Parents: Teens Are Still Vaping, Despite Flavor Ban. Here's What They're Using
Disposable vapes may be hotter than Juul among kids, according to researcher Bonnie Halpern-Felsher. She received a bag of vape pens recently confiscated by a high school principal in northern California, with flavors like Banana Ice and Cool Mint. Bonnie Halpern-Felsher hide caption
Disposable vapes may be hotter than Juul among kids, according to researcher Bonnie Halpern-Felsher. She received a bag of vape pens recently confiscated by a high school principal in northern California, with flavors like Banana Ice and Cool Mint.Bonnie Halpern-Felsher
Efforts to stem the tide of teen vaping seem to be a step behind the market. By the time Juul pulled most of its flavored pods from the market in October of 2019, many teens had already moved on to an array of newer, disposable vape products.
"Juul is almost old school ... It's no longer the teen favorite," says Meredith Berkman, co-founder of the advocacy group PAVE, Parents Against Vaping E-cigarettes.
"Among the disposables [that] are most popular, there's Puff Bar, there's Stig, there's Viigo," Berkman says. They're designed for one-time use. Then, they're tossed, she explains. "These have just flooded the market," Berkman says.
These products are flourishingdespite the Trump administration's partial ban on flavored e-cigarettes, announced in January and in effect as of Feb 5. The enforcement guidance issued by Food and Drug Administration was aimed at stopping young people from vaping. It focused enforcement on flavored cartridges, like Juul's popular products.
But it left open some "loopholes," says Matt Myers of the Campaign for Tobacco-Free Kids. "It won't take the kids and it hasn't taken the kids any time to make a switch [to newer products]."
At any time, the FDA could crack down on the new disposables. The agency has enforcement discretion to take action and in the guidance the agency specified it could take action on any e-cigarette product that's "targeted to minors."
The industry has been very creative at getting new products on the market quickly, despite regulators' efforts to curb teen use, says Cristine Delnevo, who directs the Center for Tobacco Studies at Rutgers University.
"It's a bit of a game of whack-a-mole, so when policies are aimed at one product, another product pops-up to fill the void," Delnevo says.
Delnevo and her collaborators have documented some of the rapid changes in disposable vaping products in a new paper published recently in the journal Tobacco Control.
"There are so many of these products," she says. She and her coauthors write that they heard anecdotally last September about a new vaping product, "a disposable 'pod-mod' closely resembling JUUL" that was popular among college students.
Combing through threads on Reddit, they found mention of a bunch of brands of disposable "pod-mods" — including Posh, Eon Stik and Mr. Vapor — which began to appear in the spring of 2019. "Comments focused on tasting similar to JUUL flavors, lasting longer than a JUUL pod and having a good 'hit' like a JUUL," they wrote. They also documented advertising for two brands of disposable products in a convenience store near Rutgers.
The Puff Bar, 3.75 inches long, comes in a range of sweet and fruity flavors, like Pink Lemonade. Disposable flavored vapes like this are growing popular among teens. Max Posner/NPR hide caption
Some of the most popular new products, such as Puff Bar, come in an array of appealing flavors — similar to what Juul used to sell, says Myers of the Campaign for Tobacco-Free Kids.
"This one is pink lemonade," Myers says as he shows me a Puff Bar. It's a vape pen that looks like an elongated thumb drive.
"And when you inhale it, it has a sweet, sugary flavor," says Myers. These flavors cut the harshness of the tobacco. "Young people are inhaling more deeply and getting higher levels of nicotine in their lungs than they would have with a cigarette."
(NPR reached out to the makers of Puff Bar, via an email listed on the product packaging, to ask about marketing and sales of the product. The company did not respond.)
"The Puff Bar is an extremely popular product," says Bonnie Halpern-Felsher, a developmental psychologist at Stanford University. One bar has about 300 puffs and can contain about as much nicotine as two or three packs of cigarettes. "That's a lot of nicotine," she says. And, research shows nicotine is addictive and harmful to adolescents' developing brains.
She says because these products are so new, and the landscape changes quickly, it's difficult to know how many teens are using them and similar disposable products.
But she received a bag of confiscated vape sticks and pens that a high school principal in northern California collected recently and shared with her.
"When I laid them out, the majority of them are disposable products," Halpern-Felsher says. "They come in lots of flavors, colors, [they're] very attractive to youth and that's what we're seeing them using the most right now."
What can concerned parents do?
1) Don't confront. Start with a softer approach
"We know that teens don't respond well to just being told about harms or scare tactics," says Halpern-Felsher. She says if you start a conversation by saying "Johnny, you're not vaping, right?" you're not likely to get far.
Instead, start by telling your teen what you've learned about vaping — and why it concerns you. Say something like: "I've learned how much nicotine is in the products, what have you heard?" Engage them in a conversation to share information.
Then, through that conversation, "it [may] come out whether or not the adolescent is using," she says. "If you find out they're using — tell them you'd like to get them help."
2) Know what products are still available
"Before you sit down with your kid, read up on the latest products. Know what they look like and know what the lingo is, " advises PAVE's Berkman. PAVE offers a toolkit for parents.
In addition to disposable vape sticks, there are refillable cartridges and flavored nicotine liquids, often called "e-liquids" available. "Right now, you can buy e-liquids on-line, often on websites that are not really age-protected," Matt Myers says. "And increasingly [they're available] in convenience stores and gas stations," he adds.
He says the product manufacturers "have figured out how to deliver more nicotine to young people than the cigarette manufacturers ever did," so they can be highly addictive.
"Sit down with your young people to make sure they understand that these products are not safe and that they run a serious risk of an addiction," Myers says.
3) Find help online
There are a number of online, digital QUIT programs. For instance, My Life My Quit is available in more than a dozen states. The Truth Initiative offers a text-based quitting program that young people can sign up for by texting DITCHJUUL to 88709.
For more information, parents and educators can search an online resource from the Truth Initiative of research and reports about emerging tobacco products. And Halpern-Felsher and a team of collaborators have created a tobacco-prevention toolkit.
People are throwing their Juuls out windows and drenching them in water just to quit
Henry Korman is exactly who Juul wants using its e-cigarettes. He’s not a teen, and he’s a former smoker, so he thought substituting a vape for cigarettes was a healthy decision when he switched two years ago. But then, he wanted to quit the Juul, too. He tried multiple times, cold turkey, to no avail. The Juul addiction stuck around, at least until he found sugar snap peas.
“I carry around this big bag of sugar snap peas to keep me occupied and replace the Juul,” he says. “I used to say ‘phone, keys, wallet, Juul’ — that’s what I needed to have before I left the house. But now it’s ‘phone, keys, wallet, peas.’”
Korman’s not alone in trying to kick his Juul habit. What started as a way for some people to wean themselves off cigarettes has turned into a new kind of addiction made worse by the ability to vape just about anywhere. In other cases, people who started vaping just because the Juul was around have developed new nicotine habits. For both types of users, quitting has proven immensely difficult.
Korman says he’s been eating a pound of sugar snap peas a week instead of reaching for his Juul. He decided to quit last month because the habit was costing him around $8 a day, the price of a single Juul pod. He also went on a health kick and realized he changed his diet and exercise habits, but still held onto his electronic nicotine stick.
The real motivation, though, came after recent reports about a mysterious severe lung disease linked to vaping. “You’re saying I’m going to be broke and dead?,” he asks. “No thank you.”
While vaping was initially positioned as a smoking cessation tool, it’s increasingly being cast in a darker light. A mysterious lung disease has killed at least six people in the US with more than 450 cases reported, and officials believe it’s linked to vaping — though the exact cause is still unknown. The US Centers for Disease Control and Prevention has asked anyone who uses a vape to stop while they investigate, and the American Lung Association did the same. Senator Mitt Romney has asked the Food and Drug Administration to recall e-cigarettes, and President Donald Trump called this week for a ban on all flavored e-cigarette pods. Meanwhile, Juul is under investigation for marketing to minors and positioning its devices as a healthier alternative to cigarettes without FDA approval. Juul’s own CEO told non-cigarette smokers to not use his company’s products. “Don’t vape,” he said. We reached out to Juul for this report and did not immediately hear back.
This message has reached the vapers. There’s been a significant uptick in the amount of discussion on social media about quitting Juuls and other vapes, according to data from Sprout Social, a company that monitors social media trends. Between August 11th and September 9th, there were more than 60,000 Twitter mentions about quitting or stopping the use of Juuls or vapes, compared to only 16,000 at the same time last year. The data shows a noticeable spike in people tweeting about quitting vaping in late August, around August 26th, a few days after the first person died of the lung disease. The spike in Juul users tweeting about quitting started on September 1st, the same day The New York Times published a story that called the lung disease an “epidemic.”
Shannon Dunlop is one of the people who recently quit. She started vaping because her partner kept a Juul in their bedroom. He used it before bed, and she tried it, only to get hooked. She used it for six months or so and then began Juuling in her work’s bathroom.
“I was triggered,” she says. “I couldn’t believe that I got so addicted to something that never even really called to me in the first place.”
Dunlop tried quitting by hiding her two Juuls in a drawer and not buying pod refills. That didn’t always work because sometimes she just bought more pods. Instead, her addiction broke when she went for a jog one day and her chest started hurting. She thought her Juul habit might be to blame.
“I was like, ‘I hate this thing,’” she said. “Maybe I am out of shape, but whatever, fuck the Juul.”
When she got home, she grabbed the Juuls out of her stash, turned on the sink, and drenched them in water. She posted the whole ordeal on Instagram Stories, ending the video by tossing a Juul in the trash.
“I took this huge stance and told my friends what I had done, so I felt like if I bought [more] pods, I’d just be a fucking idiot,” she says.
The Juul, once a trendy meme, is now a menace. At its peak of coolness, and before everyone realized how unamusing this addiction would become, BuzzFeed published a story of vape memes called “24 tweets about Juul’s that only teens will find funny.” Vicetried to figure outGame of Thrones star Sophie Turner’s favorite Juul pod flavor. The New York Timespublished a piece about 2017, the year it points to as kicking off the “Juul wave,” saying that Juuls had become “Too Cool.” The rate of high school students vaping increased by 78 percent between 2017 and 2018, according to the FDA and CDC.
“What resonates with our generation is the memes,” one teen told the Times. “I haven’t seen the Juul on TV. But you’ll see a bunch of memes about Juuling. It’s just, like, making it more socially acceptable — it’s perpetuating the thing that vaping is cool.”
But Juul has lost its cultural cachet. The lung disease news seems to be the main catalyst for the shift to quitting, and Juul users are turning to the usual nicotine-quitting recommendations that have helped people stop using cigarettes for decades.
Vapers say they’ve tried nicotine gum, patches, or pouches to taper their use, or try to replace their oral fixation with things like toothpicks. Some have looked into using essential oils or CBD to stop cravings. Others go to more extreme lengths, tossing their Juul into the ocean, out car windows, and into dumpsters.
Froste, a Twitch streamer associated with 100 Thieves, says he just recently quit the Juul after hearing about all the health risks associated with vaping. He started because he was hooked on cigarettes, but he says vaping took a dark turn when people started using them anywhere, unlike a cigarette.
“You can hit it anywhere you want,” Froste says. “Wherever — a restaurant, a car, anywhere, even on a plane.”
He says he quit cold turkey nine days ago after tapering his use, but now finds himself hungry all the time and needing water. He also has physical withdrawal symptoms, like a headache, cough, and sore throat.
“Yeah, it kind of sucks, but it’s not like I would rather go back to Juuling,” he says. “They’re honestly one of the dumbest things that have become popular and cool with young kids.”
If you or anyone you know is trying to quit vaping, the National Cancer Institute has an online resource available for teens. They also have more information about e-cigarettes for adults.
In This Stream
Vaping health crisis: the latest on lung injuries, exploding e-cigs, and seizuresView all 22 stories Sours: https://www.theverge.com/2019/9/11/20859645/juul-quit-vaping-cdc-fda-flavor-pod-ban-death
She’s a rapper, singer, producer, graphic designer and art director; a founder of London’s most exciting multi-disciplined collective NiNE8, and a fashion designer who has shown during Men’s London Fashion Week. Is there anything 22 year-old Lava La Rue can’t do?
With a musical aesthetic she describes as an “amalgamation of West London, my identity and heritage”, mixed with trying to meld a “very mellow psychedelic sound with R&B”, La Rue has always taken a DIY approach to life, creating her own artwork, music videos and merchandise since childhood.
In that same spirit, the Londoner kept herself busy in lockdown, self-directing her music videos and orchestrating collaborations with the likes of TikTok multi-instrumentalist Towa Bird for her track “Angel”. Her latest critically-acclaimed EP, Butter-Fly, was a departure from the brazenly political tracks that preceded it, “as I wanted to show a part of myself, and realised that all love songs are inherently political”. In times of adversity, creativity prevails, and La Rue is one of the most exciting creatives in the industry today.
Go inside her mind as she takes Vogue’s personality test.
If you could own any work of art from history, which one would you pick?
It would be pretty sick to own a Frida Kahlo. That’s kind of a flex – a big flex.
Which fictional character from a movie, series, or novel do you most identify with?
Probably Niobe from The Matrix, played by Jada Pinkett Smith. That character is literally my style icon and inspires me all the time.
Which song do you never, ever tire of hearing?
There’s this sick film called Scott Pilgrim vs the World. The soundtrack was all made by Beck and I literally never, ever get bored of listening to it. I know every single word to every song in that movie.
If you had to live in another city for a year, which one would it be?
I want to say LA because I have so many friends there. I’ve been going there to write music a lot, so I feel like I’d still be really productive as a lot of producers are based there. But if I was going to live somewhere for a year I’d probably go to Jamaica. I wouldn’t have a problem with spending a year there. I’d be with family.
What would I find on your nightstand?
Some empty JUUL pods, a cup of herbal tea and some incense.
What creative rituals do you have before/while/after working?
Before and after work, I set the mood in the house by burning incense or candles. I live close to loads of trees which no-one else can see, so I love looking out and watching the squirrels and birds for a bit. I won’t think of anything – not work, nothing. It helps clear my head a bit, and then I’ll continue into the work. I have a big nest of squirrels right by my bedroom window that only I can see right now.”
What’s your signature dish when you’re entertaining?
Either a Caribbean chickpea curry or a vegan roast. A Quorn roast with onion gravy, two big Yorkshire puddings, mash and roast veg. And sometimes I make my own stuffing.”
If you had to get a tattoo right now, what would you choose?
A cowboy boot on my calf, because I feel like the whole cowboy aesthetic really represents me. When I went on my first tour, I brought a cowboy hat with me and I told myself that I was a cowboy on the road, instead of feeling all scruffy and missing home.
What would your desert island luxury be?
As obvious as it sounds, my old iPod shuffle with all of the songs that made me want to start making music.
If you were a cocktail, which one would you be?
Probably a Long Island iced tea. I’m really tall.
Which song lyrics best describe your life at the moment?
The first line of “I Would Die For You” by Prince, when he says, “I’m not a woman, I’m not a man, I am something you will never understand.”
Name the last book that you read in one sitting.
At the moment I’m reading big heavy books on racial injustice which isn’t really a one sitting thing. But the last thing I did read in one sitting was Rituals for Every Day by Nadia Narain and Katia Narain Phillips, which my manager Milly gave me. It’s about doing little everyday things to keep you centred and focused. I read it all in one go.
What’s your star sign, and do you agree with its traits?
I’m a Gemini on the cusp of a Taurus and I agree with both the traits. I’ve come to terms with the duality of all my energies. People believe the stereotype of Geminis being two faced, but I see it as having both feminine and masculine energy. I can be both alternative – completely rock and emo – or hip hop and soul in the same sitting, I can be left and right, black and white, it’s embodying everything into one. I feel like Gemini represents that for me.
What’s the last note that you wrote on your phone?
It’s a shopping list that says: ear muffs, gloves, iPhone charger and laptop charger, because I’ve lost both those things on set for one my recent music video shoots.
Lava La Rue will be performing at Village Underground Thursday 19 August 2021.
What are the risks and side effects of JUUL e-cigarettes?
A JUUL is a type of e-cigarette or vape pen that has risen to popularity mainly due to its discrete look and high potency. Juuling may cause several side effects, including coughing, a sore throat, and headaches. Longer term use has associated health concerns as well.
JUULs and other vape pens are less harmful than cigarettes, though people should be aware that these products carry their own risks. They still contain nicotine and many other chemicals, meaning that they are not a safe alternative to cigarettes.
Keep reading to learn more about JUULs, including the associated risks and side effects.
What is a JUUL?
A JUUL is a form of e-cigarette that delivers nicotine to the lungs without using fire and smoke. The device is long and slender, looking somewhat similar to a pen or USB flash drive.
As with other e-cigarettes, vaping devices such as JUULs contain a heating element and a source of liquid, called vape juice, that contains nicotine.
JUUL is actually the name of specific e-cigarette devices that JUUL Labs manufacture, though many people now use the term in relation to other manufacturers’ vape pens.
Activating the device vaporizes the vape juice, delivering the nicotine to the lungs as vapor when the person inhales.
E-cigarette risks and side effects
Burning a cigarette and inhaling the smoke exposes the lungs and bloodstream to various chemicals and compounds, increasing a person’s risk for a range of health issues.
E-cigarettes remove this smoke completely, instead delivering vaporized nicotine through a heating element. However, vaporizing the compounds in e-cigarette vape juice may carry its own side effects and health risks.
Common side effects
Side effects from e-cigarette use are common. Using e-cigarettes, JUULs, or other vaporizer devices may cause:
These side effects may be more common when a person first starts using vape products, and they may go away with time. They may also go away if the person stops using vape devices.
Vaporizing e-cigarette juice creates very small vaporized particles and aerosols. These ultrafine particles can reach deep into the lungs, including the smallest airways, called bronchioles.
Particles in these bronchioles may cause damage and inflammation that lead to scarring of these tissues.
Additionally, a study in Pediatrics notes that these ultrafine particles may make their way into the circulatory system, potentially causing inflammation and cardiovascular disease.
Other nicotine use
E-cigarette use does not guarantee that a person will not use cigarettes. In some cases, e-cigarette use by nonsmokers and young people may actually lead them to use other products, such as cigarettes.
Smoking other products will lead to even more nicotine in the body, making it harder to quit either form of the drug.
Vape devices are relatively new, and the long-term risks are still difficult to understand. E-cigarettes and vape devices expose the body to several potentially harmful substances, and long-term exposure to these substances may carry its own risks.
The potential risks to long-term exposure of these substances include:
- respiratory issues
- damage to the lung tissue
- reproductive issues
- circulatory issues
However, when it comes to linking e-cigarettes directly to long-term risk, there is still too little research to make any broad claims.
E-cigarettes still expose the body to nicotine, which is an addictive substance. Additionally, the Department of Health and Human Services note that the liquid juice that the person inhales into their lungs contains other compounds that may be harmful, such as:
- volatile organic compounds
- heavy metals, such as tin, lead, and nickel
- natural and artificial flavorants that may contain harmful ingredients
- carbonyl compounds
How is a JUUL different?
While JUUL branded products and similar devices may feel different than larger vape pens or other devices, they behave in much the same way. A heating element warms the vape juice until it vaporizes, and the person inhales this vapor into the lungs.
Compared with other options, vape pens such as JUULs are more discrete. They produce minimal vapor, and the vapor that the person exhales quickly evaporates and disappears.
The devices themselves are also more discrete. A person may easily hide a JUUL in a pocket or purse, and it looks similar to a pen or flash drive.
Vape pens and JUULs are also different due to their easy access to different flavors and solutions. Other devices may require a person to mix their own solution or refill the device as the solution runs out.
Vape pens and JUULs provide cartridges or pods that attach to the device in seconds.
Rather than free nicotine, JUUL devices contain a proprietary blend of nicotine salts, mimicking the feel of tobacco use.
JUUL risks and side effects
As with other e-cigarettes and vape pens, JUUL has numerous health risks and side effects, including:
Overuse and high nicotine
JUUL products and other vape pens have a risk for abuse and overuse. A JUUL pod containing 5% nicotine is equal to one pack of cigarettes. Many other companies and vape juices provide less nicotine, as they are designed for people looking to wean themselves off tobacco.
Regular JUUL users may expose themselves to much higher levels of nicotine when choosing these vape pens over other e-cigarettes.
The note that people using these vape pens may become addicted faster than people smoking cigarettes.
Nicotine toxicity and seizures
The high levels of nicotine in JUUL pens may also increase the risk of nicotine toxicity with regular use. This toxicity may lead to serious health issues, such as seizures and neurological conditions. The have linked vape pen use to several cases of seizures.
JUUL products specifically also seem to appeal to young teens. The reasons for this may include the discrete nature of the device, the enjoyable flavor, and the high potency leading to a “high.”
In 2019, the warned Juul Labs about their marketing, which involved youth outreach and other practices targeted at young teens, including the promotion of appealing flavors such as mango and fruit medley.
The company also made misleading statements that their product was a safe alternative to cigarettes, without providing any evidence for this claim.
Teen use of vape pens has risen in recent years. The note that e-cigarette use among high-school students increased from 1.5% in 2011 to more than 20% in 2018. In middle-school students, this number went from 0.6% to 4.9% over the same period.
Teen use of nicotine products may be especially dangerous. Nicotine in a developing brain may quickly lead to addiction. Additionally, the nicotine the adolescent’s brain development.
Addiction and nicotine use may also lead to changes in behavior, reduced impulse control, or mood fluctuations.
There is no completely safe form of nicotine use.
Manufacturers originally intended for e-cigarettes to be a way to help smokers wean themselves off nicotine and tobacco use. The idea was that by using much lower levels of nicotine while providing a similar experience to smoking, these devices would help the person quit.
The products are now a popular alternative to smoking, but they are not free of risks.
Those looking to quit smoking or vape devices may start by using vape juice with lower levels of nicotine to wean themselves off the habit.
Other nicotine products, such as patches and gums, may provide an alternative to help a person quit.
When to see a doctor
Anyone struggling with nicotine use should see a doctor. They may be able to offer more advice on how to wean the body off nicotine or quit immediately.
Anyone noticing concerning effects, such as a persistent cough or difficulty breathing, after using JUUL pens should also see a doctor for a diagnosis.
JUUL pens are an alternative to smoking. Although they eliminate combustion and tobacco, they are not safe because they still deliver high amounts of nicotine.
These devices deliver an addictive product, and they have associations with both short-term and long-term side effects and risks. Direct research into the long-term effects of JUUL use will take time.
Anyone concerned about their symptoms or possible nicotine addiction may wish to speak to a doctor.
Dangers of Vaping
What is vaping?
Vaping uses electronic cigarettes (or e-cigarettes) to simulate traditional cigarette smoking. E-cigarettes are battery-powered or chargeable smoking devices. Some look like traditional cigarettes or pipes. Others are designed to look like pens or USB memory sticks. They use a cartridge (or pod) filled with liquid. The liquid typically contains nicotine, flavorings, and other chemicals. When you puff on the mouthpiece of the device, it activates a heating element. This heats up the liquid in the pod and turns it into vapor. You then inhale the vapor. This is why it’s called “vaping.”
E-cigarettes are often marketed as a safer alternative to smoking. But they’re not safe. They still put an addictive drug and chemicals into your body and into the air around you.
How is vaping different from JUULing?
Vaping and JUULing are the same thing. JUUL (a brand of e-cigarettes that look like USB memory sticks) is a very popular vaping device among teenagers. So popular, in fact, that its brand name has become a verb to describe vaping. Teens may also use the term “ripping” to describe smoking an e-cigarette or JUUL. For more on JUULing and how it relates to teens, see “Teens and JUULing” below.
Disputing common myths about e-cigarettes
The makers of e-cigarettes market them for a variety of uses. Researchers are still in the early stages of studying e-cigarettes. But studies have shown that e-cigarettes still contain harmful chemicals, including nicotine. Below are common myths—and the real facts.
- Myth: E-Cigs are a safer alternative to smoking cigarettes.
Fact: Makers claim that e-cigarettes don’t contain the harmful chemicals that cigarettes do. Of course, this is not true. Most devices contain nicotine. A JUUL pod contains either 3% or 5% nicotine. A JUUL pod that contains 5% nicotine is equivalent to the amount of nicotine in one pack of cigarettes.
- Myth: E-cigs aren’t addictive.
Fact: While there are some cartridges that don’t contain nicotine, most do. Any time a smoker inhales nicotine, they are inhaling an addicting and harmful chemical.
- Myth: You can use e-cigs indoors.
Fact: At first, makers of e-cigarettes said that e-cigarettes were appealing because they could be smoked in places that didn’t allow traditional cigarette smoking. This is no longer true. Many states have created laws that prohibit vaping in the same areas where traditional smoking is not allowed.
- Myth: E-cigs are a way to quit smoking.
Fact: Marketers claim it is easier to quit smoking if you switch to vaping first. But e-cigarettes contain nicotine and may even lead to a user becoming a traditional cigarette smoker.
What are the dangers of vaping?
Experts have a number of concerns about the safety of e-cigarettes and vaping.
E-cigarettes contain nicotine. In large doses, nicotine can be toxic.
- Nicotine stimulates your central nervous system. This increases your blood pressure, breathing, and heart rate. Higher doses of nicotine can cause blood pressure and heart rate to go higher. This can lead to an abnormal heart rate (arrhythmia). In rare cases, this can cause heart failure or death. Over time, nicotine can lead to medical problems. These include heart disease, blood clots, and stomach ulcers.
- Nicotine increases the level of dopamine in your brain. This chemical messenger affects the part of the brain that controls feelings of pleasure. It can motivate you to use nicotine again and again to get that feeling of pleasure. You do this even though you know it is a risk to your health and well-being. That is what makes nicotine addictive.
- The ingredients in the liquid are not labeled. This means that we don’t know for sure what’s in the liquid or in what amounts.
- There are often chemicals in the liquid. Some of these are known to cause cancer. One study found a toxic chemical that is found in antifreeze.
- Tiny particles are released by the heating element and may be harmful. These particles can cause inflammation in the lungs, which can cause bacterial infections or pneumonia.
- The liquid in the cartridge can be poisonous if someone touches, sniffs, or drinks it. There has been an increase in poisoning cases of children under 5 who have had access to the liquid.
- “Secondhand smoke” is still a problem for e-cigarettes. Secondhand e-cigarette vapor contains chemicals that harm the lungs and hearts of people who aren’t vaping.
- They serve as an introductory product for preteens and teens. Many kids start with vaping and then move on to other tobacco products.
- Right now, there is little regulation when it comes to e-cigarettes. Even if it isn’t a JUUL product, there are many other kinds of e-cigarettes available. Doctors do not know what may be in them.
Teens and JUULing
E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States, according to the Centers for Disease Control and Prevention. In 2020, the U.S. Food and Drug Administration stated that 3.6 million middle and high school students were current users of e-cigarettes. This is a disturbing trend for many reasons:
- Teenagers face increased risks from JUULs/e-cigarettes. The teen years are a critical time in brain development. This puts young people uniquely at risk for long-lasting effects. Nicotine affects the development of brain circuits that control attention and learning. It puts kids at higher risk of having mood disorders and permanent problems with impulse control. It also affects the development of the brain’s reward system. This can make other, more dangerous, drugs more pleasurable to a teen’s developing brain.
- Kids who use e-cigs like JUULs are more likely to become smokers than kids who do not, according to a three-year study. The study followed high school students as they transitioned from e-cigarettes to traditional ones.
The federal government is trying to discourage teens from buying these products. Before December 2019, people who were at least 18 years old could buy tobacco products. In December 2019, the government changed the rule and said a person had to be at least 21 years old to buy tobacco products. In January 2020, the FDA issued a policy limiting the flavors available in e-cigarettes.
There is much still to be learned about e-cigarettes and vaping. Since it’s relatively new, there aren’t long-term studies on the effects it may have. Until these long-term effects are known, doctors are encouraging patients to avoid e-cigarettes.
How do I talk to my child about JUULing?
If you suspect your child is JUULing (and even if you don’t), ask them about it. Start a conversation. Ask if they’ve seen friends doing it or seen JUULing at school. Use this opportunity to tell them the dangers of JUULing. JUULing is addictive. JUULing has been shown to lead to smoking. Smoking causes cancer, heart disease, and emphysema. Smoking is responsible for 1 in 5 deaths in the United States.
What if my child is already JUULing?
Talk to your child about quitting. Make an appointment for you and your child to talk to your family doctor about the best ways to quit JUULing. Your doctor may suggest a plan that includes some of the FDA-approved elements for smoking cessation listed below.
Things to consider
The FDA has approved 7 medications for smoking cessation in adults. These include nicotine gum, nicotine patches, and medicines. (Vaping is not one of the 7 approved methods.) There is little evidence that these same tactics will work for vaping. If you are trying to stop vaping, here are some tips to consider:
- Talk to your doctor. They may be able to suggest nicotine replacement therapy. They also may be able to prescribe medicines to help you quit.
- Make a plan. Set a date to begin the quitting process. Set goals as part of your process. These can be as small as having one less e-cigarette a day for a week. Then you can continue to cut back on a schedule until you no longer smoke or vape.
- Stay busy. Keep your mind off smoking by keeping busy. Do activities with your hands to keep them occupied. Plan ahead for times when you know you’ll want to smoke, such as after a meal or when you go out.
- Put off cravings. Cravings can be hard to resist, but they usually pass. Tell yourself to wait until a certain time, and the urge to smoke will often be gone by then.
- Get support. Surround yourself with people who support you. Tell your friends and family that you are quitting so they can be supportive. If you don’t want anyone to know you smoke or vape, join an online or in-person support group.
Questions to ask your doctor
- Can I quit JUULing cold turkey?
- Is there any sort of nicotine replacement I could try while quitting JUUL? Do you recommend this?
- How long should it take me to quit JUULing?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
How much nicotine is in JUUL?
One JUUL pod contains 20 cigarettes worth of nicotine.
The amount of nicotine in one standard JUUL cartridge is roughly equal to the amount of nicotine in a pack of cigarettes, or about 200 puffs, according to the JUUL website.
Early nicotine use can harm brain development, alter nerve cell functioning and increase the risk of young people smoking cigarettes. In fact, young people who use e-cigarettes are four times more likely to go on to smoke cigarettes than their peers who do not vape. (Interested in quitting? Learn how to quit JUUL.)
JUUL contains more nicotine than many other e-cigarettes.
Before JUUL was introduced in 2015, the most popular e-cigarette products contained nicotine strengths of between roughly 1 percent and 2.4 percent. When JUUL debuted, its pods contained 5 percent of nicotine strength.
The maker of JUUL claims its nicotine salt formulation increases the rate and amount of nicotine delivered into the blood, compared with other formulations. The company has claimed the product delivers nicotine up to 2.7 times faster than other e-cigarettes.
Many people are misinformed about the nicotine in JUUL and other e-cigarettes.
Many young people aren’t even aware that they’re consuming nicotine when they use e-cigarettes. Results from a April 2018 Truth Initiative® study published in Tobacco Control show that nearly two-thirds — 63 percent — of JUUL users between 15 and 24 years old did not know that the product always contains nicotine. The study provides further evidence that young people are unaware of the nicotine they are consuming. The majority of youth e-cigarette users think they vaped only flavoring, not nicotine, the last time they used a product.
The popularity of this high-potency nicotine delivery device raises concerns about the lack of education and regulation of e-cigarette products. In November 2018, the Food and Drug Administration proposed a plan to address the youth e-cigarette epidemic, which includes limiting the sale of most flavored e-cigarettes to adult-only stores and online. However, the plan does not address the agency’s decision to allow e-cigarettes to stay on the market through August 2022 without its review. This move, made in 2017, allowed electronic tobacco products, including JUUL, to stay on the market unchecked.
Truth Initiative is continuing to push for more action to prevent e-cigarettes from putting a new generation at risk for addiction and turning back the clock on decades of progress in the fight against tobacco. These actions include eliminating flavors, banning online sales, restricting marketing appealing to youth and requiring a thorough premarket review of e-cigarettes.
For information on quitting e-cigarettes, visit truthinitiative.org/quitecigarettes.
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