The federal government recently raised the smoking age to 21 to help curb teen vaping. Some are applauding the decision as a win for public health. Others worry it was a knee-jerk reaction.
At Great Alternatives Vape Shop in suburban Des Moines, clerk Faith White runs through a list of dozens of flavors written on a chalkboard.
"Personally, my favorite is Mario Kart, which is strawberry banana. Smurf berries is very popular, and also watermelon joy," she says.
White, 20, has been vaping for a few years. She started because her father vapes. But White supports raising the smoking age to 21. She doesn’t think it will hurt business at the shop, where many customers are older people looking to quit smoking.
"I'm almost 21 so it's not like a huge thing, but I think it would be I guess a lot safer in the long run, so I'm not opposed to it at all," White says.
Not everyone in the vaping industry agrees.
"These adults, ages 18 to 20, are either going to go to the black market to purchase these products, or they're going to return to smoking because cigarettes are far easier to get," says Sarah Linden, the president of Iowans for Alternatives to Smoking and Tobacco.
The group of about 20 shops had opposed the age increase.
Linden says vaping can help some people quit smoking entirely. "Every single vape shop owner that I know is really in this business to help people."
Linden says the problem really stems from high nicotine systems like Juul, which came on the market in 2015. One pod can have as much nicotine as a pack of cigarettes, so they’re extremely addictive.
"All the sudden these products came on the market that were extremely high nicotine content. And our feeling was that that was kind of setting the industry back," she says.
Flavored, high-nicotine systems like Juul are incredibly popular with high schoolers. According to the 2018 National Youth Tobacco Survey, nearly 60 percent who vape said they use Juul. The FDA plans to remove flavored products from the market for this type of product.
Shannon Lea Watkins, a public health professor at the University of Iowa, says much is still unknown about the health effects of e-cigarettes.
"The tobacco industry has been working on the like quote unquote, safer cigarettes for a long time," she says. "Filtered cigarettes for example ... the impression is that they are safer but in fact, they do not reduce toxic exposure."
Watkins says research does not indicate e-cigarettes are effective in helping people quit smoking. "Anecdotally, they are helping some people quit smoking, but they don't seem on trend to be helping people move away from cigarettes. And indeed, many people end up using both products."
Currently, e-cigarettes are not approved by the FDA as a tool to help quit smoking like nicotine gum and patches. But the FDA website says e-cigarettes can benefit adult smokers who substitute them for regular cigarettes.
Meanwhile, the long-term health impact of vaping is unknown.
In Indiana, at least five deaths have been tied to a vaping-related lung illness. Across the nation, more than 2,500 people have fallen ill, and more than 50 deaths have been reported.
While some vape store owners feel they’re helping people stop using cigarettes, Indiana officials worry about losing ground on tobacco addiction among young people.
"But the concern, of course, is that this increase has just addicted our next generation of Hoosiers to nicotine," Indiana Health Commissioner Dr. Kristina Box said last month.
At Just Vapor, which sits in a strip mall in an Indianapolis suburb between a pizza shop and a second-hand clothing store, owner Mason Odle says vape stores have received little guidance on the new law from federal or state officials. In fact, he says, most owners saw the news on Facebook.
Odle's okay with regulation, including raising the age. But he’s seen regulation have unintended consequences.
"I believe regulation is always going to be something that we are going to have to deal with ... " he says. "Consumers need to have a peace of mind of what they're using and to make sure that it's safe and is not harmful to them. I think that regulations to a point can be very restrictive and we've gone through that in the state of Indiana."
A few years ago, Indiana passed legislation to regulate the sale and manufacturing of e-cigarette products to make it safer.
But only one company qualified under stringent restrictions and it created a monopoly. And parts of that law were eventually struck down by a federal court.
Odle is concerned about all the proposed new restrictions, including the FDA’s ban on certain devices with flavors. "And now, I feel like we're sort of in the same situation."
This story was produced by Side Effects Public Media, a news collaborative covering public health.