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More and more people are getting sick after vaping. At least 42 people have died, thousands more have been injured, and as the outbreak grows, so do questions about the federal government's role in regulating e-cigarettes. NPR's Jim Zarroli reports.
JIM ZARROLI, BYLINE: As a high school sophomore, Yan Dichev started using a vaping product called a box mod. He liked the clouds of smoke it produced.
YAN DICHEV: Me and my friends would just sit in my car and we would just - we call it hot boxing. We would just blow a lot of smoke into the car and then open the windows, and we thought it was really cool to watch the smoke go out.
ZARROLI: That was six years ago. By the time he got to college, a nicotine-laced vaping product called Juul had come along.
DICHEV: It was something cool in college to have, especially at, like, parties. If you're out drinking instead of smoking a cigarette, you smoke the Juul.
ZARROLI: Juul was marketed as a way to help smokers transition away from cigarettes, but lots of nonsmokers, especially kids, also took it up, and an industry that didn't exist a decade ago now has some 10 million users. One reason vaping has gotten such a foothold so quickly is the government's slowness to regulate it. In 2009 President Obama signed something called the Family Smoking Prevention and Tobacco Control Act.
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PRESIDENT BARACK OBAMA: The decades-long effort to protect our children from the harmful effects of tobacco has emerged victorious. Today change has come to Washington.
ZARROLI: The law meant that the Food and Drug Administration now had the power to regulate tobacco products, including e-cigarettes, but doing so took far longer than expected. There were numerous lawsuits from Big Tobacco determined to slow-walk the regulatory process. Karen Wilson of the American Academy of Pediatrics says regulators didn't really have time to focus on vaping.
KAREN WILSON: I think they were still trying to grapple with the impact of the Tobacco Control Act on the industry - you know, the tobacco industry - let alone trying to figure out how to manage this new business that was popping up.
ZARROLI: Some members of Congress complained about the inaction. Democratic Senator Sherrod Brown of Ohio told NPR that the Obama administration was probably too cautious about taking on Big Tobacco, and that included the new vaping companies.
SHERROD BROWN: The more these regulations and rules are slow-walked, the more young people become addicted. Public officials allowing this slow walk ultimately results in terrible public health problems.
ZARROLI: By 2016 the FDA had finally come up with a rule to regulate e-cigarettes, but the Trump administration decided to delay its implementation until 2022. Scott Gottlieb, who headed the FDA then, argues that there's some evidence e-cigarettes can help smokers quit.
SCOTT GOTTLIEB: We know e-cigarettes aren't safe, but we viewed them as less harmful than combusting tobacco because after all, it's not the nicotine that causes all the death and disease from tobacco use. It's the combustion. It's lighting tobacco on fire.
ZARROLI: Gottlieb says rushing to regulate e-cigarettes too quickly can mean getting in the way of products that may legitimately help people quit smoking. A federal judge has ordered the agency to speed up the review process, but that decision is being appealed. That means long after the Tobacco Control Act became law, the FDA is still not reviewing hundreds of vaping products to determine whether they're safe. Matthew Myers is president of the Campaign for Tobacco-Free Kids.
MATTHEW MYERS: Today, nearly a decade after these products were first introduced, not a single e-cigarette has been reviewed for safety purposes, for addiction purposes, for youth abuse purposes or for efficacy in helping smokers quit.
ZARROLI: And more and more people take up vaping every year. One government survey said 25% of high school students had vaped in the preceding month, and 42 people have died this year after vaping. They had ingested a Vitamin E acetate often used as an additive to THC, the active ingredient in marijuana. Scott Gottlieb says the effort to regulate vaping has become harder because of the immense success of Juul.
GOTTLIEB: Really, what drove this was a single product. It was Juul. And what we didn't envision was the spike in the popularity - the explosive popularity of that single product.
ZARROLI: Partly because of Juul, vaping by teenagers hit a record high this year. Juul has tried to address the criticism. For example, it no longer advertises in the U.S., and it stopped selling the fruit-flavored products that appealed to teenagers. Still, Karen Wilson of the American Academy of Pediatrics says many teens have become hardcore nicotine addicts.
WILSON: We're seeing kids that are using four pods a day, and this is equivalent of four packs of cigarettes a day. I mean, it is an astounding amount of nicotine that is being delivered in these products.
ZARROLI: Among them is Yan Dichev. He's now a college senior, and he uses Juul every day.
DICHEV: I kind of have to hit it, so if I don't hit it, then I get kind of cranky. So I go and hit it, and it just gets me back to feeling like myself and feeling normal.
ZARROLI: He figures he'll try to quit after he graduates, but in the meantime, he says, he's pretty much addicted.
Jim Zarroli, NPR News, New York.
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