "more research is needed" certainly applies here, and the researchers indeed say as much.  They also plan to do a follow-up study as well in the near future.  Though if history is any indication, we should not hold our breath waiting for these results to be replicated.

Keep in mind that the infamous 2012 study that reportedly found persistently reduced IQs among adults who used cannabis before age 18, was debunked by 2014 study that found no correlation between adolescent cannabis use and IQ or exam performance (though heavy use beginning before age 15 was associated with slightly poorer exam results at age 16).  This latter study did control for tobacco, alcohol, and a host of other factors.  So it is very likely that soon another study will come a long and refute the first study discussed in this article, or perhaps find that any such effects are limited to the heaviest users, particularly those who began before age 15 or 16.  In fact, a 2018 systematic review of 69 studies of adolescent and young adult cannabis use and cognitive functioning found that reported adverse effects were much smaller in size than the prohibitionists like to claim, and generally tend to be temporary rather than permanent, even for frequent and/or heavy use.  And interestingly, no correlation with age of onset, though the mean age of study participants in these 69 studies was significantly higher than in the aforementioned Montreal study.

Other studies as well cast serious doubt on the scary claims of cannabis neurotoxicity as well, and most studies find weed safer than alcohol.

So what is the best takeaway from such studies?  It would seem that while occasional or moderate cannabis use is basically a non-problem, heavy and/or daily/near-daily use (unless medically necessary) should probably be avoided at any age, but particularly for people under 18 and especially under 15.  And while delaying the onset of use, or at least regular use, for as long as possible is probably wise for people under 18 and especially under 15, there is no hard scientific evidence that cannabis is any more harmful at 18 than it is as 21, 25, or even 30 for that matter.  Thus, there is no good reason to keep it illegal or set the age limit any higher than 18.  And even for people well under 18, the criminal law is still far too harsh a tool to apply to something like this that more likely than not turns out to be a non-problem.

The prohibitionist "scientists" and their pal-reviewers really seem to be grasping at straws now.  Apparently they think if they move the goalposts enough, they will score a touchdown.  But as we all know, that is not how science really works.

Cannabis Legalization NOT Associated With Increased Teen Use

After several years of recreational cannabis legalization in several states, on the heels of up to over two decades of medical cannabis legalization in even more states, a recent study once again puts the lie to the prohibitionist claim that legalization would result in increased teen use of cannabis among other things in their supposed parade of horribles.  In fact, the study found that recreational legalization for adults was found to be correlated with a significant decrease in both overall and frequent teen use, while medical-only legalization was not significantly correlated with teen use at all either way.  Thus, the study completely lays waste to one of the prohibitionists' strongest arguments.  So consider that perennial zombie lie dead as a doornail for good.

That said, Twenty-One Debunked, in living up to our name, would be remiss if we did not note that so far, all states that have legalized weed for recreational use thus far have set the age limit at 21 (in contrast to Canada, where it is 18 or 19 depending on the province, or Uruguay and the Netherlands, where it is 18) and the study only looked at the USA.  But given that 1) medical legalization laws (which were not correlated with teen use) generally set the age limit at 18 in the absence of parental consent and often have loopholes, and 2) other countries that set lower age limits have thus far not reported a significant jump in teen use in recent years, and 3) America's experience thus far with changes in the drinking and tobacco smoking ages, one can conclude that an age limit of 18 for recreational use in the USA is unlikely to increase teen use relative to either prohibition or a 21 age limit.  Thus, no good reason to set it higher than 18.