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Is your teen 'Juuling'? Why parents and doctors are so worried

TODAY logo TODAY 12/17/2018 A. Pawlowski

Vaping Increases Among Teens © Brianna Soukup/Portland Press Herald Vaping Increases Among Teens Teens are crazy about "Juuling," and with sales of the vape devices soaring, the U.S. Food and Drug Administration is taking steps to limit sales of flavored e-cigarettes — the kind most popular among kids.

A new survey released Monday confirmed a big spike in the number of high school students who are vaping: 37 percent of seniors have tried it, compared to just under 28 percent in 2017.

The survey, commissioned by the National Institute on Drug Abuse, also showed almost 21 percent of seniors said they had recently vaped in 2018, compared to 11 percent in 2017.

Juul, which is by far the most popular e-cigarettes product, does not offer nicotine-free flavors, so many teens may not realize they're almost certainly inhaling addictive nicotine.

In his statement last month, FDA Commissioner Scott Gottlieb cited similar statistics that "shock my conscience:" E-cigarette use among high school students rose 78 percent from 2017 to 2018, and 48 percent among middle school students. Some 3.6 million children and teens are now using e-cigarettes.

"I will not allow a generation of children to become addicted to nicotine through e-cigarettes. We won't let this pool of kids, a pool of future potential smokers, of future disease and death, to continue to build," Gottlieb said.

He said he would speed up FDA action to limit sales of flavored e-cigarette products, such as Juul, to underage users, both in stores and online. The goal is to have the flavors, including cherry, vanilla, crème and melon, sold in "age-restricted, in-person locations" that only allow adult customers. Other stores could sell them if they have a section designed so that people under 18 are kept out and the products are not visible or accessible to them. Online sales would be subject to "heightened measures for age verification."

Still, it was short of a total ban, which the FDA at one point considered.

Gottlieb said he was also starting the process to ban menthol in cigarettes because "menthol serves to mask some of the unattractive features of smoking that might otherwise discourage a child from smoking."

Juul, which has been under particular scrutiny, made its own announcement last month, noting that it would stop selling most of its flavored e-cigarettes in retail stores and adding age-verification measures online.

In September, the same month the FDA called youth e-cigarette use an "epidemic," the agency made a surprise visit to Juul headquarters to look for evidence about the company's marketing practices.

Juul sales increased 641 percent from 2016 to 2017, according to the Centers for Disease Control and Prevention, which the CDC's Brian King called a "public health concern." Teens who vape also go on to both vape and smoke more, a study by the Rand Corporation found.

A hit with teenagers

Many parents don't realize their teens are Juuling. That was true for Dr. Jenni Levy who didn't know her own 18-year-old daughter was doing it.

Her husband found an unusual cartridge in the laundry that neither recognized. A few days later, they came across an article showing the photo of Juul, an electronic cigarette that's discrete, sleek, easily concealed and resembles a flash drive. It's been a hit with teenagers and a big concern for families, teachers and doctors worried about the potential health risks.

When Levy, an internal medicine and palliative care physician in Allentown, Pennsylvania, asked her daughter Emma about the cartridge, the high school senior freely admitted she was "Juuling."

"She said, 'It's mine, it's legal, I'm 18 and I did my research,'" Levy recalled the conversation in an interview with TODAY.

"I said to her, 'We think this is a bad idea.' My biggest concern is she's sucking in vapor and we don't know what that does… I am worried about lung damage, I'm worried about addiction. I'm also concerned that it just seemed really out of character for our very level-headed, risk-averse kid — this was something I never thought I was going to have to worry about with her."

a woman standing in front of a store: Jenni Levy and her daughter, who is © Courtesy Jenni Levy Jenni Levy and her daughter, who is

Emma told her mom she was "Juuling" because she didn't think it was dangerous. She "rolled her eyes" when Levy mentioned the potential health risks. She also told her mom she found "Juuling" fun and pretty — she liked blowing smoke rings with the vapor — and her friends were doing it.

A threat to teen health

Doctors are concerned there's a misconception among teens that e-cigarettes are safe. Smoking e-cigarettes actually delivers cancer-causing chemicals that get into the body — and popular fruity flavors appear to be the worst, researchers reported in March.

The long-term consequences of e-cigarette use are unknown, said Dr. Mark Rubinstein, one of the study's authors, an adolescent medicine physician and a professor at the University of California, San Francisco. He strongly recommends against his patients using the products.

"There's no reason healthy adolescents should be exposing themselves to even potentially cancer-causing substances," Rubinstein said.

On Sept. 12, the FDA announced it had sent more than 1,300 warning letters and fines to retailers who illegally sold Juul and other e-cigarettes to minors over the summer.

Earlier, a feature in the New York Times explored how the company's hashtag campaigns, sponsorship of music events and ads may have lured teens to start vaping.

a screenshot of a cell phone: Percentage of middle-school and high-school students who have ever used e-cigarettes © TODAY, image courtesy of merchant website Percentage of middle-school and high-school students who have ever used e-cigarettes

"I do think this is one of the big threats to teen health right now," said Dr. Wendy Sue Swanson, a Seattle pediatrician who writes the Seattle Mama Doc blog.

"These are a delivery vehicle for nicotine and we know that nicotine is addictive."

Each Juul pod contains an amount of nicotine equivalent to one pack of cigarettes or 200 puffs, according to Juul Labs, the manufacturer.

Visitors to the company's website have been greeted by a message noting its products are "intended for adult smokers." Online customers must be 21 or older and the company says preventing the illegal sale of the products to youth is core to its mission.

Still, Twitter and Instagram are filled with posts showing young people "Juuling." The harmless-sounding name for the activity — instead of "smoking" or "vaping" — and the appealing pod flavors, like "Mango" and "Fruit Medley" create an illusion of safety, Swanson said.

"This is dangerous and I think it's concerning. Parents just need to be really clear to spell out the real risks — that these are likely delivering chemicals that are really bad for these kids," she noted.

A school district in Pennsylvania banned flash drives in February because they looked so much like the e-cigarettes. The concern was kids could "Juul" in front of teachers without the adults realizing it.

Levy told her 18-year-old daughter Emma that she couldn't vape in the family's house. She's never seen Emma use the device and doesn't think the girl will move on to regular cigarettes.

"I do think she'll quit," Levy said.

What to say to your teens:

Swanson offered these tips for parents who are concerned their kids are "Juuling:"

• Ask your teens what they know about "Juuling."

• Be clear that you're learning about this issue together, but mention that vaping is not in your child's best interest: "Don't believe that just because it's not a burning cigarette it's safe," Swanson advised saying. "E-cigarettes are not good for you nor is becoming addicted to nicotine."

• Emphasize that "Juuling" still means using nicotine. Using that alternative, innocuous-sounding buzzword creates a "divorce" from decades of health campaigns designed to help the public understand that "cigarettes are bad for you, cigarettes will shorten your life, cigarettes will cause harm," Swanson said.

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