JUUL: A Wolf in Sheep's Clothing

They look harmless enough—like a flash drive that might contain music or photos. But a JUUL (pronounced like "jewel") contains something more worrisome—highly addictive nicotine— and as the most popular brand of e-cigarette on the market, they have the potential to hook young people on nicotine, and could lead them to turn to traditional cigarettes. Let’s take a look at why this JUUL is no gem.

A JUUL is a brand of electronic cigarette—or "e-cigarette." E-cigarettes have been around for about a decade, and are electronic devices that vaporize a liquid mixture for the user to inhale (often called "vaping"). Most, but not all, e-cigarettes contain nicotine and a mixture of flavorings and other compounds, some of which are harmful and can even cause cancer. E-cigarettes have been marketed as a way to quit smoking, but none have been proven to be safe or effective and most e-cigarette users continue to smoke traditional cigarettes.

While e-cigarettes have not been proven to be effective at helping smokers quit, there is mounting evidence they are an effective gateway to smoking for young people. E-cigarettes are now the most popular tobacco products among young people, even kids as young as middle school students. These products are often made with fruit, candy and other flavors that appeal to kids. Kids may come for the cotton candy or bubblegum flavor, but they stay and get hooked because of the nicotine, which can even be much higher than the nicotine contained in tobacco cigarettes. In 2016, the first-ever U.S. Surgeon General's report on e-cigarette use among youth shattered the myth that e-cigarettes are harmless and flat-out stated that, "All Americans need to know that e-cigarettes are dangerous to youth and young adults."

So, what makes JUULs different? While most e-cigarettes mimic regular cigarettes in shape and size—some even with an LED at the end that lights up red when you puff—JUULs look like a flash drive. They're small, sleek and easy to conceal from parents and teachers. A JUUL appears to the eye to have almost no connection to cigarette smoking. In fact, kids sometimes call it "JUULing," and may think it’s unrelated to smoking or even vaping. But this "wolf in sheep's clothing" delivers all the nicotine and harmful chemicals as bigger, more conspicuous e-cigarettes, all in an assortment of kid-friendly candy colors and flavors.  For young people, even those who would never try a cigarette, JUULing might be seen as a fun, harmless and trendy pastime.

"I'd say that JUULing has really taken off due to the fact that it appears to be light and fun," said Sean Christensen, a high school student from Towson, Maryland. "The flavors like creme brulee, mint and mango all contribute to the idea that JUULs are just toys that don't have devastating effects on your body. Our generation has been educated on the danger of cigarettes, not on the dangers of JUULs. The fun flavors and lack of education means kids don’t associate JUULing with the dangers of smoking."

"The prevalence of JUULs has also been intensified due to marketing of JUULs to high schoolers. JUULs look like flash drives because kids must hide them. No adult needs to have a vape that looks like a flash drive; they don’t need to hide that," Christensen added. "As of right now, 18-year-old seniors will legally buy JUULs and then take them to high school to sell to underclassmen. This creates a vicious cycle as the underclassmen get addicted, turn 18, and then become supplier that causes the cycle."

Dr. S. Christy Sadreameli, a pediatric pulmonologist at Johns Hopkins Hospital in Baltimore, Maryland, and an American Lung Association national volunteer spokesperson, believes JUULs are a growing risk for young people, and parents need to talk to their kids about JUULs and all e-cigarettes.

"JUUL use is on the rise among youth, yet many parents (and medical professionals) are not familiar with it," Sadreameli explained. "JUULs come in several flavors, including fruit flavors. There is a decades-long history of the tobacco industry using flavors to attract youth to their products. JUUL contains a high concentration of nicotine, so it is highly addictive, and this is particularly concerning for teens, whose developing brains are uniquely susceptible to nicotine addiction. This means that teens who JUUL may become lifelong nicotine users."

"JUUL is not benign and its growing popularity is very concerning to health professionals like myself," Sadreameli said. "This growing popularity means we need to be more aware of it. This goes for parents too. I have started asking my teenaged patients if they use JUUL and advising them to avoid this device."

The American Lung Association has information to help parents talk to their kids about e-cigarettes and tobacco use. Once again, the tobacco industry has targeted youth as their newest customers. If you're a parent, make sure your kids know that they're being manipulated by the tobacco industry. JUUL comes in flavors teens love, it's so easy to hide and it doesn't seem anything like "really" smoking—it's a perfect way to introduce young people to what the tobacco industry hopes will be a lifetime of addiction.