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Vaping, ‘juuling’: the new addiction that your kids say is 'cool'

It’s a habit that’s putting at risk millions of youth in the United States.
By Amaya Verde, Ana Elena Azpurua and Javier Figueroa

The latest generation of electronic cigarettes have a futuristic design, they look like USB sticks and they hardly smell.

Pen drive

Latest generation electronic cigarette

High addictive power
Since the emergence of the Californian brand Juul on the market, a good part of the vapers contain nicotine levels similar to those of the traditional cigarette.

The vapers also contain flavorings and other chemicals, some known and in lower doses than those of conventional cigarettes. Others new and potentially toxic.


They are also used with active cannabis compounds such as tetrahydrocannabinol (THC) and cannabidiol (CBD) oils, purchased from authorized dispensers or in the black market.

“My son has said that ‘Everyone’ in high school has a JUUL device and is vaping. He is not someone that you would expect to use it, so if he is doing it, then I believe him when he says everyone. Teenagers think this device is not harmful to them. Think it's "cool".

A Maryland mother sent that message to the Food and Drug Administration (FDA) in June 2018, after her son collapsed in the room. According to his testimony, the young man was lying with eyes rolled up, turning blue and convulsing on the floor. Paramedics found a cool mint electronic cigarette under the 16-year-old teenager.

The current outbreak of lung injuries linked to electronic cigarettes, which has left dozens dead and more than 1,000 patients, brought to the fore another alarming health problem: the growing number of teenagers who claim to have vaped nicotine. The percentage has doubled in the last two years.

Use of cigarettes in the last 30 days among students of:

The use of these devices is expected to increase 21.5% this year.

Traditional

cigarette

40%

20%

0%

Vaping

with nicotine

1991

2000

2010

2018

The use of these devices is expected to increase 21.5% this year.

Traditional

cigarette

40%

20%

0%

Vaping

with nicotine

1991

2000

2010

2018

The use of these devices is expected to increase 21.5% this year.

Traditional

cigarette

40%

20%

0%

Vaping

with nicotine

1991

2000

2010

2018

40%

20%

0%

Traditional cigarette

The use of these devices is expected to increase 21.5% this year.

Vaping with nicotine

1991

2000

2010

2018

The use of these devices is expected to increase 21.5% this year.

40%

20%

0%

Traditional

cigarette

Vaping

with nicotine

1991

2000

2010

2018

The use of these devices is expected to increase 25.5% this year.

40%

20%

0%

Traditional

cigarette

Vaping

with nicotine

1991

2000

2010

2018

The use of these devices is expected to increase 25.5% this year.

40%

20%

0%

Traditional

cigarette

Vaping

with nicotine

1991

2000

2010

2018

40%

20%

0%

The use of these devices is expected to increase 25.5% this year.

Traditional cigarette

Vaping with nicotine

1991

2000

2010

2018

The use of these devices is expected to increase 47.5% this year.

40%

20%

0%

Vaping

with nicotine

Traditional

cigarette

1991

2000

2010

2018

The use of these devices is expected to increase 47.5% this year.

40%

20%

0%

Vaping

with nicotine

Traditional

cigarette

2010

2018

1991

2000

The use of these devices is expected to increase 47.5% this year.

40%

20%

0%

Vaping

with nicotine

Traditional

cigarette

1991

2000

2010

2018

40%

20%

0%

The use of these devices is expected to increase 47.5% this year.

Traditional cigarette

Vaping with nicotine

1991

2000

2010

2018

Source: National Survey 2018 Monitoring the Future conducted by the University of Michigan.

Electronic cigarettes reached the market in 2007 with the promise of helping adults quit smoking, but in 2014 they became the tobacco product of choice for teenagers. Four years later, the use of nicotine vapers among young people skyrocketed as never seen in the 44 years of the Monitoring the Future survey, which asks high school and high school students about their drug use in the last 30 days.

A good part of them becomes habitual vapers. Among seniors in high school, 1 in 10 reported using electronic cigarettes with nicotine almost every day.

The dangerous appeal of flavors

The White House announced in mid-September that it will seek to ban electronic cigarettes with flavors, including menthol but excluding tobacco flavor, also a type of flavor. The measure will contribute more to reducing the rate of young people who vape than to curb the recent outbreak of lung lesions, mostly linked to THC, says Eric Lindblom, director of the Tobacco Control and Drug Legislation program at the O'Neill Institute.

None of the four flavors preferred by young people resemble tobacco.

Flavors chosen by Juul users in the last 30 days.

12-17 YEARS OLD USERS

Fruit Medley

Mango

Cool mint

Menthol

26%

25%

16%

5%

18-21 YEARS OLD USERS

Cool mint

Mango

Fruit Medley

Menthol

32%

31%

22%

2%

Most prefer fruity or sweet flavors, aromas that could be recalled soon.

None of the four flavors preferred by young people resemble tobacco.

Flavors chosen by Juul users in the last 30 days.

12-17 YEARS OLD USERS

Mango

Fruit Medley

Cool mint

Menthol

26%

25%

16%

5%

18-21 YEARS OLD USERS

Mango

Cool mint

Fruit Medley

Menthol

32%

31%

22%

2%

Most prefer fruity or sweet flavors, aromas that could be recalled soon.

None of the four flavors preferred by young people resemble tobacco.

Flavors chosen by Juul users in the last 30 days.

12-17 YEARS OLD USERS

Fruit Medley

Mango

Cool mint

Menthol

26%

25%

16%

5%

18-21 YEARS OLD USERS

Cool mint

Mango

Fruit Medley

Menthol

32%

31%

22%

2%

Most prefer fruity or sweet flavors, aromas that could be recalled soon.

None of the four flavors preferred by young people resemble tobacco.

12-17 YEARS OLD USERS

18-21 YEARS OLD USERS

Most prefer fruity or sweet flavors, aromas that could be recalled soon.

Cool mint

Mango

Fruit Medley

Menthol

Fruit Medley

Mango

Cool mint

Menthol

26%

25%

16%

5%

32%

31%

22%

2%

Flavors chosen by Juul users in the last 30 days.

Source: The Truth Initiative

This new generation of electronic cigarettes of flavors are used in social environments where lighting a conventional cigarette would be frowned upon or forbidden. Its design helps them go unnoticed in a school bathroom or even in the classroom.

In the words of a 17-year-old from Florida who was vaping mint Juuls on a daily basis: "It's very easy to use. You use them anywhere, wherever and however you like." He tested them when he moved from Venezuela to the United States in 2015 and "everybody was vaping".

Another attraction of the new electronic cigarettes is that the nicotine salts they use make them less irritating than the traditional ones. Moreover, many teenagers believe that electronic cigarettes do not have nicotine or are harmless, when that is not the case, says Michael Blaha, director of clinical research at the Ciccarone Center for the Prevention of Cardiovascular Diseases.

Why do teenagers vape?

Friends

or family use it

37%

Flavors like mint, caramel,

fruit or chocolate

31%

They think they are

less harmful

17%

Social pressure greatly influences young people.

Why do teenagers vape?

Friends

or family use it

37%

Flavors like mint, caramel,

fruit or chocolate

31%

They think they are

less harmful

17%

Social pressure greatly influences young people.

Why do teenagers vape?

Friends

or family use it

37%

Flavors like mint, caramel,

fruit or chocolate

31%

They think they are

less harmful

17%

Social pressure greatly influences young people.

Social pressure greatly influences young people.

Why do teenagers vape?

37%

Friends or family use it

Flavors like mint, caramel, fruit or chocolate

They think they are less harmful

31%

17%

Source: National Youth Tobacco Survey (2016).

Studies also suggest that teenagers who start using electronic cigarettes are generally more likely to try traditional cigarettes, says Abigail Friedman, a professor at the Yale University School of Public Health, who points out that conventional cigarettes are annually responsible for at least 1 in 5 deaths in the United States. What is unknown is how many would have tried a product with tobacco anyway, he says.

With hardly any control

The poor regulation also contributed to the popularity of these cigarettes among minors, experts warn.

"No federal laws about tobacco products applied to e-cigarettes before August 2016. People referred to it as the Wild West, the old day Wild West, there was no regulation, they were uncontrolled,”says Lindblom, who worked with the FDA.

When the agency finally obtained jurisdiction over electronic cigarettes, it restricted the sale to minors and demanded labels with warnings about the use of nicotine, but allowed them to continue selling products with flavors. “FDA at that point could have taken flavored tobacco products off the market or could have taken some flavored tobacco products off the market that were particularly attractive to kids,” Lindblom notes.

Today, electronic cigarette companies are still on the market without the risks and benefits of their products being evaluated by the FDA.

“We already have this new addiction. What are we going to do about it?"

Experts warn that all tobacco products should be considered. This will prevent new electronic cigarrette bans from pushing more teenagers and adults towards conventional cigarettes which continue to be sold with menthol flavors. Decreasing the level of nicotine in cigarettes in general is also seen as a common-sense solution to reduce levels of addiction.

“We already have this new addiction. What are we going to do about it? ,” asks cardiologist Michael Blaha.

In his practice he usually cares for adult smokers who consider vaping to quit the conventional cigarette, not healthy young people affected by the use of electronic cigarettes, but he fears that it could be “the next wave of health problems” in the doctor’s office.

Images: BackyardProduction, Artisteer, AlexandrBognat y Jittima Kumruen | iStockphoto.