Electronic cigarettes go by several different names. While the most common name has been e-cigarettes, the brand name Juul not only has taken over the market, but also has become a commonly used verb.1 E-cigarettes or vaping devices heat a liquid solution to a temperature high enough it produces vapor.
The liquid typically contains nicotine and a variety of different flavors. Although some of the flavors have been approved by the U.S. Food and Drug Administration (FDA) for oral consumption, they have not been for inhalation.2 The lack of approval is based on a lack of research into the safety of the compounds once they reach your lung tissue.
The design of the product may resemble a regular cigarette, cigar, pen or a USB flash drive. The most recent designs have a sleek, high-tech appearance and are easily recharged, sometimes on your computer. The most recent device, Juul, appeared in 2016 and has been the leading e-cigarette product since early 2018.
As you might expect, other companies wanting to take advantage of this meteoric rise in popularity have created similar products to follow Juul’s high-tech look and high nicotine delivery.3 However, while skyrocketing sales have been financially profitable for the company, it may come at the price of health.
Government Agency Seized Thousands of Document Pages During Surprise Inspection
Across the country, parents and regulators have been wrestling with the growing problem of teenage e-cigarette use. Massachusetts Attorney General Maura Healey went public with her concerns that teenagers are the target of Juul e-cigarette advertising and focused her investigation on whether the California-based company adequately monitors its website to prevent minors from accessing products.4
The FDA launched what they called the5 “largest coordinated enforcement effort in FDA’s history” against 1,300 retailers who illegally sold Juul and other e-cigarette products. They announced they intend to hold retailers accountable for continued violations and will take steps to work with manufacturers directly to hold them accountable as well.
An official request for information was sent directly to Juul Labs regarding their product marketing, research on the health, toxicological, behavioral or physiological effects of the products, and youth-related adverse events.6
Weeks after the FDA requested manufacturers submit plans on how they will reduce use of their products in young people, the agency conducted a surprise inspection of Juul’s corporate headquarters, seizing thousands of documents, many related to sales and marketing practices.
“The new and highly disturbing data we have on youth use demonstrates plainly that e-cigarettes are creating an epidemic of regular nicotine use among teens. It is vital that we take action to understand and address the particular appeal of, and ease of access to, these products among kids.”
Despite Advertising and Youth-Based Flavors, Juul Claims They Don’t Target Teens
The FDA also is considering banning several flavored liquids9 as they make it easier for teens to get hooked on nicotine. Flavors Hook Kids10 describes the process as masking the taste of any harsh chemicals and tobacco. Flavors also have an emotional link, which is triggering the development of a terrifyingly high number of flavors.
While Juul has a limited number of flavors available in their vape products, there are over 15,000 tobacco and vape flavors available, customized to pique the curiosity of teens and adults. Juul Labs made a statement following the FDA seizure, saying it was:11
“… committed to preventing underage use and we want to engage with FDA, lawmakers, public health advocates and others to keep Juul out of the hands of young people.”
Research from the Centers for Disease Control and Prevention (CDC) found advertising aimed at youth for e-cigarettes continue to increase in retail stores, on the internet and in television advertising.12
Interestingly, some full-page advertising run in newspapers contains one of the oldest reverse psychology devices in the tobacco industry’s playbook — advertising warning the product contains an addictive chemical and is for adult smokers only.13
According to preliminary data from the CDC annual National Youth Tobacco Survey, the number of students who have used e-cigarettes in the last 30 days rose by 75 percent since their last report in 2016. This means nearly 20 percent of high school students are using e-cigarettes today, as compared to 11.7 percent from their last survey.14
In a survey from Truth Initiative, a nonprofit tobacco control organization, researchers found 63 percent of teens using the product did not know it contained nicotine.15
The New Nicotine Is a Chemical Disaster in the Making
Juul represents their product as the16 “most genuine alternative to smoking cigarettes.” Statements also appear to support the switch to vapor and not quitting completely when they say, “adult smokers interested in switching from cigarettes should be offered high-quality alternatives that satisfy them because satisfaction is a key component to supporting their switch to vapor.”
These goals resulted in the production of patented JuulSalts delivering a nicotine hit much more like smoking a cigarette than any other e-cigarette product.17 The breakthrough occurred when Juul began using benzoic acid to freebase nicotine salts for rapid nicotine delivery.
Since the 1960s, cigarette companies have freebased nicotine using ammonia, which can be very irritating to the chest and lungs. However freebased nicotine from JuulSalts are not as irritating and are readily absorbed into the lungs and brain.
Juul Has Over 50 Percent of the E-Cigarette Market Share
A combination of the high-tech sleek design and increased nicotine hit with high addiction rate has resulted in a meteoric rise in sales. According to Nielsen data, just two years after the launch of the company, Juul garnered more than half of the e-cigarette retail market sales in the U.S.20
As there are hundreds of other devices available to consumers, this market share is staggering. According to Meg Kenny, assistant head of school at Burr and Burton Academy in Manchester, Vermont,21 “Ninety-five percent of the disciplinary infractions we deal with in the fall and continue to deal with into the spring are all connected to the Juul.” Corinne Graffunder, director of the CDC’s Office on Smoking and Health, said:22
“There are no redeeming benefits of e-cigarettes for young people. The use of certain USB-shaped e-cigarettes is especially dangerous among youth because these products contain extremely high levels of nicotine, which can harm the developing adolescent brain.”
Early Nicotine Use Increases Risk of Addictive Behavior Throughout Life
The 2016 Surgeon General’s report23 showed a 900 percent increase in use of e-cigarettes between 2011 and 2015. Several studies have supported the hypothesis e-cigarettes are a gateway habit, leading teens from vaping to smoking traditional combustible cigarettes, hookah and cigars.24,25,26
In other studies using animal models, researchers discovered rats exposed to nicotine during adolescence grew into adulthood with a greater potential to exhibit addictive behavior.27 Exposure to nicotine during adolescence results in long-term changes in the midbrain reward center that may also be a gateway to other addictive drugs, such as cocaine, heroin and morphine.28
Nicotine administration during adulthood in animal models did not alter the function of the inhibitory midbrain circuitry in the same way it did with exposure during adolescence.29 Vapor from e-cigarettes also contains acetaldehyde and formaldehyde, and the FDA has detected antifreeze chemicals linked to cancer in e-cigarettes.30
Despite lower levels of nicotine pollution from e-cigarettes, researchers have found bystanders have similar levels of cotinine, a measure of the amount of nicotine taken into the body, as those who are exposed to traditional combustible secondhand cigarette smoke.31
A Growing Market for Illegal Sales
As Juul attempts to protect sales of their products from the website to underage consumers, a black market business has grown in the teen population. According to a high school sophomore from Houston,32 if you deal the e-cigarettes you can make a lot of money.
She described the types of dealers in her school, some of whom sold pods or devices, or who would bootleg refills if you wanted a different flavor or THC oil. Another student reported:33
“Dealers will announce on Snapchat that they’ve bought a hundred of them, and they’ll write the price, the date and the meeting place for kids to show up with cash.”
One college student argues the Juul represents his generation’s “tech-savvy ingenuity when it comes to making bad decisions.” He described his experience when he first tried Juul in 2016, saying:34
“Someone pulls one out at a party, and naturally the question is ‘Can I try it?,’ and then after ‘Can I try it?’ five or six times you end up buying your own, and, soon enough, you’re breathing in more Juul than air.”
Dr. Jonathan Winickoff, former chair of the American Academy of Pediatric Tobacco Consortium, trying to end youth smoking, commented:35
“Let’s be clear. Juul is already a massive public health disaster — and without dramatic action it’s going to get much, much, much worse. If you were to design your ideal nicotine-delivery device to addict large numbers of United States kids, you’d invent Juul.
It’s absolutely unconscionable. The earlier these companies introduce the product to the developing brain, the better the chance they have a lifelong user.”
Juul Complains Copycat Products Cut Into Profit Margins
Despite garnering over 50 percent of the market, Juul Labs has filed a patent infringement complaint in the U.S. and Europe against what they believe are copycat products.36 Their complaint with the International Trade Commission (ITC) named 18 companies, many of them based in the U.S. or China, claiming development and sale of products based on Juul’s patented technology.
They request the ITC prevent the products’ importation and sale into the U.S. The copycats are basing their marketing strategy on the sale of lower-priced products.
Juul products have become a ubiquitous presence in high schools in America in more affluent ZIP codes. In recent decades, the same areas have seen a decline in smoking combustible cigarettes. In part, this may be attributed to price. The Juul retails for $ 34.99 and a four-pack of pods cost $ 15.99 (or about $ 4 a pod).37 Combustible cigarettes, on the other hand, range from over $ 5 a pack in Missouri and Virginia to nearly $ 13 a pack in New York.38
While Juul’s complaint against copycat products focuses on its desire to “protect consumers and prevent underage use,” it is more likely driven by the company’s perceived loss of market share. Kevin Burns, Juul’s chief executive officer, stated:39 “The rapid proliferation of products infringing on our intellectual property continues to increase as our market share grows.”
Whatever the Delivery Method, Nicotine Is Addictive
While most advocates of e-cigarettes claim they are best used to help smokers quit, the delivery of nicotine is always addictive. Studies have demonstrated the health dangers with nicotine maybe slightly different in e-cigarettes, but are no less dangerous than smoking combustible tobacco.
Nicotine is one of the oldest botanical insecticides40 and a powerful poison linked to a number of different health conditions.41 Evidence suggests nicotine adversely affects your cardiovascular, respiratory, renal and reproductive systems.42
Damage to your heart and vascular cells triggers an inflammatory response that may lead to atherosclerosis and promotes tumors by affecting cell proliferation, increasing resistance to chemotherapeutic agents.
I believe the “secret” to quitting smoking is to get healthy first, making quitting mentally and physically easier. Exercise is an important part of this plan, as research shows people who engage in regular strength training double their success rate at quitting smoking compared to those who don’t exercise. Healthy eating is another crucial factor to improve your health and strengthen your ability to quit.