A Study in the Juul and Youth Vaping Epidemic

If you walk down any street, you’ll probably run into someone smoking. We’re all familiar with seeing packs of Marlboro or Newport cigarettes behind the counter at 7-11, or a local smoke shop on the main street. Smoking has had a long history in American society and has evolved into numerous new products more recently. While this product is intended to be used by adults 18+ (21+ in some states), a significant amount of teenagers and even children are now using these modernized products. 

As 2019 came to a close, we saw the initial effects of the youth vaping epidemic. Based on the most recent Center for Disease Control and Prevention (CDC) report, there have been 2,506 cases of hospitalized e-cigarette, or vaping, product use-associated lung injury (EVALI) of people across all ages. As of December 3, 2019, 78% of reported hospitalizations have been people under the age of 35, with a median age of 24 years old. Between 2014 and 2018, teen vaping use has increased from 9% to 29%. This phenomenon has parents extremely worried and medical professionals concerned. Teenagers not only have access to these harmful products, but are using them at increasing rates. 

Of all the vape and e-cigarette products available for consumption, Juul products have faced the most scrutiny. The fairly young company which markets itself as the “alternative for adult smoker” has faced significant backlash for allegedly marketing their products to appeal to minors. Their once, colorful, easy going, and Instagram friendly advertisements of the mid-2010s, along with their ease of use, design, and plentiful flavors, are said to have hooked kids onto the hazardous product. Fast forward to today, you have at least 54 people dead and thousands hospitalized, because of their heavy use of similar products. State bans of Juul products, vapes, and e-cigarettes are in place, with a federal ban potentially taking effect in the near future. This all sounds good and everyone seems to be on board; however, like Juul’s misleading advertising, the current state and perception of the vaping epidemic will leave a false sense of justice and inadequate solutions to this complex, multifaceted, and misunderstood social issue.

Here’s what we need to understand: vaping isn’t going anywhere. The trend has only increased in popularity, particularly amongst younger people. Whether it’s nicotine, marijuana, or other drugs, vaping is the modernized version of smoking. Just like how smartphones and social media revolutionized communication, e-cigarettes and vapes are doing the same for smoking. Should we really be surprised to find that younger people are gravitated to vape products, especially after decades of PSAs alerting of the dangers related to traditional smoking? In a time when smartphones and social media are constantly used as outlets to share information, is it a shock that vaping is a growing trend? Here’s what we also need to know: e-cigarette, vape, and Juul products have harmful chemicals in them, like any other drug. And, like any other drug, excessive use (or addiction) can lead to serious health consequences, including death. The EVALI patients were not the typical users of vape products. Many of them happened to use the harmful products heavily and on a daily basis, which we now know can kill you. And, like any other drug (regardless of legality or regulation), if there’s a high demand for a product, there will be a booming supply, with an industry emerging. Ultimately, people decide whether or not to purchase the drug of their choice and support that economy. 

According to the CDCP report, the thousands of cases of EVALI are not from people who used Juul products. The most commonly used product reported among EVALI patients were NOT juuls, but dank vapes (counterfeit vape products containing THC and vitamin E acetate). Despite this, Juul Labs and their products have faced the loudest pushback for fueling the vaping epidemic. Juul is charged with marketing to teenagers with their wide variety of flavors, sleek and concealing design, and glossy advertisements. But let’s think a little higher than this. Does having multiple flavors of the same adult product automatically mean that you are appealing to children? Can children like multiple flavors of something? Sure. Can adults enjoy multiple flavors and varieties of a product geared towards them? Absolutely. Creativity and choices are key to innovation and growth. How many flavors and varieties of alcohol you can find at a bar, or even a convenience store? Alcohol, which is a drug, is also heavily used among young people, with 19% of 12-20 years olds illegally consuming the product within the past 30 days. But are we hearing any calls to ban alcohol...as if, right? Let’s talk about the sleek design. That Juul sure does look like a USB drive; really tempting for a young person. How many ads do we see on TV where younger, good-looking people are happily drinking away or throwing a party with the drug that causes 88,000 deaths per year? The “cool” factor really kicks in and does the trick. But really, compare Juul’s Times Square ads in July 2015 with Dom Perignon’s recent ad outside Penn Station. They seem to have some similarities. Now, is their messaging misleading? Without a doubt. There's only a select group of people who use Juul to ease off smoking traditional cigarettes. Vaping through a single pod (1 juul pod contains about the same amount of nicotine as a pack of cigarettes) spread out through multiple days, could be safer than smoking packs a day. Many others users, and teenagers especially, partake for recreational use. EndVaping.org, a website that’s “working to end the teen vaping epidemic,” lists that Juul Labs sold their products without the proper FDA regulations. Yet, numerous drugs do not have or require FDA regulation. Juuls are no different than Vitamin C supplements, which falsely advertise for curing colds. False advertising aside, they in fact they have a minimal effect; yet, these supplements are still available to purchase. So, what’s different here?

Many lawmakers are calling for a ban on flavored e-cigarettes and vape products, which may sound good at first. But have we not learned from the failure of Prohibition, nearly a century ago? Enforcing a ban on e-cigarette and vape products will not mean that people will stop vaping. If anything, it would put more at risk. Counterfeit vape products, which contains Vitamin E acetate (causing EVALI), as well as traditional cigarettes would be used more often. After decades of research and education about the harmful effects of traditional cigarettes, why are we not calling for the same here? Other drugs, such as marijuana and opioids, do not have recreational legalization; however, many young people are using these substances anyway. You don’t need a smoke shop or convenience store to get these drugs; just call up your local dealer and grab some for friends while at it. In 2017, there were 48,000 fatalities due to opioids. That figure is significantly higher than the 54 people who died from EVALI.

It’s also worth noting that vaping is a multibillion dollar industry, which employs about 166,000 Americans. New York state generates around $31 million in taxes from vape products. With these products increasing in usage, there's more opportunities to generate awareness and tax revenue, instead of constraining an industry with people's career on the line. Numerous vape shops and other small businesses which thrive off selling vape products would surely see a significant drop in revenue and could very well be put out of business, should a federal ban be enforced. 

There needs to be more of a focus on spreading awareness and educating people, especially teenagers, on the dangers of e-cigarette and vape products. We should also not neglect the opinions and perspectives of young people, who are more likely to use and be affected by these products. With permission, I surveyed three young people ranging in age from 18-21, to hear their thoughts on the vaping crisis. All have used a juul or vape product before, with two giving it a try at 16. Access was mostly from friends and most were curious to simply give it a try. All three did not feel lured by the variety of flavors, and disagreed with a ban on these products. Reasons for disagreements, ranged from strengthening the black market, endangering more people, unfair discrimination of a socially accepted drug product, and lack of enforceability.

With the proper education, and continued research, people—young and old—should be able to make their own conscious decision to vape or not to vape. In dealing with the vape epidemic, how we address the issue and who we include in this conversation will project the outcome. From product marketing to health consequences to economic impact, all parties must be involved. Reform is very well needed; more needs to be done to guarantee that youth do not use and become addicted to these harmful products. But we must accept that people will choose to use these products of their own volition; when that's understood, perhaps we can rally around the hashtags #handsoffmyjuul and #donttakemyvape.