The rising popularity of Juul, an e-cigarette: a public health menace?

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The rising popularity of Juul, an e-cigarette: a public health menace?

By Rosemary An

A sleek electronic cigarette resembling a USB drive has become a trend in both cigarette smokers struggling with addiction and people who have never previously smoked in their life.

Juul is an electronic cigarette introduced in 2015. Unlike other e-cigarette companies that purport to help users quit smoking traditional cigarettes, Juul sales have risen meteorically since its launch. In 2016-2017 alone, Juul sales had a 641 percent increase, according to a report by the Centers for Disease Control and Prevention.

Young people under the age of 21 are prohibited from buying Juul devices and pods, but find a way to get their hands on them anyway. “My friends would get fake IDs to buy them,” Ashley Won, a high school student from Queens, said. “Or they would pay people of age to buy [devices and pods] for them.”

Juul devices are sold separately from pods, which are cartridges filled with nicotine and flavored juice. These pods come in packs of four with flavors ranging from mint to mango. In the past year, e-cigarette use rose 75 percent among high schoolers and 48 percent among middle schoolers, prompting the Food and Drug Administration Commissioner Scott Gottlieb to call this trend an “epidemic.”

Critics say Juul is creating a new public health menace — hooking teenagers, some who have never smoked cigarettes at all, on nicotine. “I always see them passing around their Juuls,” Austin Tsang, a teacher at an after-school program for middle schoolers in Forest Hills, said. “It’s ridiculous because they’re 13-year-olds.”

Organizations are conducting studies about e-cigarettes and campaigning to create change in policies and laws. Truth Initiative, a nonprofit tobacco control organization, launched a “SAFER ≠ SAFE” digital campaign “to help combat the youth e-cigarette epidemic,” Paula Kostiuk, a representative of Truth Initiative, said. The organization also conducted a study revealing 15-17 year olds have a 16 times greater chance of becoming Juul users compared to 25-34 year olds.

The FDA announced a Youth Tobacco Prevention Plan last month, placing a ban on the sale of most flavored e-cigarettes, with the exception of the mint and menthol flavors, in brick-and-mortar stores. Still, some believe there is no way to prevent all underage people from buying Juul products. “If something is prohibited, it creates a black market for that good or service,” Daniel Schulman, an e-cigarette user from Port Jefferson, said.

On sites like eBay and Craigslist, underage users can quickly purchase a Juul and pods. In response, the FDA contacted eBay, and the site allegedly removed Juul-related listings and “voluntarily implement[ed] new measures to prevent new listings from being posted.”

However, users were still able to search “Juul” on eBay to find devices and pods. The listings didn’t have the name “Juul” though — instead, they were replaced with “FIT,” or excluded the word altogether. Also, users on Craigslist were able to search for Juul devices and pods as no new measures were enacted. Since then, the listings have been removed.

Juul’s popularity may come from its marketing tactics. “[They] show e-cigarettes in a way that’s fun to use and not as dangerous,” Becky Wexler, a representative of Tobacco-Free Kids, an advocacy group that pushes for policies to protect people from the harms of tobacco, said. “It looks like a lifestyle product and not a tobacco product.”

However, marketing companies may not be targeting underage people to buy their products. According to a representative of a New York marketing company who asked not to be named due to the changing Juul laws and policies, the cost for targeting kids with product design outweighs the benefits. “It’s dollars and cents at the end of the day, so companies want to target adults,” he said.

On Nov. 13, Juul Labs announced it will temporarily stop distributing the mango, fruit, creme, and cucumber flavors to all of its over 90,000 retail stores. Instead, the pods will only be available on the Juul website, which will include additional age-verification measures like two-factor authentication by the end of the year, verifying “a user’s identity through their phone number, and then requiring a code sent to that phone to create an account,” Kevin Burns, the CEO Juul Labs, said in a press release. “We will also add a real-time photo requirement to match a user’s face against an uploaded I.D.”

A major caveat to the flavor ban is that it only affects convenience stores, not vape shops. At a local bodega or gas station, all ages are welcome to enter. At smoke shops, employees have the ability to control who enters the store. But if they aren’t checking for I.D.s, whether it is a convenience store or vape shop, there is a gray area: underage users can get away with buying Juul products.

Juul Labs makes an effort to combat the issue of smoke shops selling to underage people. At a Brookhaven smoke shop that asked not to be named due to fear of losing its distributor, two undercover representatives of Juul Labs bought pods. The employee said they looked well over the age of 21, so he did not ask for I.D. Weeks later, the shop received a warning letter from Juul Labs urging the employees ask everyone for I.D. prior to sale.

The FDA extended compliance deadlines for premarket review from Nov. 8, 2018 to Aug. 8, 2022. “Those deadlines are what we’ve been pushing to change. The cat is already out of the bag for Juul,” Wexler said. “But we’re worried about the next product that might appeal to kids.”

Juul is also popular among college students. Stony Brook University is a tobacco and smoke-free campus, and to enact behavior change, the university provides “programming throughout the year around stress reduction and stress management, as it can often contribute to alcohol or drug use,” Kerri Mahoney, the Alcohol and Other Drug Outreach specialist for the Center of Prevention and Outreach, said. “This holistic approach allows students to see the connection between mind and body and find other means of relieving stress and anxiety.”

There is some evidence suggesting e-cigarette use may help users stop smoking traditional cigarettes, but “definitive data are lacking,” according to a study by the U.S. National Library of Medicine. “No e-cigarette has been approved by the FDA as a cessation aid,” meaning these products are not guaranteed to help users quit traditional cigarettes.

For some users, the Juul is an effective alternative to smoking cigarettes. They rely on the different flavored pods and nicotine to “live a healthier lifestyle,” Gabriella Roldan, a user in Queens who transitioned to Juul in hopes of quitting traditional cigarettes, said. “[Younger people] think it’s a trend and they’re ruining it for the rest of us.”

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