Last year, the Food and Drug Administration (FDA) declared that teen vaping (and Juuling) had reached "epidemic proportions." A year later? It doesn't seem as if the obsession among teens has slowed down.
Case in point: This month, eight Wisconsin teenagers were taken to the hospital with extreme coughs, shortness of breath, and fatigue, per CBS News. Doctors suspected that vaping was the cause of these teenagers’ respiratory problems, some of whom were unable to breathe on their own when they were hospitalized.
While it's unclear what the kids were inhaling that may have caused their lung and breathing issues, some of the teens said that they may have been vaping nicotine and THC (the psychoactive compound in marijuana), as Women's Health reported previously.
Those kids are certainly not the only ones hooked on vaping. Per the FDA report released last year, there was a 75 percent increase in use among teens in 2018 compared to 2017.
But the agency isn't slowing down when it comes to cracking down on retailers to prevent kids from wanting to vape and getting their hands on Juuls and other vape products. And we'll get to that.
But first: Why are young adults so into Juuls, and vaping in general? And just how bad is it really for teens' health? Here, a primer on the controversy.
What is Juuling exactly?
First off, it's important to note that vaping and Juuling are the same thing. Juuls are a type of vaporizer or e-cigarette, designed so discreetly that most people don’t even recognize them as an e-cig. Juul devices (and other vaporizers) work by heating up a cartridge that contains oils and make a vapor that can be inhaled.
According to the company's website, they were designed to help cigarette smokers transition off of smoking. "We envision a world where fewer people use cigarettes, and where people who smoke cigarettes have the tools to reduce or eliminate their consumption entirely, should they so desire," the website says. It also says in its marketing and social media code that Juul products are "not appropriate or intended for youth."
However, the vaporizers are small enough to fit in the palm of your hand, and they can be charged when plugged into a laptop’s USB slot—making it easy for students to pass them off as flash drives in class.
Why is Juuling so popular?
Between those two design elements, and the fact that the Juul pods come in flavors like crème brulee, cool cucumber, and mango, these e-cigs have become insanely popular with kids. But they're also popular among adults, given that they were originally designed to help smokers quit, as mentioned.
Just how widespread is the Juul fad, you're wondering? The Juul vaping device was invented by two Stanford grads in 2007, and has since become the best-selling e-cigarette on the market, capturing 32 percent of the market share, according to Nielsen data. And according to not-yet published data from the FDA, there was a 75 percent increase in overall e-cigarette use (vaping and juuling) among high schoolers in 2018 compared to 2017, per the Washington Post.
In addition to convenience stores, Juul products are sold through their website where you need to verify that you are at least 21 years old by providing your date of birth, legal name, and permanent address, which are then checked against public records, before you can purchase.
However, one Boston doctor told WFXT that teenagers are still buying Juuls online by lying about their age and using a prepaid debit card.
Why is vaping (or Juuling) bad?
Many people use e-cigarettes, like Juuls, because they aren’t made with tar and all the cancer-causing chemicals you'll find in a tobacco cigarette. Still, a 2018 study published in the journal Pediatrics found that teenagers who smoked e-cigarettes had higher levels of cancer-causing chemicals in their bodies than non-smokers.
Although they’re marketed as safer than regular cigarettes, vapes are certainly not risk-free. “This is not a safe alternative,” says Michael Blaiss, MD, the executive medical director of the American College of Allergy, Asthma and Immunology. “Is it safer than a tobacco cigarette? Yes. The problem is that nicotine itself can have major effects.”
When it comes to nicotine levels, one Juul pod contains the same amount of nicotine as a pack of cigarettes, according to the company’s website. With about 200 “puffs” in each Juul pod and roughly 20 cigarettes in a pack, that actually means that the amount of nicotine in each puff is significantly less than the nicotine in one cigarette, which is one reason why e-cigarettes like this can be helpful for adults trying to quit smoking. For children who haven’t yet gotten addicted to nicotine, though, vaping is far from a good thing.
“Think of it this way: In comparing e-cigarettes to traditional cigarettes, we are comparing e-cigarettes to the deadliest consumer product on the market,” says Christy Sadreameli, MD, a pediatric pulmonologist at Johns Hopkins and spokesperson for the American Lung Association.
Is Juuling more dangerous for kids than for adults?
Vaping can be particularly harmful for children and teenagers. The human lung develops rapidly within a child’s first two years, Dr. Sadreameli says, but it continues to grow until a child is 15 years old, on average.
Exposure to e-cigarette vapor during periods of lung growth and development may be more harmful to the lungs compared to when they're fully developed, she says. “Teens who are using e-cigarettes themselves may be getting exposed to very high doses of these products," she says. "We know that e-cigarettes contain extremely dangerous compounds, such as formaldehyde, heavy metals, acrolein (which causes irreversible lung damage), and sometimes harmful substances such as menthol and diacetyl (which can cause a dangerous lung disease called ‘popcorn lung’).”
What’s more, vapes like the Juul can be even more addictive than traditional cigarettes, she says. And the nicotine inside can be incredibly harmful to their developing brains.
“Nicotine is extremely addictive and it can act as a neurotoxin and alter brain chemistry so the brain doesn't function normally without it. This can be especially harmful for teenagers whose brains are still developing,” says Carol Southard, RN, tobacco treatment specialist at Northwestern Memorial Hospital. “More importantly, nicotine is a gateway drug. Teenagers who begin with e-cigarettes are more likely to transition to combustible cigarettes, putting them at higher risk for health issues.”
Should Juul and other vape retailers be regulated?
Dr. Blaiss, Dr. Sadreameli, and Southard all hope parents and lawmakers will soon catch on to this dangerous trend. “Tobacco companies are getting savvier with marketing these vape products to teens,” Southard says. “Parents need to know what to look for and understand the dangers they could cause to teenager’s health.”
In addition, Dr. Sadreameli and the American Lung Association are urging the FDA and Congress to ban all flavored tobacco products, including Juul, cigars, and menthol cigarettes. “Reports of kids being hospitalized with severe lung damage—potentially sickened from e-cigarette use—is of grave concern to the American Lung Association,” she says. “Without urgent action by the FDA and the Congress, the health of kids and the public remain at risk.”
The FDA definitely thinks so, too. The agency first launched their anti-smoking “The Real Cost” campaign in 2014 to warn teenagers about the risk of cigarettes, but has since expanded their messaging to include vapes and other tobacco products.
In one graphic video, you can see what looks like a bunch of worms crawl from a teenager’s mouth down through her body and into her lungs. “There’s an epidemic spreading,” a voiceover says. “It’s not a parasite, not an infection, not a virus. It’s vaping.” It’s fitting that they use the word “epidemic,” since the U.S. Surgeon General has also claimed that there’s a “youth e-cigarette epidemic,” according to Dr. Sadreameli.
While videos like these hopefully make teens think twice before taking a hit from their Juul, the FDA is also taking harsher action. In 2018, the agency sent out notices demanding that five leading e-cigarette manufacturers—Juul, Vuse, Blu, Logic and MarkTen—submit plans within 60 days that spell out ways to cut down their sales to underage consumers. If the plans didn’t promise to “substantially reverse” the trend of teens and vaping, Gottlieb said the FDA would, at the time, consider steps that temporarily or permanently pull the flavored e-cigs from the market. And the pressure actually worked.
In November of 2018, Juul announced that it would stop selling most of its flavored products in retail stores, citing a crackdown from federal regulators, according to NBC News. Flavors like mango, crème, and cool cucumber were still available online, but Juul promised to add age-verification measures by the end of the year so that no one under 21 could buy the vapes.
Also in 2018, the FDA sent letters to more than 1,300 stores and online retailers, warning them that they could face penalties for allegedly selling e-cigarettes to people under 18. Another 130 sellers were handed fines ranging from $279 to $11,182 for repeat offenses.
In a statement sent to Women's Health, Juul Labs says, "JUUL Labs’ mission is to eliminate cigarette smoking by offering existing adult smokers a true alternative to combustible cigarettes. JUUL is not intended for anyone else. We strongly condemn the use of our product by minors, and it is in fact illegal to sell our product to minors. No minor should be in possession of a JUUL product."
The company also says they're also working to find ways to reduce the number of minors who use tobacco and vapor products, and to keep young people from even trying these products in the first place.
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