A year after teen tobacco use declined to a record low, the growing popularity of electronic cigarettes has sent that trend up in smoke. Vaping has become an epidemic among middle and high schoolers who can easily conceal their unhealthy habit as they head back to school this fall.
“We’re concerned e-cigarettes, and Juul, in particular, are addicting another generation of kids to nicotine and undermining decades of progress in reduced tobacco use,” said Vince Willmore, spokesperson for the Campaign for Tobacco-Free Kids. “E-cigarettes are definitely not safe for kids to use.”
The e-cigarette of choice for most teens is Juul, a device that plugs into a USB drive for recharging. While a Juul vaporizer may look like a flash drive, parents will not find their child’s English paper stored inside. Instead, the rechargeable device uses a battery, charging unit and liquid-filled pod that can deliver about as much nicotine as 20 cigarettes, according to the Truth Initiative, a nonprofit health organization dedicated to stopping teen smoking. Not all vaporizer liquids contain nicotine, though; some brands might contain THC, the active compound in marijuana that gives pot its high.
“It’s hard to design a more kid-friendly tobacco product than Juul,” Willmore said. “Juul looks like a computer flash drive so it is easy to hide, even in classrooms. It comes in flavors like mango and mint. It delivers a potent dose of nicotine so kids who use Juul can quickly become addicted.”
Navy spouse Lisa Haggerty of Poulsbo, Washington, learned firsthand about Juul’s popularity among teens after twice finding — and confiscating — her son’s devices. A fellow Boy Scout supplied her son with his first Juul device and “vape juice” refills.
“I feel scared because statistics show most kids who start with vaping at this age, at some point switch over to cigarettes,” said Haggerty, whose son was expelled from a private high school after admitting to twice bringing e-cigarettes onto school property. “I’m also frustrated that advertising makes Juul and e-cigarettes sound like they are not dangerous when they are.”
According to the 2018 National Youth Tobacco Survey, more than 2.6 million middle and high school students were e-cigarette users in 2018, which is an increase of 1.5 million in one year. That timeline coincided with Juul’s skyrocketing popularity pushing sales up 800% between mid-2017 and mid-2018, a Wells Fargo analysis of Nielsen data showed. Though federal law prohibits the sale of e-cigarettes to minors, the U.S. Centers for Disease and Control Prevention estimates one in five high school students now vape.
That figure has alarmed physicians. The American Cancer Society points out that e-cigarettes not only can expose teens to high levels of nicotine but also serve as a gateway to traditional cigarettes. A University of Pittsburgh Schools of Health Sciences study found that teens who use e-cigarettes are nearly four times more likely to become smokers, while a 2018 study published in Pediatrics journal points out that e-cigarettes may double the odds of marijuana use. In addition, some sweet-flavored e-cigarette flavors can cause respiratory irritation and ultimately lung inflammation. Meanwhile, the aerosol in a vape “cloud” exposes users and bystanders to heavy metals and other harmful substances.
Dr. Rachel Boykan, clinical associate professor of pediatrics at Stony Brook University Medical School, wants parents to know e-cigarettes pose significant risks to teens.
“With the newest and most popular pod products, like Juul, teenagers are getting a lot of nicotine,” she said. “In our recent study, we measured cotinine — a breakdown product of nicotine — and found that the levels of cotinine in pod users were as high or higher than levels found in teens who smoked cigarettes.”
When low-nicotine e-cigarettes entered the U.S. market in 2007, they were billed as a less harmful alternative to cigarettes and a tool to help adults stop smoking. But the storyline changed in 2015 when Juul released its 5% nicotine pods in a variety of kid-friendly flavors. “Juuling” became the next adolescent craze, fueled in part by the device-maker’s strong social media presence.
In response to the backlash over teen e-cigarette use, Juul in November 2018 closed its Facebook and Instagram accounts, discontinued brick-and-mortar store sales of fruity flavored pods, backed legislation aimed at raising the legal age to purchase tobacco products to 21 and outlined company efforts to develop technology-based solutions to prevent youth use of its products. The company’s action came in advance of a Food and Drug Administration crackdown on online and retail sales of flavored e-cigarette products to anyone under 21. Juul devices and tobacco-, menthol- and mint-flavored Juul pods can continue to be sold in retail stores.
Anti-tobacco groups argue the FDA has not acted fast enough. E-cigarette manufacturers have until 2021 to comply with FDA guidelines requiring them to undergo a review of their product’s public health impact to remain on the market.
“What we’ve learned from Juul is that it is very hard to put the genie back in the bottle,” Willmore argued. “The FDA has to try by banning all flavored e-cigarettes, but it also has to stop new products from being introduced that appeal to kids.”
Despite initiatives to educate teens about e-cigarettes’ health risks, a 2018 Truth Initiative survey showed 63% of Juul users ages 15 to 24 were unaware Juul contains nicotine.
Haggerty believes most parents are equally in the dark about vaping’s popularity among teens.
“I think there are a lot of parents who are clueless about what is going on with their kids,” she said.