Juuling: One year later

Last year, I wrote about the popularity of the Juul device among middle school students, high school students and young adults. Juuls, which look like USB flash drives, are a type of e-cigarette used to inhale flavored “pods” that contain as much nicotine as a pack of cigarettes. 

While
nicotine itself does not cause cancer, it is highly addictive and harmful to
the developing brain. This puts young people, whose brains continue to develop
into their mid 20s, at higher risk of developing mood disorders, issues with
memory and learning and poor impulse control. They are also more likely to
develop an addiction to other substances later in life, according to the
Centers for Disease Control and Prevention. Unfortunately, many of these
devices are also used for substances like marijuana.

Over the
past year, awareness of the risks associated with juuling has grown, and public
health officials have cracked down on e-cigarette manufacturers’ sales to
youth. Here are some of the major developments.

Nicotine Use on the Rise

The Centers for Disease Control and Prevention reported that 27 percent of high school teens used tobacco products in 2018, an increase of 38 percent over the past year. More specifically, e-cigarette use, also known as vaping, increased 78 percent among high school students, from almost 12 percent in 2017 to 21 percent in 2018.  The use of other tobacco products such as cigarettes and cigars did not really change. Therefore, we can reasonably attribute the increased nicotine use to e-cigarettes.

READ MORE: Does your child Juul?

Combatting Nicotine Use

Thankfully, Dr.
Scott Gottlieb, commissioner of the Food and Drug Administration (FDA), called
teen vaping an epidemic and announced increasing restrictions for the industry.
These measures include targeting retailers of Juuls through multiple undercover
sting operations, taking action on flavored products that are appealing to
youth, closing online sales to minors and curbing marketing of tobacco products
to youth. The FDA also expanded its tobacco prevention campaign, “The Real Cost,”
to educate teens on the dangers of e-cigarettes.

Last
September, the FDA conducted an unannounced inspection of Juul Labs’ headquarters
in San Francisco, seizing over 1,000 pages of documents and ordering Juul to develop
a youth prevention plan. In response, Juul improved its age verification system
for purchases made on its website. Shoppers must now either provide the last
four digits of their Social Security number or upload a valid government-issued
ID for review. Juul also says it has increased its secret shopper program to
verify that retailers are following the standards, while issuing fines for
those that do not. 

Tobacco 21

Most recently, the Maryland General Assembly approved Tobacco 21, a bill that raises the age for purchasing tobacco products as well as e-cigarettes from 18 to 21. That law went into effect Oct. 1.

Final Thoughts

Learning more about the different types of e-cigarette products, including Juul, is an important first step in addressing youth vaping. It is also important to recognize the signs of e-cigarette use. The flavorings in the Juul and other tobacco products contain chemicals that may be safe to eat, but are not safe to inhale into the lungs.  These chemicals can be irritating to the lungs and can cause coughing, wheezing and an increase in asthma symptoms.  The secondhand vapor, much like secondhand smoke, contains chemicals and is not harmless water vapor.

While I applaud the efforts of local and federal government to curb the use of e-cigarettes by our youth, parents and other influential adults must continue to talk to their children about the dangers of juuling.

Author

Stephen Cattaneo, MD, is a thoracic surgeon and medical director of Thoracic Oncology at Anne Arundel Medical Center.