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12/2/2018 12:26:00 PM
'Newest fad:' Concerns rise over kids' use of addictive e-cigarette variant
At a glance
How widespread is the use of JUUL in Indiana?

E-cigarettes are now the most commonly used tobacco products among Indiana youth. E-cigarette use has more than doubled among youth since 2012 based on data from the Indiana Youth Tobacco survey. JUUL is a relatively new product, first launching in 2015, but the company already has the largest market share in the e-cigarette industry and has grown more than sevenfold from 2016 to 2017.

Why is JUUL so popular among young people?

JUUL and other e-cigarettes come in a variety of flavors that are attractive to youth, such as candy and fruit flavors. There has been increased marketing and price promotion for JUUL products at locations where youth are likely to frequent, such as gas stations and convenience stores. There has also been a larger presence on social media by the JUUL company and JUUL users, which is making the product more mainstream.

What are the dangers?

What differentiates JUUL from original e-cigarettes is its use of nicotine salts, which allow high levels of nicotine to be inhaled more easily and with less irritation. The initial impact of nicotine salts when inhaled is similar to the immediate nicotine effect in traditional combustible cigarettes. Nicotine is an addictive drug and has especially negative impacts on the developing brains of youth.

What is the state response?

State Health Commissioner Dr. Kris Box sent a letter to Indiana schools alerting them of this public health issue and offered resources to staff, parents and students. The Indiana State Department of Health’s Tobacco Prevention and Cessation Commission has assembled information and free resources available for schools to use to help educate staff, parents and students ( Questions about e-cigarettes have been included in the 2018 Youth Tobacco Survey and future surveys to help monitor and evaluate Indiana youth usage trends.

Source: Indiana State Department of Health

Sue Loughlin, Tribune-Star

A relatively new trend in e-cigarettes called JUUL has skyrocketed in popularity among young people, including minors, a trend that is playing out locally — much to the concern of school and health officials.

JUUL, which looks like a USB flash drive, is a battery-powered device that heats a nicotine-containing liquid to produce an aerosol that is inhaled. JUUL comes in a variety of flavors and also uses nicotine salts, which can allow high levels of nicotine to be inhaled more easily and with less irritation. 

A single JUUL cartridge or pod has the same nicotine content as a pack of cigarettes.

The Vigo County School Corp. is seeing increased numbers of students possessing or using JUUL, which is prohibited by board policy, as are other e-cigarettes and tobacco products. 

”It’s a trend happening in schools and society,” said Tom Balitewicz, VCSC director of student services. “It is a concern of ours.”

Balitewicz estimated incidents occur at the high school level on a weekly basis, and “it’s becoming more and more frequent as time goes by.” 

JUULs are “so concealable,” something that probably adds to their popularity, as well as the different flavors, Balitewicz said.

In late October, the Indiana State Department of Health sent letters to school district officials warning of the problem and offering online resources. The Food and Drug Administration also is proposing stepped up regulations.

”Hopefully that will curtail some of it,” Balitewicz said.

For those students found using or in possession of JUUL, the first incident calls for alternative education placement in school, typically for three days, he said. A second offense calls for alternative education placement outside of school, typically three days.

The big concern for schools is the health effects on students and the higher levels of nicotine in JUULs, Balitewicz said. Health classes do include information about drugs, alcohol and tobacco use.

At Greencastle High School, Principal Chad Rodgers sent an email to parents warning them of what he described as the “newest ‘fad’ from the nicotine/tobacco industry,” or JUUL. The letter also contained a link to the state Department of Health communication.

In his email, Rodgers says JUULs have been marketed toward students, and he outlines the consequences if students are caught using or possessing them, which can include both school discipline and referral to police.  He estimates there have been less than five incidents so far this school year.

Rodgers decided to email parents after receiving the letter from the state. 

”I like transparency and honesty and I like to work collaboratively with parents,” he said. 

Use of JUUL is “no different than cigarettes were when I was in school. We had cigarettes back in the day,” Rodgers said. But JUUL “is harder to detect and harder to find. ... I don’t think it’s an epidemic, but we need to continue to educate everyone — kids, parents and the community.”

Will JUUL reverse the positive trends?

Among those closely watching the JUUL trend is Libby Ray, Vigo County Tobacco Prevention & Cessation Coalition coordinator. Growing use of JUUL by teens “is absolutely a concern,” she said. “It’s happening here just like it is elsewhere.” 

Much progress has occurred over the last two decades in terms of fewer young people smoking traditional cigarettes, which many youth describe as “gross,” she said. “We know that if you don’t start using some form of tobacco by the time you are in your early to mid 20s, the likelihood is you never will.”

But with the rapid growth in use of e-cigarettes and devices like JUUL, “We don’t really know what the long-term implications of that are,” Ray said. The fear is it may reverse the progress made.

According to the American Academy of Pediatrics, JUUL users have a significant risk of becoming traditional cigarette smokers. It says the JUUL is highly addictive and “the concentration of nicotine in JUUL is more than double the concentration found in other e-cigarettes.”

One thing Ray has found is that  “a lot of youth who are using [JUUL] don’t understand they do contain nicotine.”  Sometimes young people will ask her questions about using JUUL pods without nicotine, and she tells them, “They don’t make them without nicotine.”  

A major health concern is that nicotine can have an adverse impact on brain development, and the brain isn’t fully developed until around age 26, Ray said.

Ray said her office does “go into local schools and reach as many youth as we can with up-to-date information about these issues ...  It’s a challenge keeping up with everything. But that’s what we’re trying to do. We’re trying to make sure we get information in the hands of not only students, but also school personnel and the community at large.”

E-cigarettes started to become more popular with young people about four to five years ago, she said,  “But it was really when JUUL came along [around 2015] when they really saw a rapid change.”

She believes even the FDA “was really caught by surprise” and federal officials recently used the term “epidemic” to describe overall youth e-cigarette use.

She’s not sure why JUUL became so popular, although it’s easy to conceal and “it doesn’t look anything like an e-cigarette or traditional tobacco product.”

The pods come in many different flavors, such as fruit, creme and mint and “we know flavored tobacco products in general are more appealing to youth.”

Also, what distinguishes JUUL from other e-cigarettes is that it “is designed to more closely simulate the experience of smoking a combustible cigarette in terms of nicotine delivery ... a higher concentration of nicotine reaches the brain in a shorter amount of time,” Ray said. “It’s addictive.”  

Reports indicate JUUL now has nearly 75 percent of market share for e-cigarettes. “It’s really dominating the market,” she said.

Teen rebellion?

Stephen Held, general manager for three stores in Terre Haute that sell e-cigarettes, said just one of those stores sells JUUL and each store requires an ID to verify customers are 18 or older. “We’re doing our job” to ensure e-cigarettes aren’t sold to minors, he said.

He describes JUUL as an electronic nicotine delivery system, and its cartridges  “have a lot of nicotine compared to other e-liquids.” 

Asked his opinion on why minors are increasingly using JUUL, he said, “As a child, I remember being an adolescent and out of control and very rebellious. ... I remember being 16 and having access to everything in the world” with help from those older than himself.

”If there’s a will there’s a way,” said Held.

Personally, Held started vaping “to get away from [traditional] cigarettes.”

He doesn’t believe JUUL was necessarily marketed to youth, but for adults trying to quit traditional cigarettes and wanting e-cigarettes with less vapor and more nicotine. In that sense, “It’s helping a lot of people,” he said.

JUUL announces steps 

JUUL CEO Kevin Burns has stated its products are meant to help adult smokers quit regular cigarettes.

“We don’t want anyone who doesn’t smoke, or already use nicotine, to use JUUL products. ... We certainly don’t want youth using the product. It is bad for public health and it is bad for our mission,” Burns has said.

On Nov. 13, JUUL Labs announced it was halting store sales of some flavors to deter use by kids. 

It said it stopped filling store orders for mango, fruit, creme and cucumber pods and would resume sales only to retailers that scan IDs and take other steps to verify a buyer is at least 21. It said it will continue to sell menthol and mint at stores, and sell all flavors through its website.

The company also said it would close its U.S.-based Facebook and Instagram social media accounts, and pledged other steps to make it clear that it doesn’t want kids using its e-cigarettes.

Its full action plan can be found at:

Related Stories:
• COMMENTARY: Healthy kids are key to Indiana's future
• High-tech e-cigarettes an attractive danger to teens

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