“I don’t think anyone’s an expert on JUULs at this point,” Kelly Wieser, Associate Director of Prevention Education for NCADA, said.
Wieser attributes the rise in popularity of the JUUL to two main factors.
“When I talk with high school students in other schools, they like the hiding factor of it but they also like the fact they get a pretty immediate head rush from it so that’s leading them down the path to addiction,” she said.
The perception of JUULs as harm-free is, in Wieser’s eyes, a dangerous illusion.
“Supposedly, a pod is about equivalent to a pack of cigarettes in terms of the nicotine that’s in there,” Weiser said. “Sometimes when people vape, they might just take a drag off of it and then they put it down for a while. Other people, they just continually vape on it so there’s a risk of overdosing on nicotine.”
Ryan’s experience with using the JUUL to reduce his cigarette-smoking is not an uncommon experience.
“For smokers, there’s some indications in observational research as well as in random trials suggest that people who are using e-cigs to quit smoking or to reduce their smoking exposure, it can be a good thing. Certainly, thousands of people have reported quitting smoking with e-cigs,” Washington University Professor of Medicine Dr. Amy McQueen said. “There are plenty of people with e-cigs who downgraded their nicotine levels over time and some smoke them with zero nicotine. In that sense, it can be a new opportunity for smokers to attempt to quit.”
The ambiguous compositional makeup of the JUUL device is reason to be cautious, McQueen believes.
“With e-cigs, some of them come from China and you really wonder what’s in there. There’s no regulation and so it’s really unclear what’s in there,” McQueen said. “It’s not necessarily known what the threshold is that would then cause addiction in which case they’d try to increase their use.”
Gutchewsky seconds McQueen’s concern regarding the mysterious nature of the JUUL and other e-cigarettes.
“I worry just from a health standpoint for kids because I think e-cigarettes to the general public have been advertised as sort of a healthy alternative to cigarettes or a way to quit smoking cigarettes,” he said. “I think there’s a lot of unknowns regarding the health effects with the various vaporizers and I don’t know and it wouldn’t surprise me if down the road that we find they’re certainly not healthier than cigarettes.”
A main risk associated with teen e-cigarette usage comes from the prospect of building a tolerance for nicotine and the health implications of doing so.
“Tolerance to nicotine builds up fairly quickly in the brain to the fact that someone who is in high school might JUUL a little bit and have a full-on addiction to nicotine. In terms of what nicotine can do to the body, it raises the risk of heart attack, raises the risk of stroke; I know as a teenager somebody might think it’s not going to happen to them or they’re still young, you know, ‘I’ll quit at some point,’ but knowing that nicotine is very hard to quit, it leads them down a path [that is] very challenging health-wise,” Wieser said.
According to the St. Louis County Department of Public Health, “e-cigarettes with nicotine have the potential to more greatly affect addiction among youth than adults since brain development continues until the mid-20s. Decision making, impulse control, sensation seeking, and peer pressure are all examples of brain development activities among adolescents. Physicians are especially concerned that teens who vape will develop an addiction to nicotine.”
Ryan insisted that smoking the JUUL was a better alternative for him, both on the financial and health side of things. He also mentions that the process of using the JUUL allows him to more effectively control his use.
“I save more money and I actually like the taste better than cigarettes. Plus, it is a better alternative although it’s not healthy either. It still ends up working out better,” Ryan said. “There’s chemicals in it for sure; there’s like 10 percent nicotine. But cigarettes have more. I typically buy one pod each time I buy because I can save and control it with the JUUL.”
Wieser pointed out that the transition from vaping to smoking cigarettes may often be a natural one especially for Missourians, given the financial implications of the state’s low cigarette taxes.
“In Missouri we have really cheap tobacco prices. It makes our cigarette prices cheaper than other places. At some point, a $50 starter pack of the JUUL is a whole lot more than a pack of cigarettes,” she said. “In Missouri, a pack of cigarettes is potentially a lot cheaper to the point where people would move from vaping onto traditional cigarettes with those 7,000 chemicals and the cancer risks and everything else.”
McQueen believes that the popularization of e-cigarette devices like the JUUL may act to reverse the efforts made in the public health arena to advance anti-smoking rhetoric.
“A concern in the public health community is that we’ve done so much to denormalize smoking behavior in this country and that’s really helped us to reduce cigarette smoking in the adult population and we’ve had some success with teens and young adults but this new perceived cool and perceived lower risk, perceived newer technology option might revamp the whole ‘smoking is cool’ social norm,” she said.
Wieser suggests that the ambiguous and nuanced nature of the JUUL product makes it an attractive option for teens. The perception, Wieser asserts, does not necessarily match the reality.
JUULs are inconspicuous, easier to hide, adults don’t always know what they are, they have a flash drive appearance. On their site, they’re supposedly very upfront about the fact that these are for adults and not for teens. In terms of the marketing, in terms of the videos you see online and that kind of thing, it’s very enticing for teens. It’s kind of like how sometimes advertising doesn’t match the reality.
— Kelly Wieser
Wieser hopes that education will serve as a vehicle to deter teens from using products like the JUUL.
“In the moment, something like this is new or innovative, but I don’t think people think three years from now, or 10 years from now, what the ramifications will be. You’d hope that through education you could provide some information that would make people think twice and at least try to make some healthy choices,” Wieser said.