Cigarette smoking has been on a steady decline among teens for the past decade. That’s good news … but, a new craze called “Juuling” is threatening to reverse that. A Juul is a brand of e-cigarette that has become popular among middle and high schoolers, at least in part because of youth-friendly flavors and a discrete, concealable design. If Juuling is not yet on your radar, it should be, as it is quickly moving from a trend among a small percentage of teens to a major health crisis, with many implications still unknown.
Our Country’s Long Relationship with Tobacco
The history of smoking in the United States is as old as the country itself, with tobacco at the center of many early Native American spiritual ceremonies. European settlers fueled the economic growth of America through the tobacco trade, with many linking the country’s dependence on this cash crop to the birth of the slave trade. Tobacco use spiked after World War I, when soldiers returned home addicted to tobacco.
During the decades that followed, smoking took on a “cool” vibe, with ad campaigns like the Marlboro Man driving cigarette sales despite emerging research on the associated health risks. By the late 1950s, research confirmed those links between smoking and a variety of life-threatening diseases, pushing cigarette packs to carry a warning label by the ‘60s. Smoking bans in public places followed but did not really take root until the early ‘90s. By then, smoking had reached its peak in the U.S. population, with slightly more than 50 percent of eighth-, 10th-, and 12th-graders combined reporting cigarette usage, according to the University of Michigan’s Monitoring the Future (MTF)report.
By 2017, the number of teens smoking cigarettes had dropped to 17 percent, thanks to a growing awareness of the harmful effects. According to the MTF study, “it takes quite some time for the public to comprehend adverse consequences of a particular drug, thus when a new one comes on the scene, it has a considerable honeymoon period before usage declines as awareness peaks.” The United States had reached the point of steady decline in cigarette smoking among teens, with usage dropping by nearly two-thirds since 2000. Now, we may reverse those gains due to the popularity of vaping and Juuling. As defined by MTF, “vaping involves the use of a battery-powered device to heat a liquid or plant material that releases chemicals in an inhalable vapor or aerosol, or mist. Examples of vaping devices include e-cigarettes, ‘mods,’ and e-pens. The vapor may contain nicotine, the active ingredients of marijuana, flavored propylene glycol, and/or flavored vegetable glycerin. The liquid that is vaporized comes in hundreds of flavors, many of which (e.g., bubble gum and milk chocolate cream) likely are attractive to teens.”
The New Honeymoon with Vaping and Juuling
The MTF survey began tracking vaping usage in 2015, with more than one-third of 12th-graders reporting usage at that time. In 2017, MTF began tracking the substances used in the devices, with 25 percent of 12th-graders reporting nicotine usage and 12 percent reporting marijuana vaping. MTF researchers believe these numbers are likely to grow.
Although originally touted to help an adult population curb cigarette smoking, vaping may be introducing a whole new generation to nicotine and potentially other dangers not yet fully understood. Many researchers are now tracking evidence that vaping predicts cigarette experimentation. According to JAMA Pediatrics, as reported in the Wall Street Journal, “teens and young adults who try e-cigarettes are about three times more likely to try cigarettes later.” In addition, according to a recent article in USA Today, “Nicotine, contained in varying amounts in e-cigarettes, can rival the addictiveness of heroin and cocaine. For young people, whose brains are not fully developed, it can be particularly dangerous, leading to reduced impulse control, deficits in attention and cognition, and mood disorders.”
And, by all measures, vaping appears to still be in its honeymoon stage. The trend that appears to be accelerating this is Juuling. A Juul is a vaping device that resembles a flash drive and can be used for smoking all types of substances. In an interview with CNN, Pamela Ling, a professor at the University of California-San Francisco School of Medicine, said, “Because it’s referred to as Juuling, not smoking or vaping, some students may think what they’re doing is harmless. They may not even know it contains nicotine.” She goes on to point out that “one Juul ‘pod,’ the nicotine cartridge inserted into the smoking device and heated, delivers about 200 puffs, about as much nicotine as a pack of cigarettes, according to the product’s website.”
The maker of Juul has now taken measures to restrict teen access to the product, but many students report that the product is relatively easy to come by. After months of complaints by parents, teachers, and others, the Food and Drug Administration (FDA) is finally stepping in. It announced in April that it had begun “a large-scale, undercover nationwide blitz” on the illegal sale of e-cigarettes to minors, online and in stores. The FDA has discovered numerous violations and has sent warning letters to more than 40 retailers. Next steps include:
- Working with eBay to prevent sales of Juuls through re-sellers.
- Working directly with the manufacturers of Juuls to hold them accountable for taking action to prevent teen access.
- Investigating companies that are using misleading advertising to lure teens into using vaping products.
- Engaging in research-based campaigns to alert students to the dangers of all tobacco products.
Actions Schools Should Take Now
So what can schools do to protect students? Experts suggest a few essential steps:
- Revise school policies to specifically call out vaping and related devices.
- Develop programs to educate students on the dangers of vapes and Juuls.
- Train faculty and administrators to recognize the use of vapes and Juuls at school.
- Inform parents about the dangers of vaping and what they can do at home to protect their children.
- Share this American Academy of Pediatrics fact sheet with parents and teachers.
Some schools have taken even more proactive steps, such as placing sensors in bathrooms to detect vaping. Others have banned the use of flash drives that so closely resemble these devices. Clearly, every school needs to take this threat seriously and to take proactive steps that fit with the age of the students they serve.
Unfortunately, the long-term health effects of vaping and Juuling on both the development of the teen brain and overall physical health are just beginning to be discovered. There is time to end the honeymoon period for these devices if we act now as a community. Please share what actions your school is taking to deal with this crisis so that together we can end this epidemic.