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This was especially the case for people aged 14 to 17 (74%) and 18 to 24 (68%). The 2022–2023 NDSHS was conducted before these restrictions were put into place. At the time, in most jurisdictions, it was legal for adults to purchase e‑cigarettes that did not contain nicotine from a broad range of retail settings, including those used to purchase tobacco products. Prior to 2024, adults could also import nicotine e‑cigarettes with a prescription via the personal importation scheme. The first study found that vaping can worsen several heart disease risk factors at levels equal to tobacco cigarettes, while the second found that e-cigarettes decrease blood flow in the heart even more than tobacco cigarettes. However, e-cigarettes still pose health risks, even without nicotine.
Juul’s C.E.O., Kevin Burns, who is fifty-four, has a friendly dad-who-loves-his-vacation-house demeanor. Burns described Juul to me as a "cigarette-killing company." Before he accepted the job, he said, he convened an informal focus group in his kitchen with his son, who’s in high school, and a few of his son’s friends. He asked them why they had these things, when they got them, how prevalent they were. "We have frustrations about how the product is glorified on social media," he told me. I admitted to Winickoff that I was probably endangering my lungs as a weed smoker. He gamely pointed out that I could look into ingested forms of marijuana, and noted that my brain was in a much more stable place than it had been when I was twenty-one.
Cigarette smoking is still the No. 1 cause of preventable death in this country, killing nearly five hundred thousand people each year. (According to some studies, more than half of longtime smokers will die from smoking-related complications.) It’s incredibly hard to stop smoking