What is Juul - the "Safe" Smoking Alternative - Smoking? (12/10/2019)

On September 9th the U.S. Food and Drug Administration (FDA) sent Juul Labs, Inc. (Juul) a warning letter for, "marketing unauthorized modified risk tobacco products, including in outreach to youth" and outlined various violations made by the company.¹ The exigency of this letter had been previously established by the US Surgeon General in late 2018, "emphasizing the importance of protecting our children from a lifetime of nicotine addiction and associated health risks by immediately addressing the epidemic of youth e-cigarette use."² Juul has remained steadfast in the position that its product is designed to help existing smokers quit smoking traditional cigarettes. However, analysis of the company's marketing practices, public statements, and the demographics of their consumer base completely disrupts this narrative and eviscerates the possibility for Juul to make an ethical appeal with any legitimacy. Furthermore, the ideological influence of consumerism on personal identity and buying decisions is considered to help contextualize the popularity of Juul's products. If regulators want to protect youth from nicotine and the accompanying health risks, then operating within a consumerist society, it is vital to change the perception of vaping, given empirical evidence links this to the undesired consumer buying behavior.

What kind of action would spur the FDA to issue a warning letter to a company like Juul? From the FDA's own website, "When the FDA finds that a manufacturer has significantly violated FDA regulations, the FDA notifies the manufacturer. This notification is often in the form of a warning letter." In the warning issued to Juul, a compelling argument is structured through specific examples of the company marketing its product to minors. For example, the FDA cites testimony from a House subcommittee hearing which revealed that a "JUUL representative speaking with students at his presentation stated, 'FDA was about to come out and say it [JUUL] was 99% safer than cigarettes...and that...would happen very soon...'"¹ In the media, the FDA has vehemently denied the intention to release any such statement. A damaging blow to Juul's credibility. Nevertheless, Juul's website touts, "As scientists, product designers and engineers, we believe that vaping can have a positive impact when used by adult smokers, and can have a negative impact when used by nonsmokers. Our goal is to maximize the positive and reduce the negative."⁴ The purported focus on adult smokers is not consistent with the product's main consumer base. The statement contradicts the recent Center for Disease Control and Prevention (CDC) data that states more than one in four high schoolers self-reported they had vaped in the past 30 days.⁵

As of November 5th, the CDC has also confirmed 2,051 cases of e-cigarette or vaping product use associated lung injury (EVALI) as well as 39 deaths.⁶ Juul's statements have failed to establish a coherent narrative to convince their audience that they are taking an appropriate response to this health crisis. An examination of statements by Juul finds a frightening lack of narrative fidelity. In August, Juul Spokesman Ted Kwong said, "We recognize that youth use of vapor products is a problem that requires an effective and appropriate response from industry and regulatory bodies."⁷ Federal prosecutors have now launched a criminal probe into the company, and this statement is evidence that the company's leadership is aware of the increasing amount of scrutiny being placed on them. According to the FDA, a warning letter will, "also makes clear that the company must correct the problem and provides directions and a timeframe for the company to inform FDA of its plans for correction."³ Therefore, If Juul had established a coherent narrative that was consistent with the facts around vaping and transparent about the company's intentions, no such measure would be necessary to intervene and prevent them from marketing to youth. Since this is not the case, the US Surgeon General has gone so far as to release a statement at the end of 2018 declaring youth vaping an epidemic. Notably, Juul is specifically mentioned 14 times in the four-page document.²

The complexity of the narrative surrounding Juul can be better understood through the works of the renowned scholar of communication Walter Fisher, Professor Emeritus, USC. Fisher has been lauded for his contribution to the discipline of communication for his model of Narrative Paradigm. In his theory, he postulated that human beings naturally are drawn to storytelling as a means of sharing information, and the stories they tell help them to interpret and assign meaning to their reality. This model assumptively accepts that human behavior and beliefs are based on good reason, while also accounting for history, culture, personal experience, and character in the evaluation of these stories.⁸ Rybacki and Rybacki succinctly describe that "Fisher suggests that it is in our nature as humans to use stories to get at truth."⁹ The elaborated model of this theory proposed in 1985, according to Fisher, goes beyond other existing theories and models of communication due to its inclusion of the concept of narrative rationality which provides for a logical framework for assessing these stories. Asserting that "The only way to determine whether or not a story is a mask for ulterior motives is to test it against the principles of [narrative rationality]" Drawing off these principles will, therefore, allow for an examination Juul that moves towards an assessment of, "whether or not one should adhere to the stories one is encouraged to endorse or accept."¹⁰ The concept of narrative rationality includes two foundational principles as criteria for such an assessment-narrative coherence and narrative fidelity.

Intuitively named, narrative coherence looks at how well the components of a story fit together cumulatively and whether or not a story is free from contradiction. Essentially, the degree to which a story makes sense. The irony of Juul claiming it is aiming to "eliminate cigarettes" despite being owned by Altria, one of the world's largest cigarette manufacturers, is astonishing and disembowels any potential narrative coherence by Juul. Furthermore, Juul was criticized for its use of social media advertising before deleting all of its profiles and putting a stop to advertising on those platforms in December of 2018. At the time, experts like Jidong Huang, an associate professor of health management and policy at Georgia State University, believed that "[Juul is] taking advantage of the reach and accessibility of those platforms to target the youth and young adults, basically everybody can see their product because there are no restrictions."⁸ Narrative fidelity concerns how well the story corresponds to the experiences and understanding of the reality of the audience. Juul deliberately ridding itself of its social media presence and eliminating the Chief Marketing Officer position from its executive ranks is evidence of a lack of narrative fidelity. The narrative put forth by Juul thus far in no way corresponds with the reality of who its customers are and their experience with its product. Why would a company rid itself of the employee and medium responsible for criticism the company has received from regulators if that criticism was unfounded? If beliefs and behaviors are based on good reason, then the story that Juul was not intentionally marketing its product to minors is not grounded by good reason because it does not reflect the reality experienced by consumers.

Further, even more compelling, evidence of Juul's lack of narrative fidelity and what consumers they hoped to reach is the imagery the company used to advertise its product. A study of Juul's advertising imagery from 2015-2018 conducted by researchers at the Stanford University School of Medicine in 2019 concluded that their advertising was, "patently youth-oriented." The research conducted was the first to examine advertising efforts by Juul in an academic setting and took into account the company's website, Instagram, Facebook, Twitter, hashtags, and customer directed emails.¹¹ Advertisers prefer visual communication because this allows for an impression that resonates with audiences in a more visceral way than many other forms of communication. Audience Reception Theory is based on work by British Sociologist Stuart Hall and provides the theoretical basis for much of the modern applied marketing research that is conducted. This theory is relevant to marketers on the basis that it describes how viewers interpret media based on their own individual cultural background and life experiences.¹² The Stanford research team noted Juul's advertising imagery included, "models in their 20s appearing in trendy clothes engaged in poses and movements more evocative of underage teens than mature adults."¹⁰ Knowing that consumers would interpret these images based on their own cultural background and life experiences, these depictions of their product provide seemingly irrefutable evidence of who Juul was really trying to reach with their marketing messages. Furthermore, in the conclusion of the Stanford study it is definitively stated that: "JUUL's mission statement to 'Improve the lives of the world's one billion adult smokers' and their repeated assertion that their product is meant for 'adult smokers only' has not been congruent with its marketing practices over its first 3 years."¹⁰

The works done by both Hall and Fisher make sure to carefully leave room to take into account cultural influences in communication. To consider why "advertisers spend millions researching how to induce us to purchase" the cultural aspect of this equation must be explored. Especially given that "their findings often lead to increasingly innovative, and sometimes intrusive, ways to market their products."¹³ Additionally, In 2004 the American Psychology Association had a cover story dissecting how the "glut of marketing messages encourages teens to tie brand choices to their personal identity."¹² The interrelated nature of marketing and consumer behavior with culture is manifest and crucial to determining how regulators should respond to Juul. The cultural ideology of consumerism is argued by academics across many fields of study to be the dominant ideology in American culture. The writings of Raymie McKerrow in his piece titled, "Critical Rhetoric: Theory and Praxis" provide a roadmap for analyzing and interpreting ideological considerations such as consumerism. Similar to Fisher, his critical rhetoric "...seeks to unmask or demystify the discourse of power," but instead, "the aim is to understand the integration of power/knowledge in society–what possibilities for change the integration invites or inhibits." He is concerned with truth like Fisher, claiming that if one knows the absolute truth there is no need for rhetoric because there is no need to persuade a particular audience or person. He proposed that a critique of freedom where the offered and suggested truth is constantly open to being critiqued and discussed. It is a way of double-checking in order to reach the truth of a matter. In his critique of domination, he finds unequal power relations that are not accepted by society.¹³ Using the techniques provided by McKerrow allows for a critical understanding of consumerisms influence on Juul's popularity.

According to the distinguished historian and Professor Emeritus at Pennsylvania State University, Gary Cross, for the first time in history, there are no practical limits to consumerism. But, what is consumerism and how did the help propel Juul to become the fastest company to ever reach a $10 billion dollar valuation? The extensive body of work on consumerism as a cultural ideology by Cross provides a lens for understanding the cultural environment Juul has assuredly benefited from. One of his most well-known books, An All-Consuming Century, provides a detailed historical look of how over the most recent century consumer goods have progressively come to dominate American life. Given, America is the largest consumer market in the world and many economists closely watch levels of consumer spending to forecast economic growth his assertion is not unwarranted. According to Cross, consumerism is identifiable in part by, "the endless variation of clothing, travel, and entertainment provided opportunity for practically everyone to find a personal niche, no matter their race, age, gender or class." He also asserts that the American fixation on the acquisition of goods and services in ever-increasing amounts is currently thriving.¹⁴ Consumerism is simply the preoccupation of a society with the acquisition of consumer goods, a cultural force Juul assuredly benefits from.

Thus, the rhetoric around Juul provides an interesting case study given the demographics of people who vape and the differing attitudes towards vaping and traditional tobacco by different ethnic and socioeconomic groups. Who is vaping? The most recent, preliminary data reported suggest that 27.5% of high school students said they had vaped in the last 30 days on a recent CDC survey.⁵ However, while the popularity of vaping amongst young people is well documented racial and class disparities on attitudes towards vaping and usage rates should also be considered. Although there is still much research to be done on the demographics of vaping researchers at the Boston University School of Public Health have made a few key findings on this topic. They found, "Non-Hispanic black smokers were 73 percent less likely, and Hispanic smokers were 74 percent less likely to exclusively switch to e-cigarettes than non-Hispanic white smokers. Smokers with incomes below the federal poverty line were 52 percent less likely to make the switch than smokers whose incomes were at least double the federal poverty line."¹⁵ While this data is telling it is also reflected in their findings on how these groups viewed traditional tobacco and e-cigarettes. Furthermore, they found white and high-income participants to have the least positive views of tobacco and comparatively more positive views on e-cigarettes than Black or Hispanic participants. Also, "black and Hispanic smokers were twice as likely as white smokers to believe e-cigarettes were more harmful than cigarettes."¹⁵ Researchers were unsure of what caused a significant difference in opinions among different ethnic and socioeconomic groups but these opinions are foundational to understanding the behaviors of consumers.

Juul has recently been on an extensive campaign attempting to reposition its products' brand image as a high-tech smoking cessation aid. This will likely end quickly given the company has decided to eliminate the position of Chief Marketing Officer (CMO) from the company entirely moving forward. The question that begs to be asked after this move by Juul is straightforward: what is a Juul in the mind of consumers? In a 2012-2015 content analysis study that analyzed over 3 million tweets on vaping, the social image category was the most common reason cited, accounting for 37 percent of the vaping-related tweets analyzed.¹⁶ In 2016 researchers at the University of Chicago researching economic behavior found, "a prominent role of social image concerns in motivating behavior."¹⁶ Essentially, their research concluded that consumers gravitate towards products or services that are seen as socially desirable- like iPhones. To that end, a 2018 editorial in the Washington Post proclaimed, "Juul is the iPhone of smoking"¹⁷ an analogy often drawn upon when business analysts try to find products to compare Juul to. The Washington Post analogy draws off a phenomenon in teen consumer spending that is succinctly explained by Marcia Flicker, associate professor in Business at Fordham University. In a 2014 analysis of consumer spending data from Piper Jaffray, Flicker explained the social image consideration in terms of the specific iPhones teens display: "Will they buy the iPhone 6 when it comes out, or be stuck with the slower iPhone 5? Or, even worse, still have an iPhone 4?"¹⁸ This comparison is helpful in terms of understanding the interrelated nature of marketing, social image considerations, and buying decisions within a consumerist culture.

Drawing off a myriad of research on social identity, group membership, and consumer behavior Harvard Business Review advised their readership: "The implications for marketers are obvious. If social identity shapes decisions, then a company's marketing strategy should encourage customers to tune in to an identity that inspires behaviors like visiting a website, going into a store, buying the product or service, getting more value from it, telling others about it, and helping design a better product."¹⁹ Given that the FDA is preventing Juul from having these kinds of interactions with teenagers it is no surprise the company no longer sees the need for a Chief Marketing Officer. However, the Aristotelean mode of persuasion ethos constitutes the character of an entity as manifested in its beliefs and aspirations. It is the ethical appeal that tries to persuade by establishing credibility and evoking that what is being argued for benefits the greater good of society. The job of the Chief Marketing Officer is to develop clear messaging for a company that reflects the beliefs and aspirations of the company. Juul's supposed "mission is to improve the lives of the world's one billion adult smokers," is emblematic of what is considered an ethos argument. However, with Juul, it is clearly established that there is a stark contrast between the company's proposed values and their conduct.

What options then do regulators have to accomplish their goal of protecting young American consumers from nicotine and its associated health risks? Furthermore, what is the best course of action given the tenuous effect of age restrictions already in place? Considering, "Nicotine exposure during adolescence can harm the developing brain – which continues to develop until about age 25,"² and changing the national age restriction to purchase products containing nicotine to 25 is simply unrealistic.² Perhaps a strategy similar to the one used to shift public perception on smoking traditional cigarettes could be implemented. Much research has been done on the effectiveness of these policies to see which prove to be most effective. In 2004 the National Institute of Health found that particularly, "specific types of counter-marketing campaigns are proving to have a significant and important impact on youth smoking. Hard-hitting campaigns that include pointed messages about industry manipulation of information about what is in cigarettes and about the health effects of smoking are..."²⁰ With the lack of narrative coherence and fidelity exhibited by Juul and the growing body of evidence showing the dangers of vaping, the ammunition for such a counter-marketing campaign already exists.

What do experts think? With the prominence of vaping in highschool well-established, comparisons to traditional cigarettes as a forward-looking indicator are frightening if these rates continue at similar levels. With, "A large body of research shows that very few people in the United States initiate cigarette smoking or become habitual smokers after their teen years. Nearly 9 out of 10 current adult smokers started their tobacco use at or before age 18."²⁰ It would seem most reasonable to start with a focus on prevention. A Yale study last year, of students at three Connecticut public schools, found those who used e-cigarettes were much more likely to smoke traditional cigarettes in the future. Humberto Choi is a pulmonologist at the Cleveland Clinic who leads a task force on smoking cessation and was interviewed by USA Today in late 2018 with regard to teen vaping. She said, "reducing vaping will ultimately require the same long-term effort as reducing cigarette usage among teens, from educating them about vaping in health classes to doctors asking about e-cigarette usage during annual check-ups." Elaborating that, "it's going to take another decades-long effort."²¹ Her expert opinion points to the potential that it is possible to accomplish the goal of regulators to accomplish their goal over a long enough period of time with sustained effort. Vaping products are, after all, just a modern derivative of traditional cigarettes.

If regulators really want to quell youth vaping, it is advisable to immediately launch the kind of hard-hitting, counter-marketing campaigns used against cigarette manufacturers that include pointed messages about the manipulation of information by Juul and health effects. This method has proven success in significantly impacting youth using traditional cigarettes. Logically, exploiting the same mediums Juul has to give consumers a dissenting view based on factual information that: "Nicotine exposure during adolescence can impact learning, memory, and attention. Using nicotine in adolescence can also increase risk for future addiction to other drugs. In addition to nicotine, the aerosol that users inhale and exhale from e-cigarettes can potentially expose both themselves and bystanders to other harmful substances, including heavy metals, volatile organic compounds, and ultrafine particles that can be inhaled deeply into the lungs."² It would be an excellent starting point. The unwanted consumer behavior is likely to continue unless the millions of young people vaping are presented with information that makes them reconsider the buying decision. Since age restrictions have not prevented the explosive growth and widespread use of e-cigarettes now is the time for regulators to be asking what else they can do. The social image associated with the product will shift as consumer sentiment does. What better way is there to shift the consumer sentiment youth have towards Juul then by exposing how that the company targeted youth specifically, with no regard for the potential health consequences they might encounter to make billions of dollars off an addictive product?