JUUL – The Biggest Threat to the Health of the American Youth

Table of content

1. Overview
2. The Biggest Public Health Crisis of 21st Century
3. The Kingpin
4. The Marketing Angle
5. Health Concerns
6. Rise in JUULing among teenagers and young adults
7. Parents are going after JUUL
8. Government Crackdown
9. Has JUUL Become Responsible?

1- Overview

With the help of strict anti-smoking laws and regulations, cigarette smoking among U.S. adults (aged ≥ 18 years) has hit an all-time low as the rate fell from 42.4 percent in 1965 to 14 percent in 2017, the US Centers for Disease Control and Prevention (CDC) reported. (1) This historic low in the prevalence of smoking among adults is no doubt one of America’s most remarkable public health achievements so far as millions of smoking-related deaths have been prevented over the last five decades. But the hard-won success may now be in peril because of vaping.

2- The Biggest Public Health Crisis of 21st Century

When e-cigarettes or vaping devices were first introduced to the American market back in 2007, they were hailed as the ‘safe’ new alternative to smoking traditional cigarettes, which is why vaping, as an idea, quickly gained popularity among adults trying to kick the habit. Vaping devices were designed to look and feel like real cigarettes, even down to emitting artificial smoke; however, they did not actually contain any tobacco. Users could inhale vapor which looks like smoke without any of the carcinogens found in tobacco smoke which are harmful to the smoker and others around them. No doubt, people soon became very optimistic about e-cigarettes. Thanks to a slew of severe health issues that have been reported in people who vape, however, vaping has now become one of the biggest public health crises facing the country. According to the CDC, more than 800 people have ended up in the hospital due to severe breathing problems and lung damage attributed to vaping and at least twelve people have died so far. (2) These reports have made it clear that vaping is dangerous and the idea that these things are somehow radically more ‘risk-free’ than cigarettes is just not true.

3- The Kingpin

At the front and center of the vaping industry is San Francisco-based e-cigarette firm behind the stylish and popular JUUL (Pronounced: jewel). Just two years after this sophisticated, sleekly designed, discreetly high-tech vaping device was introduced in the United States, JUUL Labs went from being a little-known brand to the world’s most popular and successful e-cigarette company ever. A research by the Centers for Disease Control and Prevention also concluded that JUUL is the most popular and successful e-cigarette brand in the market today. (3) According to an article published by the National Institutes of Health (NIH), JUUL currently claims about 72 percent of the e-cigarette market in the U.S., (4) and is valued at a $38 billion. (5) Juul’s quick rise in popularity even prompted an American daily newspaper, the Boston Globe, to call it “the most widespread phenomenon you have likely never heard of.” (6)

JUULs are like other e-cigarettes, in that they are essentially a portable “nicotine-delivery device” designed to deliver a nicotine experience truly akin to a cigarette, but they do have a couple of caveats that set them apart. Unlike other e-cigarettes, JUULs use nicotine salts from leaf-based tobacco for their core ingredient, in lieu of the standard free-base nicotine. JUULs also have a one-of-a-kind form factor. Unlike other unattractively large ‘tank systems’ in the market, they look modern, sleek and feel precisely machined. With their flat and rectangular profile, rounded edges and a gently burnished finish, they look less like an e-cigarette and more like a USB drive (and can, in fact, be charged in the USB port of a computer.) They are also small enough to fit in the palm of the hand, which makes them very easy to carry around and keep out of sight.

4- The Marketing Angle
Cigarette companies have always moved heaven and earth to persuade consumers in choosing their brand over their competition by making veiled and blatant health claims. Before the health risks of smoking were proven by medical research and realized by the American public, many American tobacco companies ran cigarette advertisement campaigns that incorporated testimonials by doctors.
In 1930, Lucky Strikes published an ad claiming that it had removed the pungent irritants present in cigarettes manufactured the old-fashioned way, making their cigarettes less irritating to sensitive and tender throats than other cigarettes. Following in Lucky Strikes’ footsteps, the Philip Morris Company created an ad in 1937, claiming that doctors had conducted a piece of research showing that “when smokers changed to Philip Morris, every case of irritation cleared completely and definitely improved.” Camel also whipped up a similar Medical Relations Division and advertised it in medical journals. It even bragged in a 1946 ad that “more doctors smoke Camels than any other cigarette.” As anyone would expect, all of these doctors were sponsored by the cigarette brand they were campaigning on behalf of.

JUUL seems to have adopted this strategy and designed an entire brand based on the idea of switching from harmful cigarettes to safer vaping devices. As a matter of fact, some of its promotional materials seem to be plagiarised directly from old cigarette spots with catchphrases like “simple, smart, intensely satisfying” and “smoking evolved”, while others apply the long-standing idea of switching to new ground, by calling their products a way to “improve the lives of the world’s 1 billion adult smokers by putting an end to cigarettes.” Even though these ads do not explicitly say customers will be healthier if they switch from cigarettes, the message is absolutely unmistakable – JUUL has been exploiting the lack of public awareness about the hazards of vaping.

4.1- JUUL’s Youth Targeted Ads

All things said, what JUUL’s empire has really been built on are its ‘youth-oriented’ marketing campaigns. JUUL has been intensively marketed to the youth via social media platforms such as Instagram, Twitter and Facebook. In fact, according to Kantar Media, the company invested $1 million into their engaging and wide-reaching online marketing campaigns targeted to the younger generation. (7) From making colorful ads that feature attractive young models and social media influencers wearing crop tops and ripped jeans, flirting with the camera as they show off their flash-drive shaped vaping devices to flourishing hashtags on Instagram and Twitter #juulpods, #juulnation, #juulgang, #juulcentral, #juultricks, #juulmemes) and accounts devoted to celebrity JUUL use (@sophie_turner_juuling), JUUL’s marketing has made it a major part of the pop-culture zeitgeist – and thus, more appealing to teenagers and young adults.

5- Health Concerns
The long-term health effects of the ingredients in JUUL — a solution of propylene glycol, vegetable glycerine, flavoring chemicals such as diacetyl, heavy metals (such as nickel, tin, and lead) and other volatile organic compounds – are still being researched, but what we do know is JUUL has the highest concentration of nicotine that of all the e-cigarettes in the market. Each cartridge (called a “JUUL pod”) contains about the same amount of nicotine as one or two packs of cigarettes (0.7 ml or 59 mg/ml). (8) This means that nicotine-related health consequences are certainly the most severe in JUUL. Nicotine usage is commonly associated with chronic obstructive pulmonary diseases (COPD) like bronchitis and emphysema and cancer of lungs, larynx, oral cavity, esophagus, pharynx, etc. Furthermore, prolonged usage of JUUL can develop into addiction over a period of time and can lead to mood disorders, lowered impulse control, cognitive impairment, and attention problems among teenagers and young adults.. JUUL also has an extremely high concentration of benzoic acid at 44.8 mg/ml. (9) Benzoic acid is known to cause coughs, sore throat, abdominal pain, nausea, and vomiting.
Furthermore, JUULing can be a gateway to combustible cigarettes. A study on the association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths found that youth who vape are more likely than non-users to start smoking cigarettes, and the higher nicotine concentrations in JUUL might heighten the likelihood of this transition. (10) There is a growing concern that JUUL might create an entire generation of nicotine-addicted youth, reversing the dramatic reductions in smoking achieved over the last 50 years.

No matter what chemical substance or in what quantity you introduce into your body (whether by inhaling, ingesting or even just touching), if your body is not accustomed to it, there will likely be certain side effects. E-liquids used in JUUL pods are no exception as these ingredients are either chemicals or substances derived through chemical processes. This means that while the health risks of JUULing are undoubtedly very severe.
Secondhand exposure to JUULing is a form of air pollution and poses some health risks as well. A report on the effects of e-cigarettes among youth and young adults prepared by the Surgeon General concluded that secondhand emissions contain toxic substances at concentrations that are above recommended levels and linked to serious lung diseases. (11)

6- Rise in JUULing among teenagers and young adults

While rates of cigarette use among American youth have declined, rates of e-cigarette use are rising. According to the Monitoring the Future (MTF) 2018 survey conducted by the researchers at the Institute of Social Research at the University of Michigan and funded by the National Institute on Drug Abuse (NIDA), about 37.3 percent of high school seniors, 32.3 percent of sophomores and 17.6 percent of middle school students have reported vaping at least once in 2019, compared to just 27.8 percent of high school seniors, 23.9 percent of sophomores and 13.3 percent of middle school students in 2017. (12)
Furthermore, a research paper on the prevalence and correlates of JUUL use among American youth and young adults surveyed found that of 14,379 surveyed (aged 15 to 34), 6.0 percent reported using JUUL at least once, and 3.3 percent reported using JUUL at least once in the past thirty days. Rates were higher among participants aged 15–17 and 18–21 years, with 9.5 percent and 11.2 percent reporting ever use, and 6.1 percent and 7.7 percent reporting current use, respectively. Among current users aged 15–17 years, 55.8 percent reported use on three or more days in the past thirty days, and over a quarter reported use on 10–30 days. (13) These findings suggest that teenagers are not just experimenting with JUULs, but rather using them on a regular basis. JUUL use is also very popular among middle school and high school students. According to a Truth Initiative Survey, nearly one-fifth of students have seen a JUUL used in school. (14)

6.1- Why is JUUL a hit among the youth?

The characteristics that purportedly make JUUL more popular among youth include:
• Sleek and youthful product design and packaging
• Sweet flavors like Fruit Medley and Crème Brulee
• Celebrities positively portraying vaping on the Internet and in TV and movies
• Subtle scent
• Suggestions that vaping makes you happier and improves your social status
• Low price tag
• Discreet profile that is easy to conceal – teens have reported bringing them to class and taking a puff or two while sitting in class.
• Many teenagers even have the misperception that it using JUUL is completely safe. A 2015 Stanford university study qualitatively analyzing the adolescents’ perceptions of risks and benefits of conventional cigarettes, e-cigarettes, and marijuana found that some of the participants believed that e-cigarettes did not contain nicotine, only water vapor. (15)
Then there is the concern of how easy it was to buy a JUUL. Despite the fact that the U.S. Food and Drug Administration (FDA) subjects JUULs to the same rules as tobacco products (16), middle and high school students can still go to their website, click a button that says they are at least 18 or 21 years old and purchase a JUUL.

7- Parents are going after JUUL

As their kids get hooked on JUULing, parents can do nothing but watch their children fall prey to the epidemic. To help such parents discourage their kids from picking up the habit of JUULing, three wealthy and influential mothers from New York who take their moralistic war on vaping very seriously – Dina Alessi, Meredith Berkman, and Dorian Fuhrman joined forces and formed the advocacy group Parents Against Vaping E-Cigarettes (PAVe) in the spring of 2018.
Founded as a grassroots response to the most serious adolescent public-health crisis our country has faced in decades, the group’s primary purpose is to educate people about the dangers of JUULing, advocate against their use and lobby for legislative action. When it was launched, the group immediately grabbed national press exposure has grown to about a dozen chapters across the country.

8- Government Crackdown

Although e-cigarettes have been on the market for almost a decade before JUUL, none of them really took off. Even today, when there are many e-cigarette brands in the market (Blu, Vuse, Ruyan, NJOY, Logic and E-Swisher), JUUL still holds most of the e-cigarette market share. Naturally, then, JUUL is largely blamed for the vaping explosion, putting a sharp focus on the company.
An outbreak of lung injuries among e-cigarette users across much of the United States has focused national attention on the potential dangers of vaping, prompting the federal government and some states to take policy steps in response. On April 2018, the US Food and Drug Administration (FDA) commissioner Scott Gottlieb, M.D. announced several new actions and efforts aimed to stop youth use of, and access to, JUUL. (17) Among these actions were:
• Conducting a large-scale, undercover nationwide blitz to crack down on the sale of JUUL to minors
• Contacting eBay to remove several listings for JUUL products
• Asking JUUL to turn over documents about the design and marketing of its products so that their youth appeal can be fully examined

9- Has JUUL become responsible?

In response to the FDA’s crackdown, JUUL Labs announced their very own strategy to combat youth use. In their press statement, they announced that they were raising the minimum age required to purchase JUUL from 18 to 21. They also pledged to invest $30 million on campaigns aimed at limiting youth use of JUULs. (18) The FDA followed up by issuing a warning letter to JUUL for illegally selling its products to minors. The FDA gave JUUL sixty days to lay out its plans to address widespread youth access and use of its products or else, some or all of their flavored products could be pulled from the market. In September 2018, the FDA also made an unannounced inspection of JUUL’s San Francisco headquarters and seized a collection of over a thousand pages of documents on the firm’s sales and marketing practices. (19)
Sixty days after the FDA’s ultimatum, the CEO of JUUL Labs Kevin Burns sent out a press release (20) stating that the company would stop selling its flavored JUUL pods (mango, fruit, crème, and cucumber) through retail stores in compliance with the FDA’s investigation. He also announced that the company will make their flavored products available only on www.juul.com, where only someone verified to be over 21 would be able to make the purchase. On top of that, customers are limited to purchasing two JUUL devices and fifteen JUUL pods per month, and no more than ten devices per year. Kevin also announced that JUUL’s US-based Facebook and Instagram accounts would be shut down, while their Twitter presence would be limited to communications that do not promote JUUL products and their YouTube will be used exclusively for their customer testimonials.

About The Authors

Steve Samples | James Ames

Sources

• Source 1: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.html
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• Source 11: https://e-cigarettes.surgeongeneral.gov/documents/2016_SGR_Exec_Summ_508.pdf
• Source 12: https://www.drugabuse.gov/related-topics/trends-statistics/infographics/monitoring-future-2018-survey-results
• Source 13: https://tobaccocontrol.bmj.com/content/early/2018/10/30/tobaccocontrol-2018-054693
• Source 14: https://truthinitiative.org/research-resources/emerging-tobacco-products/nearly-1-5-youth-say-they-have-seen-JUUL-used-school
• Source 15: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515157/
• Source 16: https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes#ref
• Source 17: https://www.fda.gov/news-events/press-announcements/fda-takes-new-steps-address-epidemic-youth-e-cigarette-use-including-historic-action-against-more
• Source 18: https://www.mercurynews.com/2018/04/25/san-franciscos-juul-to-invest-30m-to-fight-underage-vaping/
• Source 19: https://www.wect.com/2018/10/03/fda-seizes-documents-e-cigarette-maker-broader-crackdown-underage-vaping/
• Source 20: https://newsroom.juul.com/2018/11/13/JUUL-labs-action-plan/