Tagged Public Health

Viewpoints: Plenty To Win Or Lose For Dem’s Presidential Candidates Weighing In On Health Care At Debate; Start Telling Us How ‘Medicare For All’ Would Work

State Highlights: Foster Children Return To Oregon Following Charges Of Abuse From Caretakers; Missouri’s Planned Parenthood Lawyers Seek Answers About License Denial

Startling Rise Of Suicides In Black Teens Since 1991 Sparks Concerns About Access To Care, Failing Outreach Efforts

Dozens Of Investigations Into Deaths In California Have Been Thwarted Because Victims’ Bodies Were Harvested For Parts

Controversy Over Red Meat, Diet Soda Highlights Just How Complicated Nutrition Science Can Be

Purdue Pharma, Sacklers Granted Brief Reprieve In Bankruptcy Court As Judges Urges Company And States To Talk

In 2009, FDA Was Sent An E-Cigarette Device With A Warning That A Vaping Crisis Was Coming. What Happened In The Next Ten Years?

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! Yours truly is back from beautiful Vietnam and it seems I missed one or two … ahem … minor news events while traipsing around.

I come bearing no souvenirs but rather two health reminders (one via Sen. Bernie Sanders). Firstly, don’t forget your flu shot — Australia has had an unusually early and severe season, which rarely bodes well for our own. The second comes in the form of a hard-earned lesson from a 2020 candidate: Don’t ignore those heart attack warning signs! (This is especially directed at women, who are dying unnecessarily from cardiac events.)

Now enough mother-henning. (You missed me, didn’t you?) On to the news of the week!

The Supremes are back in action, and a look at the high court’s docket reveals a potentially doozy of a politically charged term (with rulings expected to land as the general election heats up in 2020).

In the health care sphere, a big case to watch is the Louisiana abortion suit. An essentially identical Texas law — which requires doctors performing abortions to have admitting privileges at nearby hospitals — was ruled unconstitutional by the court in 2016, but that means little with two new justices appointed by President Donald Trump weighing in.

The New York Times: As the Supreme Court Gets Back to Work, Five Big Cases to Watch

Oral arguments in two other health-related cases were held this week. The justices grappled with the moral and legal complexities of the insanity defense. The case prompted questions such as this one from Justice Stephen Breyer: One defendant kills a victim he thinks is a dog. “The second defendant knows it’s a person but thinks the dog told him to do it,” Breyer said. “They are both crazy. And why does Kansas say one is guilty, the other is not guilty?”

The New York Times: Supreme Court Opens New Term With Argument on Insanity Defense

Tuesday was all about LGBTQ rights. Although most of the justices were divided along ideological lines on whether federal civil rights legislation applies to sexual orientation and gender identification, Justice Neil Gorsuch hinted his vote might be in play. As an avowed believer in textualism, he suggested that the words of Title VII are “really close, really close” to barring employment discrimination for those workers. But don’t go placing bets on the outcome yet. He also noted that he was worried about “the massive social upheaval” that would follow such a Supreme Court ruling.

The New York Times: Supreme Court Considers Whether Civil Rights Act Protects L.G.B.T. Workers

On that note, the 2020 Democratic candidates participated in an LGBTQ forum on the eve of National Coming Out Day. There were a handful of notable moments through the night (including a zinger from Sen. Elizabeth Warren that was met with loud applause), but much of the spotlight was on protesters who demanded the candidates pay attention to violence against black transgender women. “We are hunted,” said one member of the audience.

CNN: Protesters Interrupt CNN LGBTQ Town Hall to Highlight Plight of Black Transgender Women

Elsewhere on the campaign trail this week, controversy over a pregnancy discrimination talking point from Warren’s stump speech prompted women — including Warren rival Sen. Amy Klobuchar — to speak out on social media about their own and their mothers’ experiences.

NBC News: Women Rally in Support of Elizabeth Warren by Sharing Their Own Pregnancy Discrimination Stories

Sanders’ campaign confirmed that the health scare from last week was indeed a heart attack. The 2020 candidate — who promised to return “full blast” to the race — said he hopes people learn from his “dumb” mistake of ignoring the warning signs. In true politician-running-for-office style, he also was able to use the scare as a way to emphasize the importance of his signature policy proposal, “Medicare for All.”

Reuters: Democratic Presidential Hopeful Sanders Says He Was ‘Dumb’ to Ignore Health Warnings

In a sign of what’s to come for Big Pharma, South Bend Mayor Pete Buttigieg, one of the field’s more moderate candidates, released a drug pricing plan that is decidedly not moderate. The move falls in line with a broader sense that there’s an ever-growing appetite among even middle-ground Dems for action to rein in drugmakers.

Stat: Buttigieg Unveils an Aggressive Plan for Lowering Drug Prices

And for you political wonks out there, this was an interesting read on the shifting political dynamics of doctors, who once used to be a sure thing for the GOP.

The Wall Street Journal: Doctors, Once GOP Stalwarts, Now More Likely to Be Democrats

A key ruling on the health law is expected in the next few weeks, but officials (on condition of anonymity,  mind you) said that if the ruling is against the ACA, the Trump administration will ask the court to put any changes on hold — possibly until after the election. The reports further support the idea that the law, which has been, uh, politically fraught (to say the very least) over its entire life span, is at the moment viewed as an Achilles’ heel for Republicans.

The Washington Post: Trump Administration Plans to Delay Any Changes If the ACA Loses in Court

Two other major news items out of the administration this week to pay attention to:

The Associated Press: Trump Signs Proclamation Restricting Visas for Uninsured

The Associated Press: Overhaul Is Proposed for Decades-Old Medicare Fraud Rules

The first teenager’s death in the outbreak of vaping-related lung illnesses drove home this week public health officials’ message that young people are “playing with their lives” when they partake. The number of cases jumped to 1,299 as of Oct. 8, with the number of deaths rising to 26.

The Wall Street Journal: New York City’s First Vaping-Related Death Is a Bronx Teen

Reuters: U.S. Vaping-Related Deaths Rise to 26, Illnesses to 1,299

Although Juul is facing a barrage of lawsuits, one filed this week was notable. It was believed to be the first from school districts, which claim that fighting the vaping epidemic has been a drag on their resources. While some legal experts are dubious about whether the school districts can establish their standing, others aren’t ruling it out.

The New York Times: Juul Is Sued by School Districts That Say Vaping Is a Dangerous Drain on Their Resources

And the ripple effect of the crisis is spreading to life insurance prices.

Bloomberg: Prudential Plans to Boost Life Insurance Prices for Vapers

Time for you to flex your ethical muscles for the week: Should there be boundaries to highly personalized medicine? A pricey drug designed — and named for! — just one patient sparked questions this week about how far researchers should go in the name of curing a single person. Especially when there are thousands of patients out there with rare diseases. Would only the wealthiest subset be given cures? Who would decide which patients deserve limited research hours over others?

The New York Times: Scientists Designed a Drug for Just One Patient. Her Name Is Mila.

And ProPublica shines a light on the practice of drug companies using flashy Facebook ads, cash incentives and other marketing techniques to woo Mexican residents over the border to donate plasma. It’s not as innocuous as it might seem — donating too much plasma can compromise the immune system. (Selling plasma has been banned in Mexico since 1987.)

ProPublica: Pharmaceutical Companies Are Luring Mexicans Across the U.S. Border to Donate Blood Plasma

In the miscellaneous file for the week:

  • An Ohio doctor is being charged in 25 fentanyl-related deaths. How on earth was such a lapse allowed to occur? The New York Times peels back the curtain on years of lapses and missed warnings in one Columbus intensive care unit.

The New York Times: One Doctor. 25 Deaths. How Could It Have Happened?

  • During the week of World Mental Health Day, research finds that Americans are starting to internalize all the political rhetoric (and myths) about the connection between mental health and violence. “People want simple solutions: They want to be able to neatly explain things,” said one expert.

Los Angeles Times: Americans Increasingly Fear Violence From People Who Are Mentally Ill

  • There’s more than one way to keep a community healthy, and that goes beyond doctor’s offices, clinics and hospitals. A growing number of medical professionals are embracing the notion that steady paychecks, stable housing and good food are crucial to supporting their patients before they get sick.

The New York Times: When a Steady Paycheck Is Good Medicine for Communities

  • In a sad sign of the times, a muppet on “Sesame Street” is going to have a mother struggling with addiction. The storyline is meant to help an ever-increasing number of children affected by the opioid crisis.

Stat: ‘Sesame Street’ Launches Initiative to Help Explain Parental Addiction to Kids

  • High levels of uranium were found in the blood of Navajo women and babies in a study that underscored the real costs of America’s atomic development. Lawmakers are pushing for legislation that would compensate those who have been exposed.

The Associated Press: US Official: Research Finds Uranium in Navajo Women, Babies

  • And the Nobel Prizes are given out this week: In medicine, scientists who worked with oxygen and cells were honored. Their work has the potential to be the building blocks for things like cancer treatments.

The Washington Post: Nobel Prize in Medicine Awarded for Discovery of How Cells Sense Oxygen

That’s it from me! It’s good to be back with you guys, and I hope you have a great weekend!

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Taking The Cops Out Of Mental Health-Related 911 Rescues

DENVER — Every day that Janet van der Laak drives between car dealerships in her sales job, she keeps size 12 shoes, some clothes and a packed lunch — a PB&J sandwich, fruit and a granola bar — beside her in case she sees her 27-year-old son on the streets.

“’Jito, come home,” she always tells him, using a Spanish endearment. There he can have a bed and food, but her son, Matt Vinnola, rarely returns home. If he does, it is temporary. The streets are easier for him. Home can be too peaceful.

But the same streets that give Vinnola comfort are also unsafe for a man battling dual demons of drug use and chronic paranoid schizophrenia.

Police and criminal courts often intervene before Vinnola gets treatment or care. Since his first diagnosis of severe mental illness in 2014, Vinnola has collected a litany of charges from misdemeanors to felony trespassing and drug offenses. Over the past four years, Vinnola has been charged in four separate Colorado courts and arrested multiple times almost every month either for new offenses or on warrants for failing to appear in court.

But soon, he might encounter mental health professionals on the street instead of cops. Denver is one of at least eight cities considering an Oregon program called Crisis Assistance Helping Out On The Streets to decriminalize and improve the treatment of people with severe mental illness — while saving the city money. The 30-year-old CAHOOTS program diverts nonviolent, often mental health-related 911 calls to a medic and a mental health professional instead of law enforcement.

Denver police and community service providers visited Eugene, Ore., in May to shadow CAHOOTS teams. Denver police officials said they are considering the model as an option to push beyond their existing co-responder program that sends mental health professionals on about six 911 calls a day.

Over 8 million people struggle with schizophrenia or bipolar disorder in America, and an estimated 40% of people diagnosed with schizophrenia go untreated, according to the Treatment Advocacy Center, a nonprofit focused on mental health. Individuals with those illnesses often lose the ability to realize their deficits, creating a roadblock in accessing care and attending medical or court appointments.

Low-level offenses can land those with paranoia, hallucinations or a reduced ability to communicate, like Vinnola, in the criminal justice system. An estimated 383,000 people with severe mental illness are behind bars nationwide, according to the Treatment Advocacy Center, while only a tenth of that number are in state hospitals.

The Push To Rethink Safety

Since the 2018 publication of a Wall Street Journal article about CAHOOTS, calls have poured into its organizers from officials in Los Angeles; Oakland, Calif.; New York; Vancouver, Wash.; and Portland, Ore., among others.

The Eugene CAHOOTS team shows up in work boots, jeans and T-shirts — and without police officers — in response to 911 calls diverted to the program.

“That difference in uniforms can assist folks with letting their guard down and being open to accepting the help that is being offered,” said Tim Black, the Eugene CAHOOTS’ operations coordinator.

For people with a history of volatile arrests often while in mental health crisis, this could make treatment more accessible, less traumatic and safer. One in 4 deaths from police shootings represent people with mental illness, according to the Treatment Advocacy Center.

Vinnie Cervantes, the organizing director for Denver Alliance for Street Health Response, believes using medics and mental health professionals as response teams means treating people with dignity.

“There are plenty of fantastic officers, as people, but they have their roles enforcing a system that has been violent, that has been racist, that has been dehumanizing,” Cervantes said.

Van der Laak said she thinks her son would be more willing to accept treatment if police were not part of the intervention in his mental health crises. She worries that his delayed responses to commands and difficulty answering cops will be perceived as defiance and escalate into an arrest — or worse.

Giving Voice To Her Son

After van der Laak’s son was diagnosed with paranoid schizophrenia in 2014, her everyday gaze shifted from the city skyscrapers and Colorado blue sky to the people living on Denver’s streets. It’s hard for her to pretend they don’t exist. That would mean her son doesn’t exist.

She doesn’t understand how people do it — walk by her son as if he’s just a tree, or nothing, even when his bare feet are bloody, his clothes torn and his face visibly dehydrated, all visible signs of Vinnola fighting his internal battle with schizophrenia.

“His brain just doesn’t work like yours and mine,” she said.

Janet van der Laak walks on Federal Boulevard in Denver looking for her son, Matt Vinnola, on July 19, 2019. Van der Laak tries to make contact with business owners and employees along this stretch of road, giving them her phone number to call instead of the police if they see her son.(LJ Dawson for KHN)

Vinnola’s mother said her son is not a danger to anyone other than himself, but many people associate mental illness with violence. People with severe mental illness are more than 10 times more likely to be victims of a violent crime than the general population, according to the U.S. Department of Health and Human Services.

Vinnola agreed to be interviewed for this article but was unable to answer questions for more than a few minutes. His answers were fragmented and short. He struggled to understand the questions. Van der Laak said he answers the same way in the courtroom.

Van der Laak is outspoken for her son, calling herself his advocate and voice. She attends his court dates, toting legal and medical paperwork in a thick manila folder. He might not attend, but she won’t miss a chance to speak up against a justice system she sees as incapable of being responsible for her son’s treatment.

“It’s critical that I’m there. Because if I am not, they will railroad him and he will end up in jail for long periods of time,” she said. “And that’s not where he needs to be.”

Dr. Sasha Rai, director of behavioral health at the Denver County Jail, said a person in a mental health crisis needs to be in a more therapeutic place for treatment than jail. To him, the biggest obstacles to care for the people he treats in jail are a lack of stable housing and the stigma of mental illness.

“If you were sick with cancer, they’re not going to stick you in jail for 84 days until they find a place to get you care,” van der Laak added, referring to when her son spent over two months in jail in 2017 awaiting one of the 455 beds in the state’s mental health hospital after being arrested for violating probation.

A Burden Lifted

The Eugene Police Department uses its CAHOOTS staff for more than mental health calls. They deliver death notices across the city, hand out water bottles and socks to people living on the streets, and take after-hours community medical referrals. The staff offers those services to the city for half the cost of a police officer.

Nationally, police officers carry the brunt of responding to mental health issues. In 2017, law enforcement agencies spent $918 million transporting people with severe mental illness, according to a 2019 survey from the Treatment Advocacy Center. It also estimated that officers spend 21% of their time responding to and transferring people for mental health issues.

“Our police officers try the best they can, but they are not mental health professionals,” said Eugene Police Lt. Ron Tinseth.

In 2017, Eugene diverted 17% of an estimated 130,000 calls to its CAHOOTS teams. This freed up Eugene police officers to respond to higher-level emergencies.

Like many police departments, Denver is feeling the pressure of mental health issues. From July 2018 to July 2019, the department said, it received 15,915 mental health-related calls, almost a 9% increase from its annual average over three years.

To enact a program like CAHOOTS, the Denver Police Department would have to iron out details such as insurance to cover responders and partnerships with local nonprofits that offer services like sobering-up shelters, medical care and substance-abuse counseling.

Lisa Raville, executive director of Denver’s Harm Reduction Action Center, a Denver nonprofit focused on helping those who use drugs, asserts that the power of a CAHOOTS program lies in its community relationships and the ability of first responders to simply ask, “How can I support you today?”

“And then you can do it. Maybe it can be possible. Maybe this person can find some sort of safety,” she said. “We all deserve that.”

Until then, when van der Laak’s son is on the streets, she uses Facebook and her neighbors to keep track of him. She gives store clerks near the streets he chooses to live on her phone number in the hope they will call her to pick up her son during a crisis, not 911.

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As Vaping Illnesses Rise, So Do Pleas To Quit-Smoking Help Lines

“I stopped for a few days and then I ended up buying new pods. The withdrawals got to me.”

“My friends are the ones who got me into vaping. And they think I shouldn’t stop, but I want to because I don’t want to hurt my family if I get sick.”

“I feel like I get winded easily and I just know it’s not good for me. I want to quit so bad but it’s really hard when all your friends are vaping around you.”

These are just a few of the messages that teen vapers texted in September to the new “My Life, My Quit” program, which offers phone, text and chat lines to young people trying to quit smoking in 13 states.

Even though “quitlines” were designed to help people kick cigarette habits, calls and texts from people who use e-cigarettes are climbing as more people fall ill with a mysterious and devastating respiratory illness linked to vaping.

Health officials are investigating 1,299 cases in 49 states and the District of Columbia, including at least 26 deaths. In California, more than 120 residents have fallen ill, at least three of whom died, according to the California Department of Public Health.

The department in September called on everyone to refrain from vaping, “no matter the substance or source,” while the investigations continue. The Centers for Disease Control and Prevention also advised people to “consider refraining” from using e-cigarette products, especially those that contain THC, the main psychoactive ingredient in marijuana, which has been linked to most of the illnesses.

The rise in calls to help lines means the message is penetrating, said Stanton Glantz, director of the University of California-San Francisco Center for Tobacco Control Research and Education.

“The more we learn about e-cigarettes, the more dangerous they look,” Glantz said. “Callers are right to be worried, frankly.”

Optum, which operates tobacco quitlines for 23 states and the District of Columbia and for more than 1,000 employers, logged a 50% increase in callers asking for help to quit vaping since the CDC released its first report on the illnesses in early September, said Seth Serxner, the company’s chief health officer.

The majority of state quitlines are run by Optum or National Jewish Health, a respiratory research hospital in Denver, whose My Life, My Quit program is aimed at youths. National Jewish Health runs help lines for 16 states — not all of which offer My Life, My Quit — enrolling about 100,000 people each year into tobacco cessation programs.

The quitlines are publicly funded, and the counseling is free.

Almost 20% of callers to Optum’s help lines said they used vapes, up from 3% during the same period in 2015, Serxner said.

“People are going, ‘Whoa, I didn’t know this was that bad for me,’” he said.

In July, National Jewish Health enrolled 88 people into its cessation program who said they vaped exclusively. In August and September combined, the organization enrolled 457 people who vaped exclusively, more than five times the July figure, said Thomas Ylioja, clinical director for health initiatives at the organization.

Calling 1-800-QUIT-NOW routes callers to counselors in their state, where they can get counseling to help them set quit dates and identify triggers that could lead to a relapse. If clients give permission, counselors follow up with them in the days and weeks after their initial call, when quitting can be most difficult.

Depending on where callers live and what kind of insurance they have, they may qualify for free nicotine replacement therapy, like patches, gum, lozenges or prescription medication. Vapes and e-cigarettes are not a federally approved treatment for smoking cessation, so help lines have not recommended them to clients to help them quit.

Not all state quitlines are seeing an uptick in calls. Calls from vapers were flat for West Virginia’s help line from July through September compared with the same period in 2018, said Lindsy Hatfield, program director for First Choice Services, which operates the state’s quitline.

But starting in August, Hatfield noticed that some callers didn’t realize that their Juul e-cigarettes, the nation’s most popular brand, could addict them to nicotine, even though it is listed as an ingredient on the package.

“Some people we found did not know that Juul was an e-cigarette, vape or nicotine device,” Hatfield said. “They felt that Juul did not have nicotine in it, and so it couldn’t be the same thing” as an e-cigarette.

The University of California-San Diego runs California’s tobacco quitline (which offers help in English and Spanish) and serves about 30,000 callers a year. It also runs a national help line for people who speak Mandarin, Cantonese, Vietnamese and Korean.

Since 2017, the quitline has received a steady increase in calls from people who vape. Most said they were using e-cigarettes to quit or cut down on cigarettes because they thought of vapes as a “better alternative,” said Niki Hoang, a San Diego-based counselor and former smoker who has been with the help line for seven years.

Hoang and her colleagues noticed a change this summer: Callers who used vapes to quit cigarettes are now trying to quit vaping, she said.

And smokers who have never tried vaping are vowing to stay away, saying they don’t want to “be the guinea pig,” according to Hoang.

The summer’s influx of calls prompted the help line to train the California staff — about 60 counselors — on the history of the devices and how to counsel people who want to quit.

The calls for help are a far cry from 2007, about the time vapes hit the U.S. market and were described as safer than cigarettes.

Millions have started using them since then, including teens and young adults. Recent federal data funded by the National Institute on Drug Abuse shows that 25% of this year’s high school seniors and 20% of 10th graders reported vaping nicotine in the past month. That’s more than double the use reported in 2017.

Little research exists on the best strategies to stop vaping, so quitline counselors generally employ techniques they’d use for cigarette addiction.

But there is at least one key difference between smoking and vaping that might make the latter more difficult to quit, said Ylioja of National Jewish Health. Vapers have an easier time evading restrictions on smoking in indoor spaces or public places because the smell dissipates faster, he said.

That makes it difficult for vapers to make a plan to avoid situations or people sparking future cravings.

“They have a harder time identifying what triggers might be,” Ylioja said. “They were using these products in so many different social situations.”

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‘We Vape, We Vote’: How Vaping Crackdowns Are Politicizing Vapers

Vapers across the country are swarming Twitter, the White House comment line and statehouse steps with the message “We Vape, We Vote.”

They’re speaking out after a slew of attacks on their way of life. President Donald Trump announced his support for a vaping flavor ban in September. Some states temporarily banned the sales of vaping tools or flavors. And the Centers for Disease Control and Prevention has warned people to stop vaping until public health experts can find the cause of more than a thousand cases of lung injuries nationwide.

The backlash from vapers and vape shop owners is getting louder as they argue their small businesses and their rights to what some see as a smoking cessation tool are being trampled.

“Rather than just vote a party ticket, they may in fact change their vote for anybody who comes out and wants to have a critical conversation about vaping,” warned Alex Clark, the CEO of the Consumer Advocates for Smoke-Free Alternatives Association, a self-described tobacco harm-reduction nonprofit in Plattsburgh, N.Y.

Political groups are noticing that vaping is an identity, not just a hobby. Conservative powerhouse Grover Norquist, whose Americans for Tax Reform group hosted over 200 vaping advocates last month in Washington, D.C., cautions this is an electorate Trump should not ignore for 2020.

Vaping activists have already claimed success in a handful of races. Now some advocates say this burgeoning anger could shape the votes of the nation’s more than 10 million adult vapers and 20,000 vape shop owners.

“Are there enough vapers to swing states like Michigan?” added YouTube vaping influencer Matt Culley. “Absolutely.”

The Vaping Electorate

Jason Volpe has owned a vape shop in Caledonia, Mich., for six years. He supports raising the age to buy tobacco to 21 and encourages young customers to use products with lower levels of nicotine.

Volpe, who voted for both President Barack Obama and Trump, is not afraid to talk about politics in his shop. He gives discounts on Election Day to customers with an “I voted” sticker.

Lately, he said, his customers come in angry at what they call government overreach. They are unhappy with Democratic Gov. Gretchen Whitmer, who temporarily banned the sale of nearly all flavors of vaping liquid.

“That’s not supposed to happen in America,” Volpe said. “Are they going to come after our guns next?”

He said his customers — from the liberal to the “very red farmers” — feel under attack. It’s a common grievance in a community that sees itself as continually marginalized by the government even after some vapers used the devices to quit smoking.

There’s a strong libertarian and conservative streak in the movement that the Libertarian Party has capitalized on, selling “I Vape I Vote” T-shirts online alongside a pledge to “vote for candidates who support vaping.” Issues surrounding vaping, like supporting small businesses and promoting personal liberty, are a natural fit for this segment of the right.

Clark, the “smoke-free” advocate, is a registered Democrat who is disappointed that the left isn’t embracing vaping. He considers it hypocritical for them to back marijuana legalization but not vaping.

Volpe just wants his shop to stay open. He feels betrayed that people with heroin addictions can have a safe place to use drugs and that flavored alcohol is still on the market, but not the blueberry maple syrup-flavored vape juice he uses. The stress around the flavor ban sent him to the emergency room last month. What he thought was a heart attack turned out to be anxiety.

A Vaper Voting Block?

Vocal vapers point to Wisconsin Republican Sen. Ron Johnson’s shocking election victory in 2016 as proof of their power.

Johnson became a folk hero on vaping websites after pushing back on proposed Food and Drug Administration vaping regulations. But early in fall 2016, the incumbent was down in the polls and not expected to recover.

Then Mark Block got involved. He’s the former chief of staff for Republican Herman Cain’s 2012 presidential campaign and owned an online vape store at the time. Block said he met with at least a hundred vape shop workers across the state and leveraged their networks to contact what he estimates was upward of 200,000 voters. Some shops registered people to vote. He also started a political action committee, Vape PAC, which raised over $3,000 and distributed some 400,000 postcards.

After Johnson’s victory, the senator specifically thanked vapers: “You made tonight possible; I truly appreciate it. I will be on your side.”

But Tom Russell, campaign manager for Johnson’s opponent, former Sen. Russ Feingold, doesn’t buy the idea that vapers swung the election, saying he didn’t see any money or data to that effect.

“The reality is to the extent there was a Tea Party, previously unmotivated voting bloc, they were motivated by Donald Trump,” he said. “I’m pretty sure it wasn’t ‘Vape Nation.’”

Vaping advocates also point to a 2014 state election in New Mexico as an early victory for their growing cause. That year, state Rep. Liz Thomson, a Democrat, lost her reelection bid to Republican Conrad James, a pro-vaping candidate who got a last-minute boost from Clark’s CASAA and vaping groups. The American Vaping Association put out a celebratory press release, and Americans for Tax Reform called Thomson vaping’s “first victim.”

Thomson, though, considers the loss a fluke, not the work of vapers. “I do not believe they had any effect in my race,” said the legislator, who later won back her seat. “It was a confluence of factors that was bigger than their group.”

In 2018, Block joined the late stages of the California race of embattled U.S. Rep. Duncan Hunter. Known as the vaping congressman, the Republican has helped create pro-vaping legislation.

But he was indicted for campaign finance violations in 2018.

Reusing the 2016 playbook, Block went to vape store after vape store in the last three weeks of Hunter’s race, handing out postcards with an illustration of the congressman vaping that say “Blaze your own trail.”

Hunter narrowly won.

What’s Next

Those races were almost like a practice run. Right now, vaping activists are scrambling to create the framework for a broader political campaign.

Clark said CASAA feels pressure to make a voting guide, but it doesn’t have the resources to figure out which candidates are truly pro-vaping. The group’s first attempt at a guide in 2016 involved surveys sent to some 900 candidates, but Clark said only 200 or so of the “most fringe” candidates responded.

The American Vaping Association, a nonprofit advocacy organization in Stratford, Conn., is training vapers on the basics of politics — how to speak at local government meetings, register people to vote and talk to the press and elected officials without getting worked up, said its president, Gregory Conley. He also is focused on targeting primaries, where he said it’s a lot easier and less expensive to have impact.

The seeds of a grassroots movement seem to be in place. The organizing and get-out-the-vote work is happening online and in vape shops, which Norquist calls the “megachurches” of this community.

The Vapor Technology Association, a trade group that represents e-liquid manufacturers, vape shops and other vaping professionals, said state and local associations are ahead of the national organization when it comes to voter mobilization.

“We haven’t really had to move them because they’re doing it already,” said Chris Howard, the association’s board treasurer.

Vapers are terrified they’re about to lose what they say is the only tool that saved them from smoking — and saved their lives. That’s a powerful motivating force, Culley said. Plus, all the jobs lost from a potential flavor ban — which Trump had announced his support for on Sept. 11 — wouldn’t be a good look for the president, he said.

Trump followed that announcement with a tweet two days later that was more ambiguous about his intentions for a ban: “While I like the Vaping alternative to Cigarettes, we need to make sure this alternative is SAFE for ALL! Let’s get counterfeits off the market, and keep young children from Vaping!”

The damage was already done, according to vape shop owner Mike Moran, who offers customers voter registration paperwork in his two stores in New Jersey. He blames Trump’s initial tweet for kicking off the wave of state bans.

“If Donald Trump lets this go down because of his misstatement, I’ll vote against him,” Moran said. “His words caused this.”

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