Tobacco 21 Laws' Benefits Are An Illusion

Another recent study found that while self-reported teen smoking and vaping rates declined after Tobacco 21 laws, biomarker exposure showed mixed evidence at best, implying that fewer young smokers are identifying as smokers (and similar findings for vaping).  Thus, the supposed reductions in smoking and vaping in surveys and sales data are at least largely an artifact of underreporting and cross-border shopping rather than real reductions.  Oops!

Looks like it was all just another mirage, kinda like with the 21 drinking age.  What next, a study that finds that water is wet and the sun rises in the east?

Case Closed: Tobacco 21 Laws Don't Work

The latest study of Tobacco 21 laws shows they were a resounding....DUD in terms or reducing young adult smoking, vaping, or smokeless tobacco use rates in the USA.  Being published in a famously anti-tobacco journal, Tobacco Control, the authors of course wanted to put a positive spin on it though nonetheless, as shown below (emphasis ours):  

Results Although we did not find evidence that state T21 laws were associated with cigarette, smokeless tobacco or ENDS [i.e. vapes] use overall, the federal T21 law was associated with lower use of all three tobacco products by 0.39–0.92 percentage points. State flavour restrictions were associated with lower use of cigarettes by 0.68 (−1.27 to –0.09) and ENDS by 0.56 (−1.11 to –0.00) percentage points, but not with smokeless tobacco. A three-way interaction revealed that state and federal T21 laws together were associated with a lower prevalence of ENDS use among 18–20 years, but there were no differences in cigarette use from both policies combined versus either alone.

Conclusion State and federal T21 laws are broadly effective at reducing adult tobacco use, while state flavour restrictions specifically lower use of cigarettes and ENDS.

Got that? The state level laws were useless, period, but the federal Tobacco 21 law passed in December 2019 was somehow "broadly effective" because it appeared to trivially reduce tobacco/nicotine product use by not even a full percentage point.  Never mind that that latter was not enforced until well into 2020, enforcement still remained spotty for a while, and that its passage coincided with two major confounds:  1) the EVALI (vaping illness) outbreak that, while clearly due to adulterated black market THC vape products, was fearmongered by the mainstream media to include all vape products, and 2) the COVID-19 pandemic that, for better or worse, seemed to discourage smoking and encourage quitting, since many people feared that smoking made them more vulnerable to the virus.  But no, it HAD to be due to the Tobacco 21 law, because reasons.  Or something. 

Even flavor restrictions were more effective than Tobacco 21 laws!

So how many IQ points did YOU lose from the mental gymnastics of reading all for the above quoted article abstract beyond the stuff in bold?  The study was behind a paywall of course, so we couldn't delve further into it, granted.  But even a cursory reading of the abstract shows that the Tobacco 21 laws are a joke, and not a very funny one at that.  And worse, it may have even driven some young vapers (back) to smoking, which would clearly be a net public health loss.  But try convincing the zealots of that!

These unimpressive findings dovetail nicely with other studies as well.  As for whether raising the tobacco/nicotine age limit from 18 to 21 reduces the use of such products among people under 18, the evidence for that is very weak and mixed at best.

As for the few previous studies that did appear to find statistically and practically significant effects from the Tobacco 21 laws, those apparent results are most likely a result of short-term effects as well as an artifact of confounders like cigarette tax hikes.  

(Cigarette tax hikes, which mean higher prices, are in fact one of the most effective and cost-effective ways to reduce smoking at the population level, though they still have their limits of course.  And while they may be classist, at least they are not ageist, and they don't blatantly violate anyone's civil rights.)

Regardless, even if Tobacco 21 laws were ever proven to be effective, Twenty-One Debunked would still oppose them on principle, as we believe that in a free society worthy of the name, civil rights inherently supersedes "public health".  That is true in regards to tobacco, alcohol, cannabis, or anything else.  

(Mic drop)

UPDATE:  A few older studies have found modest but significant decreases in retail tobacco sales following the raising of the smoking age to 21 in early adopter states like California and Hawaii.  And another study found no change in overall ever or current smoking among California 18-20 year olds, but did find a modest decrease in daily smoking among that age group relative to 21-23 year olds (whose daily smoking actually increased three years later) in the same state.  This of course echoes Miron and Tetelbaum (2009) as well as Asch and Levy (1987 and 1990), Males (1986), and Dee and Evans (2001) in regards to the 21 drinking age.  That is, endogeneity, early-adopter effects, short-term effects, and seesaw/delay effects all appear to be at play here.  The supposed miracle turned out to be a mirage all along, in other words.  Thus, especially in light of the most recent study discussed in this article, there were really no benefits that cannot be alternatively achieved with higher cigarette taxes and/or better enforcement of the previous 18 age limit, and if anything the 21 age limit appears to be counterproductive in the long run.

UPDATE 2:  Even the CDC's very own 2022 study found mixed and ambiguous effects of Tobacco 21 laws, and such effects sometimes even appeared to differ by race as well (in favor of whites, with null or even perverse effects on young people of color).  Oops!

UPDATE 3:  Another recent study found that while self-reported teen smoking and vaping rates declined after Tobacco 21 laws, biomarker exposure showed mixed evidence at best, implying that fewer young smokers are identifying as smokers (and similar findings for vaping).  Thus, the supposed reductions in smoking and vaping in surveys and sales data are at least largely an artifact of underreporting and cross-border shopping rather than real reductions.  Oops!

The Stupid Literally Burns Like Cigarettes

In Australia, there is quite a furor right now among the chattering classes in regards to a sharp increase in teen tobacco smoking from 2018 to 2023 after over two straight decades of decline.  And one of the things people are blaming is.....wait for it....vaping.  Because reasons.  Or something.  But there is one very glaring problem with this theory.  In Australia, vape products are technically legal, but ONLY if they do NOT contain any nicotine at all, thus kind of defeating the purpose.  That's right, nicotine vape products have never been approved for legal sales in Australia (and probably never will be any time soon), meaning anyone who wants to use them must either smuggle them in from abroad or buy them on the black market.  And interestingly enough, vaping itself also appears to be on the rise as well down under.  Thus, it truly takes a special kind of stupid to not only perversely create a situation where vaping and smoking both increase at the same time, but to then blame the increase in smoking on vaping.

Even more notable is the fact that in Australia, cigarettes have some of the highest taxes (and thus prices) in the world, plus so many other world-leading "best practices" tobacco control polices as well.  This additionally shows that while vice taxes and some other policies may work well to a point, all of these policies inherently have their limits in practice. 

Our working theory:  it is actually the banning of nicotine vaping, combined with the harmful effects of one of the strictest lockdown and Zero Covid regimes in the world, that ultimately snatched defeat from the jaws of victory in the long fight against tobacco smoking, particularly for youth.  And we must stress that while nicotine in any form is far from benign and definitely NOT for kids, banning or unduly restricting vaping (which is still significantly safer than the known deadly habit of smoking that it often displaces) is therefore a net public health loser of a policy.  And a policy like Australia's that perversely increases "dual use" of both is even that much worse still.

One could even argue that their truly massive cigarette black market created by their insanely high taxes, especially combined with their vaping black market from their nicotine ban, actually increased underage (under 18) use of both products since black market sellers typically don't ask buyers for ID.

Note also how the increase did not begin until 2020 (implicating the lockdowns as a contributing cause), and occurred for 14-17 year olds but interestingly NOT 18-24 year olds (putting the lie to the idea that their age limit of 18, as opposed to 21, was in any way related).  Also note that in England, where the age limit is still 18 and vaping is literally promoted by public health authorities, teen smoking continued its long decline through at least 2021.  New Zealand, where the age limit was still 18 (until very, very recently), smoking rates among 15-24 year olds nosedived as soon as nicotine vaping was officially legalized in 2020, despite an even stricter lockdown there.  Thus it seems to be the combination of 1) black markets, 2) vaping bans, and 3) lockdowns that is the cause of the jump in teen smoking in Australia.

But good luck trying to convince the nanny-state zealots to use even a little bit of common sense!

QED

Do Tobacco 21 Laws Really Work?

A recent study claims that Tobacco 21 laws work to reduce teen tobacco use.  But upon closer examination, there is less here than meets the eye.  While this new nationwide study controlled for a host of other variables and spanned from 2012-2019, it still leaves the reader with more questions than answers.  

For example, the supposed effect in survey data in grades 8, 10, and 12 was statistically significant for combustible cigarettes, particularly for grade 12, but NOT for vape products at any grade level, while for the Nielsen sales data the apparent effect was much larger for vape products than combustible cigarettes.  How exactly can this glaring contradiction be explained away?  Also, no significant effect was observed on heavy smoking, which intuitively should have had the largest effect size of all due to heavy smokers facing the greatest "hassle costs" when cigarettes become even somewhat more difficult to obtain.  And even for cigarette smoking in general, the absolute difference-in-differences was a few percentage points at most, for a substance whose popularity and prevalence was already declining among all ages long before the age limit was hiked to 21 (in contrast to vaping, which increased dramatically among young people during this period).

Furthermore, the study did not look beyond the first two years post-enactment of such laws, so any observed effects may very well be merely short-term effects (cf. Miron and Tetelbaum 2009 for the 21 drinking age and alcohol-related traffic fatalities).

Interestingly, the study authors do concede that at least some of the observed effect on people under 18 is a result of increased ID checking and increased perception of risk of of tobacco products.  Of course, we know that it is not really necessary to raise the age limit higher than 18 to achieve such effects.

Overall, this nationwide Tobacco 21 study (the second of its kind) was rather less impressive that an earlier nationwide study by different authors, for reasons that are not entirely clear.  But it is very likely a repeat of what we like to call "The Incredible Shrinking Effect Size", a phenomenon that we have seen before with studies of the 21 drinking age over time.  Which means that it was most likely a statistical mirage all along, at least in the long run.

Regardless of what sort of effects, or lack thereof, that Tobacco 21 laws supposedly had, we at Twenty-One Debunked nonetheless oppose such laws on principle 100%, just like we oppose the 21 drinking age and toking age as well.  Let America be America Again!

UPDATE:  A recent pro-21 article made a Freudian slip about what happened since Texas raised their smoking age to 21 in 2019:

"Since then, the use of tobacco by teens decreased from 21.8% in 2019 to 19.1% in 2021, according to the CDC and the American Lung Association."

That is NOT a particularly large difference in teen tobacco use (which includes both smoking and vaping), especially since teen vaping had already peaked by 2019 and teen smoking had already been plummeting for decades.  Technically, the latter data were from the 2020 Texas School Survey, not 2021, and the 2019 data were from the CDC YRBS, as each survey is done only every other year.  But either way, the point still stands.  In fact, when compared to the 2018 TSS data, the 2020 TSS data are almost identical.

2023 UPDATE:  The study in question has been recently revised, but not in a way that materially alters any of the above conclusions or criticisms.  In fact, reading between the lines, not only does the results look even less consistent and statistically significant than before, but now the effect size on survey results seems to be much larger for vaping than for smoking at all grade levels, implying that some vapers have likely switched to smoking.  That makes the Tobacco 21 policy a net public health loser.

2024 UPDATE:  A 2021 study of California, one of the first two states to implement a statewide Tobacco 21 law in 2016, showed weak and unimpressive numbers in a difference-in-differences analysis.  Womp womp.

Is There Really Any Link Between Vaping And COVID?

Is there really any link between vaping and COVID?  Most likely not, according the results of the largest study on the matter to date.  That study, done by the Mayo Clinic, found literally no correlation between vaping and being diagnosed with COVID.  And of course, the MSM was predictably crickets about that.

Not only that, they found that current combustible cigarette smokers were at a lower risk of contracting the virus.  That latter finding is rather puzzling until you consider something a bit esoteric that is frequently pointed out by Dr. Dmitry Kats:  some of the nicotine in tobacco, upon combustion (and also in the liver to a degree), turns into nicotinic acid, better known as Niacin (Vitamin B3) which he notes seems to really work wonders in curing and preventing COVID.  To achieve this same benefit without putting one's lungs in jeopardy, it would be better to simply take niacin directly, at least 500 mg at a time, along with cofactors Vitamin C (which gets depleted by smoking), Vitamin D, zinc, quercetin, thiamine (which also gets blocked by nicotine), B-12, magnesium, selenium, melatonin, and the amino acid lysine.  

So why did a previous smaller study seem to find that (younger) vapers were more likely to get COVID than non-vapers?  Well, smaller sample size can magnify any biases and confounders in a study, and one obvious bias is that younger vapers often share devices, which can clearly spread the virus.  They may also be more likely to attend parties that can turn into superspreader events.  But the act of vaping itself, while not exactly the healthiest habit in the world, does not appear to be directly causally linked to an increased risk of contracting the disease. 

Interestingly, even that previous smaller study of teens and young adults only found a correlation with "ever used" vape products, but NO correlation with recent use.  That is a rather strange finding for a study that purports to show a causal link to vaping.

As for the theory that people who got that mysterious vaping illness EVALI in 2019 and early 2020 were at greater risk of COVID later on, that may very well be true.  But we know now that it was primarily the result of black market THC (i.e. cannabis) vape products adulterated with questionable additives, most notably Vitamin E acetate.  And it is very telling that states where cannabis was legal for recreational sale in 2019 saw not only fewer per capita cases of EVALI than states where it was not, but also fewer COVID deaths as well.  Ditto for countries where cannabis was and still is fully legal (Canada, Uruguay) as well as where it is de facto legal (Netherlands) compared to their neighbors where it was not.  Thus, the lingering subtle lung damage from using tainted vapes several months prior may very well increase one's susceptibility to severe and fatal COVID, meaning that the cannabis prohibitionists whose policies created these black markets may have even way more blood on their hands than we thought.

But legal and untainted vape products, whether nicotine, cannabis, or otherwise?  The evidence that they significantly increase the risk of COVID simply isn't there, period.  Another myth bites the dust.

Et Tu, DeSantis?

Florida's controversial Governor Ron DeSantis (R) has been a bit of a mixed bag overall.  The True Spirit of America Party (TSAP) is, to put it mildly, not exactly a fan of Republicans in general and Trump supporters in particular, but has nonetheless generally agreed with his light-touch, focused protection handling of the COVID-19 pandemic, which has actually yielded a lower cumulative per capita death rate than the national average (and much lower than several lockdown states) despite Florida's significantly older and fatter population.  And in terms of excess all-cause mortality, wide-open Florida even did better than the overall strictest state of all, California.  There are some bad things about DeSantis of course, such as his latest Georgia-style voter suppression efforts and his heavy-handed and poorly-written anti-rioting law that arguably throws out the proverbial baby with the bathwater, but generally he is not too terrible by current low-bar Republican standards.

And of course, Twenty-One Debunked in particular has supported the fact that he was one of the most prominent holdouts in keeping the legal smoking age at 18 despite the trend towards raising it to 21 at the local, state, and eventually federal levels.  After all, he has previously opposed and vetoed every single attempt to raise Florida's smoking age any higher than 18.  Well, until now, that is.  Like most other governors, as of today, DeSantis has officially SOLD OUT and signed into law a bill that raises Florida's smoking and vaping age to 21, effective October 1, 2021.  True, this new law does have an exemption for military service members aged 18-20, making it a shade less bad than some other states, but we still oppose this law on principle like we oppose all inherently ageist Tobacco 21 laws, period.

One could argue that any state law that sets the age limit below 21 is effectively void since the federal smoking age has been 21 since December 2019, but that is beside the point.  A state that chooses to remain 18 in spite of the federal Tobacco 21 law is a principled state with integrity, and is at the very least NOT helping the federal government enforce such an ageist abomination.  Today, Florida lost that status.

DeSantis is now the 34th governor to raise the age limit for tobacco and vaping to 21, bringing it to now more than two out of three states who set it at 21.  With "allies" like him (and Trump, who raised the federal age limit to 21), who really needs enemies?

The Cannabis Black Market Has A Kill Switch, And We Know What It Is

We keep hearing over and over again that the black market for cannabis comtinues to persists despite legalization for several years in several states.  And we also are learning that this black market is selling notoriously tainted counterfeit THC vape products which are the primary cause of the "mystery" vaping lung illness now known as EVALI.  National legalization should really be a no-brainer at this point.

But why does the black market persist so tenaciously even in states like Colorado and Washington that have had legal recreational sales for over five years now?  The answer is overtaxation and overregulation, particularly in terms of retail licensing fees and quotas.  And the kill switch for the black market is thus really quite simple:

So what to do?  Cut the taxes on cannabis, yesterday, for at least a year or two before raising them again.  Consider a complete tax holiday for a few months, like Oregon did when legalization began there.  Ease up a bit on licensing regulations (and fees) for both producers and retailers.  Allow at least all liquor stores to sell weed alongside their booze, and further consider allowing any store that sells cigarettes to also sell weed as well, including grocery and convenience stores.  Lower the age limit to 18, yesterday.  Encourage current black market dealers to "go legit", by giving amnesty to unlicensed sellers and allowing them to obtain retail licenses.  And once these things are done, then crack down hard on what remains of the black market, particularly the illegal commercial growers and higher-ups in the illegal businesses and organized crime syndicates.

Problem solved.

And of course, fully legalize cannabis at the federal level as well.  Period.

Of course, once the black market is dead and gone, then by all means, tax away.  But now is NOT the time for overtaxation or overregulation.

So what should the tax on cannabis be?  To start with, we at Twenty-One Debunked believe it should be no higher that $10/ounce for bud and $2.50/ounce for trim at the production/cultivation level, with no other taxes aside from regular sales tax.  Consider a three-month tax holiday as well, like Oregon did in 2015.  Then, after the first year or two, the tax should be no higher than $50/ounce for bud and $15/ounce for trim, much like it is in Alaska today.  As for concentrates and edibles, those are best to tax based on THC content, e.g. 1 cent/milligram of THC.

Indeed, recent studies in both the USA and Canada do bear this out.  Allowing a legal alternative to the black market will out-compete with the latter, but only if the price of legal cannabis flower remains below about $14/gram.  Above that threshold, adult customers will readily switch back to the black market if it is the cheaper option, at least in the first few years post-legalization.

As for the price elasticity of demand for cannabis, that has been a controversial topic, but recent studies find that it is relatively inelastic at low prices, but becomes quite elastic at high enough prices, implying an "elastic zone" above some threshold (in one study, $15/joint, or about $30/gram based on the study's half-gram definition of a joint) for high-quality weed.

Interestingly, some other studies find cross-elasticity between alcohol, tobacco and cannabis among young people, such that raising the cigarette tax and even the beer tax can lead to reduced cannabis consumption.  Thus, any fears that falling cannabis prices will lead to more teen use can be addressed by simply raising the taxes on the other two substances in the meantime, before the cannabis black market is eradicated.  (Which will also decrease the use of alcohol and tobacco as well, by the way.)

Remember, there is really no good reason why cannabis needs to be regulated any more stringently than alcohol or tobacco.  After all, while it is not completely harmless for everyone, the fact remains that by just about any objective, rational, scientific measure, cannabis is safer than alcohol, tobacco, most prescription drugs, aspirin, and even Tylenol, while it is less addictive than coffee.  Thus our laws and regulations need to align accurately with reality, since facts > feelings, even in a "post-truth" society.

The Federal Smoking And Vaping Age Is Now 21 (Part Deux)

As we had noted a little over a week ago, Congress raised the federal age limit for the sale of tobacco and vape products from 18 to 21 as part of a must-pass budget bill to avoid yet another government shutdown, and on December 20, 2019, Trump signed it into law, and even had the GALL to brag-tweet about it.  And while Republican Senate Majority Leader Mitch "Awkward Turtle" McConnell, a big supporter of the age limit hike, was no doubt very pleased with himself for his "victory", we need to remember that both parties overwhelmingly supported it.  Tyranny is apparently as bipartisan as it is whimisical--and very cowardly as well.  And of course, Big Tobacco and Big Vape overwhelmingly supported it like the cowardly quislings that they are.

If that wasn't bad enough, it looks like the FDA isn't wasting any time in implementing the raising of the tobacco and vape product sale age to 21.  As of December 27, 2019, they officially noted on their website that it is now illegal to sell tobacco or vape products to anyone under 21.  They could have waited up to 180 days to formulate new regulations plus an additional 90 days before enforcing them, according to the new law, but apparently even that very small mercy is somehow beneath them.  And of course there is no grandfather clause either in this disgusting new law, nor will there be in the FDA regulations.  In other words, 18-20 year old young adults in a whopping 31 non-21 states (and several territories) who were legal to buy cigarettes and vapes just a week ago are suddenly banned from buying them now.  Talk about adding insult to injury!

And of course the new federal 21 law also applies just as much to our men and women in uniform, despite a few Tobacco 21 states having the small mercy to carve out an exception for them.  The new federal law has NO such exceptions, and is really a slap in the face of so many of our troops.  You know, kinda like the 21 drinking age has been for over three decades now.

The only silver lining to this ageist abomination is that it may very well anger enough Americans to challenge it in court, and if successful, we may get the two-for-one special of getting that other ageist abomination, the 21 drinking age, struck down as well.  And possibly even for cannabis too, though federally there is no such age limit (yet).  Otherwise, there is really no upside to this new law.  All it will do is effectively create an even more massive black market and greater disrespect for the rule of law.

In fact, it may very well drive many teen and young adult nicotine vapers back to smoking, since even with strict enforcement, regular cigarettes will be at least somewhat easier to get than vape products due to the difference in the size of the markets, general accessibility, and the design of the products.  Talk about a lose-lose proposition for public health!

As a wise man once said, "America will never be destroyed from the outside.  Rather, if we lose our freedoms, it is because we have destroyed ourselves from within."  That wise man, Abraham Lincoln, did not use those exact words it turns out, but his words came very close nonetheless.  And that (mis)quote turned out to be very prescient indeed, as America really seems to be rotting and rusting from within.

The song "21 Guns" by Green Day comes to mind, as does the song immediately following it on the same album, "American Eulogy".  And of course there's also Five Finger Death Punch, with "Stranger than Fiction":

"It's stranger than fiction, how [we've] decayed..."

The Vaping Lung Illness Mystery Has Been Solved

Looks like the "mystery" vaping lung illness (now called EVALI) has been largely solved.  And the primary culprit is indeed the same one that Twenty-One Debunked and many others had long suspected several months ago:  Vitamin E Acetate, a common additive found almost exclusively in black-market and counterfeit THC (and probably some gray-market CBD) vape cartridges.  Though harmless when ingested orally or applied topically, when inhaled it is apparently a different story:  this "thick and greasy" oil, and perhaps also its byproducts upon heating it to high temperatures, can indeed cause serious lung damage, and quickly.  It certainly does NOT belong in the lungs at all!  And both samples of vape cartridges as well as (more recently) samples of lung fluids taken from EVALI patients now confirm such suspicions, as noted recently by the Centers for Disease Control (CDC).  But we could have told you that a while ago.

The illness was apparently quite rare before June 2019, when the epidemic apparently exploded, peaked in September, and sharply declined thereafter.  In other words, this was not a trend, this was an event.  Something had clearly changed about vaping between 2018 and the first half of 2019.

Prior to 2019, Vitamin E Acetate was not widely used in THC vape products, whether legal or illegal, and according to cannabis industry insiders it first emerged as a cutting agent for products made in late 2018 at the earliest.  It may very well have been used before that, but if it was it was too rare to be of any concern or on anyone's radar.  But then, the black-market and counterfeit THC vape product purveyors discovered that this cheap additive can be used to dilute (or "cut") the expensive THC distillate oil while (unlike with other, thinner cutting agents) still maintaining a thick enough consistency to fool unsuspecting buyers into thinking it is purer than it really is, and thus greatly increasing the profit margins.  Yes, you read that right--for filthy lucre.  And they now have a ton of karma to answer for.

And while there apparently have also been some bad actors in the legitimate cannabis market that used this additive here and there, the fact remains that it has been quite rare overall.  And there is still no evidence that Vitamin E Acetate was ever used in any nicotine-containing vapes, whether legitimate or counterfeit.  (Note that those EVALI patients who reported "only nicotine" vaping and not THC may not have been entirely honest.)  In other words, it is fundamentally a black-market and counterfeiting problem that is best solved with legalization and sensible regulation, not blanket prohibition or overregulation.

There may very well have been other additives to blame as well, along with heavy and hard metals leaching from the heating coils of janky devices.  And perhaps some statistical flukes thrown in for good measure.  But these other minor culprits are basically sideshows compared with Vitamin E Acetate, and again the best solution is legalization and regulation of such products and devices, not prohibition.

Of course, that would make too much sense.  But truth is always the first casualty in any moral panic.

And really, SHAME on anyone (politicians, pundits, regulators, and activists) who cynically and disingenuously used the horrendous and hellish suffering of the over 2500 EVALI victims (and over 50 deaths) as a ploy to push their hateful and regressive prohibitionist agendas, while essentially hiding or denying the real cause of the illness for several months, before finally admitting it well after the epidemic had peaked.  You had a chance to save so many lives and prevent so much suffering, but you chose to sit on it, because reasons.  You now have just as much blood on your hands as the aforementioned bad actors that chose to adulterate their products with questionable additives for filthy lucre.  What you did was unforgivable in our view, but you now have a chance to make amends (albeit belatedly) to keep your karma from getting any worse.  So what are you waiting for?  Legalize and regulate yesterday!

JANUARY 2020 UPDATE:  The latest CDC report confirms yet again that the vast, vast majority of EVALI patients, among those for whom data is available, reported obtaining THC vapes from "informal" sources.  And while the anti-legalization lobby seized upon the finding that 16% of those reporting THC vaping reported obtaining their products from "commerical" sources, keep mind that that figure also includes unlicensed pop-up shops that may appear legitimate but are not, and there is always the possibility of recall bias when more than one product is used or shared.  Again, the real solution is to legalize, regulate, and root out the bad actors, not to categorically ban cannabis or vaping.

Though relatively rare, Vitamin E Acetate  has recently been found in some legal THC vape cartridges on the shelves of licensed dispensaries, including medical dispensaries upon testing, at least in Michigan.  A product recall was rightly issued.  Another state that bothered to test for it, such as Massachusetts had found none of that additive in their legal products, but had temporarily quarantined their products in November so they could be tested before reaching consumers.  This is how the system of quality control is supposed to work, and far better than the black market, which has ZERO quality control.

(For those who are interested, the hypothesized underlying chemistry of how exactly Vitamin E Acetate can cause EVALI can be found here and here.  Once thought to be lipoid pneumonia based on a handful of case reports, it turned out to be more like chemical burns in the vast majority of cases.)

The Federal Smoking And Vaping Age Has Been Raised To 21

Well, it's now official.  As part of a must-pass budget bill to avoid yet another government shutdown, Congress attached several provisions unrelated to spending, most notably a rider that hikes the federal age limit for the sale of tobacco and vape products from 18 to 21 nationwide.  And on December 20, 2019, Trump signed it into law, and even had the GALL to brag-tweet about it.  And while Republican Senate Majority Leader Mitch "Awkward Turtle" McConnell, a big supporter of the age limit hike, was no doubt very pleased with himself for his "victory", we need to remember that both duopoly parties overwhelmingly supported it.  Tyranny is apparently as bipartisan as it is whimisical--and very cowardly as well.

For practical purposes, the new age limit actually takes effect after 180 days plus an additional 90 days, meaning an effective delay of nine months from the date of signing.  Thus, by September 2020, Tobacco 21 will have been fully phased in nationwide.

The text of the new federal Tobacco 21 law does two things:  1) amends the Family Smoking Prevention and Tobacco Control Act of 2019 by changing "18" to "21", and 2) while it technically no longer forces states to change their own laws (unlike the original version), nonetheless amends what was once called the Synar Amendment by requiring states to enforce (against vendors) the new federal age limit of 21 for the sale of tobacco and vape products, in order to quailfy for certain substance abuse prevention grant monies.

Though weaker than its original version, it is that second provision that may prove to be the Achilles heel of this law if it were to be challenged in court, on both Tenth Amendment as well as Fourteenth Amendment.  And if such a challenge ever proves successful, it will no doubt also overturn South Dakota v. Dole, and the National Minimum Drinking Age Act along with it.  But until then, it is long past time to be very, very angry at what passes for "leadership" in America's long, dark night of the soul.

Winter is coming, in more ways than one.

UPDATE:  Looks like the FDA isn't wasting any time in raising the tobacco and vape product sale age to 21.  As of December 27, 2019, they officially noted on their website that it is now illegal to sell tobacco or vape products to anyone under 21.  FEH.

The Anti-Legalization Movement Is Grasping At Straws Now

The anti-legalization movement in regards to cannabis has been getting quite desperate lately.  For example, Kevin Sabet of the anti-legalization group Project SAM has lately been disingenuously harping on the mystery vaping illness (now called EVALI) and shifting the spotlight onto legal cannabis vape products from licensed dispensaries while glossing over that inconvenient fact that the vast, vast, majority of the over 2000 EVALI cases so far are linked to black-market and counterfeit THC vape cartridges (as well as sketchy gray-market CBD vape cartridges).  In fact, non-legalization states have had far more EVALI cases than legalization states, though no state seems to be immune to it.  And the primary culprit appears to be Vitamin E Acetate (and possibly other questionable additives), and perhaps even the heavy metals from janky devices, as opposed to the actual cannabis itself, though he slyly glosses over that as well.  The biggest irony, of course, is that banning legal cannabis dispensaries will only drive even more consumers to the black market, thus pouring gasoline on the raging fires of EVALI.

In other words, Kevin Sabet and Project SAM are nothing more than concern trolls, and need to be taken with at least a grain of salt, if not a whole pound.  While there have been a few outlier cases of EVALI ostensibly linked to legal cannabis products from licensed dispensaries in some states, most of these cases remain either unconfirmed and/or the use of black market, counterfeit, or modified vape products has not been entirely ruled out in such cases.  To the extent that any of these are in fact caused by rogue and adulterated products from bad actors in the legitimate cannabis market, the solution is better regulation and oversight, NOT prohbition.

(In the meantime, it is probably best for the time being for current cannabis vapers to switch to dry-herb vaporizers, which have never been linked to EVALI or any other illness, to vape regular weed if you don't want to smoke it, just to be on the safe side.  Or at the very least, do your research and due diligence, and avoid all black-market, counterfeit, janky, suspect, and/or modified products like the plague.  And there are also edibles and tinctures.)

Oh and by the way, the anti-legalization movement is apparently also tainted with some thinly- and not-so-thinly-veiled anti-Semitism as well.  Not everyone of course, but as the Labour Party in the UK has unfortunately learned the hard way, failing to condemn it, turning a blind eye to it, or even creating a mere perception of same, has the same impact as deliberate and overt Jew-hatred and Jew-baiting does, and we know impact > intent.  And of course, the anti-Semitism in the broader cannabis prohibitionist movement goes back to at least Nixon and his notorious red-baiting and Jew-baiting conspiracy theories, while the movement's virulent racism and xenophobia in general goes all the way back to the very genesis of the movement over a century ago.

To be fair, there is no evidence that Kevin Sabet (or Project SAM in general) personally holds any anti-Semitic or racist views, with their only known bigotry being against cannabis and its users.  But in the broader cannabis prohibitionist movement today, others like Roger Morgan et al. DO apparently hold enough anti-Semitic views to be willing to openly repeat (if not concoct) long-since debunked anti-Semitic conspiracy theories (mainly involving George Soros) all the same, and the silence from Sabet and Project SAM (who just so happen to also share a connection with Morgan) is truly deafening indeed.

To the cannabis prohibitionist / anti-legalization movement, we have one question for you:  how does it feel to be on the wrong side of history?  Because we wouldn't know anything about that.

Pennsylvania Raises Smoking Age To 21

It's official, Pennsylvania just raised the legal age limit for tobacco products from 18 to 21, effective July 1, 2020, making them the 19th state (and counting) to do so.  And the new law also expands the legal definition of tobacco products to include vaping products as well, since apparently they didn't even have an age limit for vaping products at all (though the federal age limit of 18 applied by default from 2016 onwards).

The part about including nicotine vapes in the definition of tobacco products is totally reasonable.  But raising the age limit to 21 is really not justified at all.  And Pennsylvania had been seeing so much progress in reducing teen smoking and vaping already, mainly due to tax hikes on both.  It would really be a shame to risk derailing such progress now with such an utterly illiberal and ageist law.

Yes, there is an exception in the new law for active military and veterans, who only need to be 18 or older instead of 21 to buy tobacco products.  But that one silver lining does still not make it OK to deny adult rights to otherwise legal adults over 18 who are legally old enough to join the military, regardless of whether they are actually in the military or not.  Thus, the exception does not actually resolve the inherent ageism and hypocrisy of this otherwise bad law.

I like to joke about "the other Tri-State Area", where NY, NJ, and PA all meet.  Port Jervis, NY, Montague, NJ, and Matamoras, PA are all right next to each other, and Matamoras is basically "come for the fireworks, stay for the cigarettes", since fireworks are legal in PA to sell to nonresidents, cigarettes are cheaper in PA, and the age limit in PA for tobacco has been 18 (until July 2020) while it is 21 in NY and NJ.  Looks like the tobacco part of that equation will no longer be true, at least the age limit part, and the price difference is also narrower now for cigarettes, and reversed for vape products, due to the tax hikes.  And gas is also more expensive now in PA than either of the other two states, while NJ gas is almost as pricey as NY now.  Thus the whole microeconomic dynamics of "the other Tri-State Area" are fundamentally different now, except for the fireworks of course.

HALF Of America Now Has A Smoking/Vaping Age Of 21

As of July 2019, HALF of the American population now lives in jurisdictions with a tobacco/nicotine smoking/vaping age of 21 now.  It is a total of 18 states as of September 2019, and hundreds (if not thousands) of localities, and given the population distribution it adds up at least half of the population living in such places.  And now Pennsylvania, currently 18 statewide (with none of their localities setting it any higher), but soon to be surrrounded on all sides by states with an age limit of 21, unfortunately looks to join them as well.

That is a shame, since Pennsylvania has seen more progress than the national average in terms of reducing teen smoking (and less of an increase in teen vaping) in recent years, while the increase in teen vaping continues unabated nationwide regardless of the states who raised the age limit to 21 in recent years.  Pennsylvania raised their cigarette tax and implement a hefty vape tax on recent years, so that could be part of their relative success story.

UPDATE:  As of November 27, 2019, Pennsylvania raised their smoking age to 21, effective July 1, 2020.  And New York's hike to 21 has just gone into effect in November as well.  Thus, now MORE than half of the American population (and growing!) lives under a Tobacco 21 regime now.

In The UK, Cooler Heads Still Prevail When It Comes To Vaping

With all of this mass hysteria going on in the USA over vaping, we should keep in mind that our friends across the pond in the UK are generally NOT freaking out about it.  So what is so different over there?

First of all, regulation of advertising and promotion of vaping products is stricter in the UK.  Also, the nicotine content of such products is capped at a level significantly lower (as much as two-thirds lower) than the average of today's leading brands in the USA.  Even when those very same brands, most notably JUUL (aka "may their name and memory be forever blotted out"), are sold in the UK, they have to reduce their nicotine levels to be able to sell them there.  That, of course, is an EU-wide regulation, binding on all member states including the UK (at least until Brexit, just to Regrexit, if finalized).  The dose makes the poison, basically, and capping it greatly reduces (though does not eliminate) adverse side effects, not to mention the chances of young experimenters becoming addicted to nicotine so disturbingly quickly.

Also, the age limit is 18 over there (strictly enforced on vendors, just like regular cigarettes and alcohol), and there are no flavor bans either.  If anything, they seem to have an even wider variety of flavors.

Public Health England (PHE) certainly does NOT recommend that non-smokers ever take up the habit of vaping, but they do encourage current adult smokers to switch to vaping if they can't quit nicotine otherwise.  And they caution vapers not to vape any illicit or homemade products or add anything to the legitimate pods or liquid. Overall, authorities and the public health community keep a cool head about vaping, and guess what?  In the absence of moral panic, there does not seem be any real vaping epidemic among young people over there, and while there have been occasional reports of adverse reactions in general, there so far have not been any reported cases of the mystery vaping-related lung illness that the USA is currently grappling with.  (Of course, as we have already noted before, that mystery illness is primarily due to unregulated black-market vape products, especially THC ones, which often contain very questionable additives.)

That’s not to say that nobody is freaking out over there at all.  Every country has its share of that it seems.  But over in the UK at least, it currently seems to be confined to the tabloids for the most part.

We can really learn a lot from our friends across the pond.  So let's be adult about this, shall we?

Calling It QUITS

There is a new bipartisan bill in Congress now, called the Quell Underage Inhaling of Toxic Substances (QUITS) Act.  And to be honest, it is a mixed bag overall.  It would:

• Ban flavored e-cigarettes (i.e. vape products) and other flavored tobacco products, including menthol.
• Increase the federal cigarette tax from $1 per pack to $3 per pack.
• Create a tax on e-cigarettes equivalent to $3 per pack.
• Increase annual funding for the CDC's Office of Smoking and Health from $210 million to $500 million.

The first item on the list, the flavor ban as we have noted before, is too broad and largely due to the moral panic around vaping these days.  Throwing out the proverbial baby with the bathwater is likely counterproductive, and slopes are slipperier than they appear.  other items on the list are overall a good idea though.  At least all of these also apply to, and does not ignore, the real elephant in the room:  combustible cigarettes and other combustible tobacco products, which kill over 480,000+ Americans per year, while vaping has killed eight people so far in all of its history, and even then, mostly via black-market THC products rather than legitimate ones.  And while even one such death is one too many, compared to combustible cigarettes, that's essentially a mere rounding error in statistical terms.

Another strength is that it does not raise the age limit for tobacco or vaping products at the federal level.  And that, Twenty-One Debunked is happy about.

So what can be added to the bill to improve it, while also removing or narrowing the flavor ban?  Here are some of our ideas:

• Cap and reduce the maximum allowable nicotine content of vape products down to current European and Israeli levels. 
• In fact, while we're at it, cap and gradually phase down the maximum allowable nicotine content of combustible cigarettes down to a non-addictive level as well.
• Tax vape products in a manner that is directly proportional to nicotine content.
• Enforce better (targeting vendors) the current federal age limit of 18 for both vaping and combustible tobacco products.
• Restrict advertising of vape products, similar to how it is for combustible tobacco products.
• Actually REGULATE the vaping industry, and require quality control testing.
• Crack down on black-market and counterfeit vape products, and root out any bad actors in the legitimate market as well.
• Legalize and regulate cannabis at the federal level, and implement strict quality control standards as well for both cannabis as well as tobacco/nicotine products.
• Require ALL vape products, whether nicotine, THC, CBD, or otherwise, to transparently disclose all ingredients, and immediately ban the use of questionable additives believed to be linked to the outbreak of the mystery vaping illness.

Let's be adult about this, shall we? 

When It Comes To Vaping, Don't Throw Out The Baby With The Bathwater

In the wake of both the mysterious vaping-related lung illness epidemic, and also the recent increase in vaping among young people (something for which Tobacco 21 laws have apparently done NOTHING to stem the tide, by the way) both the federal government and several state and local governments are beginning to crack down on vaping to one degree or another.  Yes, Houston, we have a problem.  But it is important to keep a cool head and not throw out the proverbial baby with the bathwater.

The FDA plans to ban all flavored vape products other than tobacco (yuck!) or unflavored (meh), as is Michigan.  San Francisco, on the other hand, already passed a ban on ALL vape products regardless of flavor.  The state of New York just passed an emergency executive ban on all flavored vape products other than tobacco or menthol, effective October 4th.  And California's governor announced a crackdown on counterfeit vape products, though he lacks the authority to pass any flavor bans without the state legislature passing it.

Going too far with such bans would only increase the very black market that is the most likely cause of the mystery vaping illness (though with that it is mostly black-market THC products, though some appear to have been nicotine only).  At the same time, while vaping can help some adult smokers quit, it's not like there really is any overarching benefit society from nicotine that comes in fruity, candy, or dessert-like flavors either.  It really is a balancing act.

Twenty-One Debunked once grudgingly supported some degree of flavor bans in the past, mainly as an alternative to Tobacco 21 laws, but in light of current events, we no longer support such bans today.

New York's flavor ban--if there must be one at all--is somewhat more reasonable than the ones that don't even allow menthol.  And clearly counterfeit products need to be cracked down upon, and bad actors and questionable additives rooted out at once.  And capping and reducing nicotine levels of vape products down to European and Israeli levels would also make such products less addictive than they are currently.  But anything more stringent than these things would likely do more harm than good.  (That goes for setting the age limit any higher than 18 as well.)

As for cannabis vaping products, the best way to eradicate the sketchy and janky black and gray market products is to fully legalize and regulate cannabis nationwide, period, with an age limit of 18, strict quality control, and reasonable taxes on such products.  And again, crack down on counterfeit products and products with questionable additives.  But that would make too much sense, wouldn’t it?

So let's be adult about this, shall we?

UPDATE:  Looks like Michigan's emergency executive flavor ban contains a loophole that allows flavored nicotine-free e-liquids and pods, and also allows flavorless nicotine packets one can combine with such e-liquids (albeit sold separately).  So this particular ban is actually far more reasonable than meets the eye, while still having the intended effect of making it somewhat harder and less convenient for people under 18 to vape flavored nicotine.  And it will likely keep vape shops open for business for the foreseeable future, while JUUL will still get a swift kick in the margins now that their ready-made pods will be verboten if they have any flavor other than tobacco.

And at the other extreme, on September 24th, Massachusetts Governor Baker has literally banned ALL vape products for four months by an emergency executive action.  And that will just throw gasoline on the fire by dramatically growing the black market. DERP!  Didn't think that one through, did you Charlie?

JUUL Is Circling The Drain

Looks like JUUL Labs just bit off far more than they could ever possibly chew, and they are now choking on it as we speak.  These quislings have asked for a ton of karma for years now, and now they seem to be getting it.  Their share price is in warp-speed decline right now.  As per the famously time-tested Seneca effect, their growth was relatively slow at first, but it looks like their ruin will be very, very rapid indeed.

First, they managed to get a new generation of young people hooked on nicotine with a sleek, deceptively seductive, fruity- and candy-flavored product (with excessively high nicotine levels, and more addictive than conventional cigarettes) and even more deceptive, Big Tobacco-style marketing, all while bragging about how supposedly "woke" they were.  Then they made a deal with the devil himself, Big Tobacco, when they literally SOLD OUT to them.  And then when these cowardly quislings were finally called out on their misdeeds, they threw 18-20 year olds under the bus by supporting the ageist abomination that is Tobacco 21 laws.  They even threw the rest of the vaping industry under the bus as well.  At the end of the day, they are really nobody's friends, never were, and never will be either.

And now with that mysterious vaping-related illness reaching epidemic proportions, albeit most likely driven by black-market products with questionable additives, as well as homebrew concoctions and modified devices (though JUUL still has yet to be exonerated), the moral panic around vaping that JUUL effectively helped to create has reached such a fever pitch that the Trump administration (and several states) are passing or at least considering flavor bans for vape products.  That will be the final kiss of death for JUUL, since most of these proposed bans will only allow tobacco-flavored products (yuck!) or unflavored products (meh), not even menthol or mint.  Even if the ban is later lifted, if (when) it passes they are basically dead and done by that point.

And if that itself doesn't ultimately bankrupt them, the mounting lawsuits against them sure will.

Now a corporate "person" without a country, what ever will they do?  (Plays the world's smallest violin)

Somebody call the coroner quick, JUUL is now circling the drain as we speak.  Let's hope they take their Big Tobacco parent company, Altria (aka Philip Morris) down with them as well.  And no, we will never, ever mourn their loss, not in a million years.

Good riddance! May your name and memory be forever blotted out, JUUL.

UPDATE:  As of September 25, 2019, their CEO, Kevin Burns, was essentially forced to resign, replaced with a Big Tobacco executive from Altria, and they pulled all advertising from the USA.  And the company agreed to accept the flavor ban as well.  And now they are embroiled in a criminal investigation as well.

About That Mysterious Lung Illness Related To Vaping

There have been recent reports of a mysterious lung illness that appears to be linked to vaping.  Fingers are being pointed all over the place right now, since it is still not clear exactly what (let alone which products) are causing it and why.

Here's what we do know so far.  As of the end of August 2019, there have been over 200 possible cases of severe lung illness and/or damage (and even one reported death) in the USA that may be linked to vaping, though the symptoms haven't always followed a consistent pattern.  Not all cases have been confirmed, and it all still needs to be fleshed out and other variables accounted for, but vaping of some sort is the only factor that we know is common to them all.  And it's not just young people either (though many of them are), as even people in their thirties have reportedly also succumbed to it as well.

Many, but by no means all, of the cases involved vape products containing THC (i.e. the primary psychoactive component of cannabis), and virtually all of those had been purchased on the black market (mostly in non-legalization states) based on what we know so far.  And as much as JUUL Labs wants to believe and assert it, this does NOT yet automatically exonerate nicotine-containing vape products such as theirs.  And no one should pretend that it does.

(Separately, there are also three recent reports of seizures thought to be linked to the JUUL brand specifically, presumably due to their very high nicotine content, so they really shouldn't be so smug.)

It is important not to create or fan the flames of a moral panic about vaping in general, as that is likely to be counterproductive.  Much more research is necessary until we know more.  So what advice should be given in the meantime?

• First and foremost, do NOT vape anything that you get from the black market, whether it's THC or otherwise.  They are inherently unregulated by definition, with no quality control, and thus you really don't know what you are getting.
• Especially avoid the pseudo-legitimate sounding (but actually always black market) THC brands "Dank Vapes", "Chronic Carts", and "West Coast Carts".  Avoid them like the plague!  (Ditto for the apparently very bad actor, gray market CBD brand "Diamond CBD" as well.)
• Do your research and due diligence before buying any vaping product on the legitimate market as well.  Google is your friend, but don't believe everything you hear or read.  This is true whether it is nicotine, THC, CBD, "just flavoring", or anything else for that matter.
• Avoid any oil-based vape products when possible, especially for unfamiliar brands.
• Do NOT modify vaping devices or use any homebrew products with vaping devices.
• And last but not least, if you are not currently addicted to nicotine, do NOT vape (or smoke) anything that contains nicotine.  Keep in mind that all JUUL brand products contain high levels of nicotine, as do many other brands as well.

That seems like sensible advice for now.  As for government officials, the best thing they can do right now is regulate the vaping industry better to quash bad actors and improve quality control, cap nicotine levels, and also legalize cannabis nationwide for everyone over 18 (while keeping the taxes low) in order to quash the black market as well.

Let's be adult about this, shall we?

UPDATE:  As of September 5, 2019, researchers seem to be zeroing in on the most likely cause: specific additives found in primarily black market THC vaping oils and cartridges.  Thus far, only one case has been possibly linked to a THC vape product (of undisclosed brand) purchased from a licensed dispensary (in Oregon), which could be a fluke or confounded by other products, but it is possible that even some legitimate products contain such harmful additives.  And while nothing has been ruled out as yet, the aforementioned advice still remains sound:  avoid all black market vape products, don't vape nicotine if you aren't already addicted, and do your research.

As of September 6, the number of possible (not all of which confirmed) cases of the mystery vaping illness has now reached at least 450, including four confirmed deaths and possibly a fifth one as well.  At this rate, we would hate to see what the casualty toll will ultimately climb to by Friday the 13th (next week).  Regulators really need to root out the questionable additives and bad actors, yesterday.

As of September 9, several theories abound as to what exactly is causing this now-epidemic mysterious illness, from questionable additives (such as Vitamin E oil) to black market products to home-made concoctions influenced by YouTube videos to even Chinese tariffs steering vapers towards cheaper and janky products (and this means nicotine too).  Again, it is still under investigation, but the above advice nonetheless remains sound for the time being. 

And for those who are still concerned:

If you currently vape nicotine, DO NOT go back to combustible cigarettes or any other combustible tobacco products!  If you are concerned about vaping, you can always switch to snus, lozenges, or any of the available nicotine replacement therapy products currently on the market (patches, gums, lozenges, and inhalers).  At the very least, stick to the top-shelf stuff.

If you currently vape "just flavoring", be sure that it really IS "just flavoring" (spoiler alert:  it usually is NOT, and all JUUL brand products contain high levels of nicotine).  But really, what's the point of that?

If you currently vape cannabis derivatives (whether it's THC, CBD, or both), and you don't have access to legal and licensed dispensaries where you live and/or you still don't trust the stuff on the shelves there, but you still don’t want to combust (smoke) weed, there are always dry-herb vaporizers out there (remember those?), as well as edibles, capsules, oils, and tinctures for using cannabis products orally.  Or at least stick to the top-shelf stuff for now.  But DO NOT vape, juul, or dab anything from the black market, the street, pop-up shops, or any homemade concoctions.  EVER.

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.