- The Washington Times - Sunday, April 1, 2018

It’s the latest smoking craze that has teenagers buzzing on social media — and public health officials warning of a new nicotine-addicted generation.

“People JUUL at parties, JUUL when they’re driving — it’s a social thing. They’re JUULing all the time,” said C., 17, who said some students at her high school use the popular electronic cigarette in class.

Similar to vaping, JUUL is a brand-name e-cigarette that has outpaced its competition thanks to its sleek, discreet shape — many compare it to the size and look of a thumb drive — and its unique vaping formula of flavored nicotine and salt.

Its battery can be recharged on a laptop within one hour, and its liquid-filled cartridges come in flavors — cool mint, creme brulee, fruit medley — that anti-smoking advocates say target teens.

Juul’s website, which asks users if they are 21 or older before allowing access, says the device is not for teens or anyone who has never smoked. It is intended only as an alternative for cigarette smokers who have had little success in quitting smoking, the company says.

“The entire conception, premise, operations, mission of the company is to eliminate cigarettes and get adult smokers to switch to our vapor product,” said company spokeswoman Christine Castro.

“It is not intended to be discreet. It was not designed to look like a flash drive,” Ms. Castro said. “It was designed specifically and intentionally to help smokers switch.”

Still, on Twitter, Instagram and other online forums, young people have put up funny posts about using, losing or being addicted to their JUULs. Some post videos of themselves in classrooms or locker rooms using their JUULs and playing with the smoke.

Sam, 17, who goes to school with C., said JUULs are associated with a “kind of delinquent culture.”

“Almost like you’re trying to appear cool,” he said.

The problem has become widespread at their co-ed, religious school in New York, and administrators have listed it on announcements of banned substances, “no smoking, no drinking, no vaping,” said the two students, who asked not to be identified for fear of reprisals.

“But vaping isn’t JUULing,” C. said. “JUULing is more intense.”

That intensity is the rush of nicotine into the system from the company’s unique liquid formula. At 5 percent nicotine per volume, one JUUL cartridge, or pod, is the equivalent to a pack of cigarettes.

“We’re very concerned about JUUL because it has become such a popular product among young people very, very rapidly,” said Robin Koval, CEO of the Truth Initiative, a nonprofit youth anti-smoking organization.

According to internal research by the Truth Initiative, a survey of teenagers found that a significant percentage using JUULs said they were “unaware or unsure that the product contains nicotine.”

“We know that nicotine has effects on young people’s cognitive development. If you become addicted to nicotine at a younger age, it makes you more susceptible to other addictions later on. It makes it harder to quit nicotine, whether that’s from an e-cigarette-type product or combustible product,” Ms. Koval said.

Among teenagers, anti-smoking campaigns and tighter restrictions on cigarette sales have helped curb cigarette use to a historic low of 4.2 percent among high school seniors in 2017, compared with a peak of 24.6 percent in 1997, according to the National Institutes of Health’s Monitoring the Future Survey.

Yet applause by health officials and advocates is tempered by a rise in vaping popularity. In its first survey of the subject, it found that nearly one-third of 12th-graders reported using some kind of vaping device. The majority said they vaped “just liquid,” followed by nicotine and marijuana.

The JUUL company says on its website that it sells only to adults 21 and older, uses verification tools to prevent underage purchases and has a youth prevention section with an email contact to address concerns.

“Kids should not use any nicotine product including ours and we’re working very hard to make headway on that,” said Ms. Castro.

On flavors

JUUL’s packaging carries California’s Proposition 65 warning, which states that the product contains chemicals known to cause cancer and birth defects or other reproductive harm. The website also warns that the product contains addictive nicotine.

Ms. Castro said the company has an in-house research team looking at youth prevention to engage educators and parents. The company offers its curriculum free to schools and will help compensate extra costs associated with after-school activities or offer to cover the cost of an addiction counselor.

“I don’t think any tobacco or nicotine delivery device company should be doing their own prevention work,” said Bonnie Halpern-Felsher, Ph.D., a developmental psychologist and pediatrics professor at Stanford University School of Medicine.

Researchers for the American Lung Association conducted a 2002 study of the tobacco industry’s objectives in funding youth smoking prevention programs.

“The industry has used these programs to fight taxes, clean-indoor-air laws and marketing restrictions worldwide. There is no evidence that these programs decrease smoking among youths,” the researchers said in their report.

The body of research on e-cigarettes’ potential benefits and drawbacks is growing but inconclusive. Health professionals acknowledge that vapor is preferable to cigarette smoke. Yet emerging research shows that the chemicals in liquid products and the devices that heat them can carry cancer-causing chemicals, albeit at lower levels than traditional cigarettes.

It’s not known if e-cigarettes are effective for quitting smoking.

“The comparison is e-cigarette or JUUL versus nothing,” said Ms. Halpern-Felsher, whose research focuses on understanding and reducing health risks among youths related to tobacco, alcohol, drugs and other risk-seeking behavior. “A lot of the youths who are using e-cigarette or JUULs never intended on smoking. So it’s not a harm-reduction conversation that a lot of people are trying to make this. This is an initiation of any tobacco product.”

The Food and Drug Administration, which regulates tobacco products, is walking a fine line for e-cigarettes. It is encouraging companies to devise products that draw smokers from cigarettes as it also weighs regulations that will make tobacco and vape products less addictive and less appealing to children.

Ms. Halpern-Felsher said the flavors of JUUL products are huge draws for teens and that the FDA should ban all flavored tobacco products.

“The idea that tobacco industries, including cigarettes or JUULs, are putting flavors in or having flavors because they want to promote this to adults is ridiculous,” she said. “Youths, first of all, think that the flavors are for them, not for adults, and they are definitely more flavor-sensitive than are adults, so the FDA absolutely needs to regulate flavors.”


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