Health

As Juul vaping surges among teens, health concerns grow

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The 17-year-old Oakland high school senior first tried a Juul after a friend gave him one.

It looked like a computer gadget, but the sleek 4-inch device delivered puffs of sweet-flavored nicotine vapor anytime he wanted. It didn’t set off smoke alarms or smell like cigarettes. It smelled of mango, mint or creme brulee.

Now, less than a year later, he hits a Juul dozens of times a day. He needs it, he says. At school, home, hanging out with friends.


He says he wants to quit. But when he goes without a hit for too long, he gets a headache and body aches. He gets irritable.

“I’ve tried nicotine gum,” said the teen, who attends Bishop O’Dowd, a college-prep private school. “I’ve tried patches.”

But he can’t. And, he says, neither can many of his peers.

The graduating senior agreed to speak with The Chronicle about what he described as an addiction to nicotine on the condition he not be identified.

E-cigarettes are marketed as a safer alternative to combustible cigarettes, a tar-free way to wean off nicotine. The vaping industry, worth about $1.1 billion in sales annually and growing, includes a wide range of companies that say the products are not meant for youths or new users.

Yet health officials have been sounding the alarm over the escalating use of e-cigarettes, and especially Juuls, among young people for a few years. The products, they say, come in hundreds of fruit and candy flavors — mango, sweet tart, watermelon, caramel cappuccino — making them attractive to teens. More than 1 of every 4 high school seniors used a vaping device in 2017, according to a University of Michigan survey of 43,000 middle and high school students.

Last month, the Food and Drug Administration announced a plan to crack down on the sale of Juuls to youths and requested the San Francisco maker of the product, Juuls Labs, turn over documents related to the device’s design, marketing and ingredients.

In an email, Juuls Lab officials said the company supports efforts to reduce the product’s access to youth and will work with school districts and law enforcement on prevention efforts in addition to adding a label on packaging that says, “For alternative for adult smokers.”


Students and educators say they noticed Juuls, which came onto the market in 2015, explode in popularity in schools this past year. While teen vaping has been on the rise over the last several years, Juuls appear to have ushered in a cultural phenomenon among teens, a trend fueled by the addictive power of nicotine, the ease of acquisition and the pull of peer pressure.

As Juul e-cigarettes’ popularity surges, parents, teachers and the Food and Drug Administration are concerned. Photo: Jessica Christian / The Chronicle


Photo: Jessica Christian / The Chronicle


As Juul e-cigarettes’ popularity surges, parents, teachers and the Food and Drug Administration are concerned.

Teens bedazzle and personalize their Juuls, buying colorful and designer “skins” to cover the otherwise electronic-looking devices. They post videos and photos on social media, using Juul hashtags and showing how to sneak hits in class or perform vapor tricks, like blowing O’s. They pass a Juul around from one freshman to the next at lunch. At parties, Juuls, which light up after a hit, are spun to form illuminated rainbow circles in the air.

Some young users wear shirts, hats and other products to show loyalty to the brand. They wear hoodies that allow for surreptitious hits through the drawstring.

And Juul users have their own vaping vernacular: zeroing, Juuling, party mode, Juul nation.

Unlike old-school cigarettes, vaping is a communal experience, bonding young people from across the high schools and hierarchies — drama kids, athletes, band geeks, musicians, the straight-A students and the class clowns.

“It’s not just a thing to do now, it’s a community; you do it, you’re in it,” said the student. “I don’t think I’ve met a single person in the past six months that doesn’t vape.”

At Bishop O’Dowd, freshmen form huddles at lunch to pass one around, the student said. Seniors meet up after school at a cemetery to blow swirls of vapor into the sky. He’s heard middle school students are starting to do it too, meeting up in the big bathroom stalls, something confirmed by education officials and youth surveys.

It’s like being in a club, he said.

“You see a person with a Juul, and it’s, ‘Oh, Juul gang,’” he said. “It’s almost like a way to relate to one another.”

That sense of belonging can be a powerful pull, teens said, a symbol of coolness to combat adolescent angst.

At Dublin High School, Principal Maureen Byrne started seeing Juuls and other vaping products this academic year.

She keeps a box of the e-cigarettes confiscated from students to show to parents and teachers who previously had no idea that what they thought was a computer flash drive, a phone charger, or a flashlight is actually a Juul, or Suorin, or vape pen.

Dublin High School Principal Maureen Byrne chats with students. She is working to dispel the notion that vaping is harmless. Photo: Photos By Jessica Christian / The Chronicle


Photo: Photos By Jessica Christian / The Chronicle


Dublin High School Principal Maureen Byrne chats with students. She is working to dispel the notion that vaping is harmless.

And she’s stepped up awareness campaigns to dispel the notion among students that the product is a “harmless cigarette.”

“For whatever reason, it is definitely exploding this year,” Byrne said. “It’s definitely pervasive and scary and disgusting.”

School officials across the Bay Area say they have incorporated vaping into the health curriculum. In San Francisco, tobacco and e-cigarette prevention education is required in every grade starting in kindergarten.

In Pittsburg, vaping hasn’t been a huge issue so far, district officials said, but prevention efforts are ongoing. At Martin Luther King Jr. Middle School, students recently gave a peer presentation on the dangers of smoking and vaping, with a strong visual deterrent: a blackened pig’s lung that had been infused with tar.

But vaping with Juuls is costly and appears to be popular in more privileged communities where youth can afford the $50 to buy a device and a starter pack of four nicotine-infused pods — each with about 200 pulls or the nicotine equivalent of a pack of cigarettes. Additional pod packs cost about $16.

At Bishop O’Dowd, Principal James Childs didn’t directly address the apparent use of Juuling among his students, but said officials there keep tabs what children are doing.

“We try to stay current on trends, remain watchful of the students, vocalize our expectations, and engage in education for our parents so that together, we promote health and wellness within our student body,” he said.

At Oakland School of the Arts, one student said she had never seen a Juul until the beginning of this school year.

“I started seeing this hard-drive type of thing and I didn’t know what it was,” she said. “I started seeing them everywhere after that.”

She said she’s tried them a few times, adding the devices are prolific at parties where students from various Bay Area high schools pass them from partygoer to partygoer.

“It’s so kid friendly, it’s so scary to me,” the teen said. “They’re making it attractive to people who are our age.”


The founders of Juul Labs, James Monsees and Adam Bowen, say they developed the product to be a solution to a health crisis, offering combustible cigarette smokers a tar-free alternative.

“Our company’s mission is to eliminate cigarettes and help the more than one billion smokers worldwide switch to a true alternative,” the company said when asked to comment for this report. “We cannot be more emphatic on this point: No young person or non-nicotine user should ever try Juul.”

Juul vape pens or e-cigarettes look like flash drives or flash lights and come in hundreds of flavors that appeal to youths. Photo: Jessica Christian / The Chronicle


Photo: Jessica Christian / The Chronicle


Juul vape pens or e-cigarettes look like flash drives or flash lights and come in hundreds of flavors that appeal to youths.

Given the popularity of the Juul, it appears a rash of new nicotine users, including the graduating senior from Bishop O’Dowd, have not heeded the warning. He says his habit is costing him up to $100 a month.

The company saw a 700 percent sales increase in 2017 and now controls more than half the $1.2 billion e-cigarette/vapor market, according to industry reports.

The surge of adolescent Juul users has resulted in an onslaught of media attention and cries from parents and policymakers to address the problem, restricting access to underage users and regulating the nicotine content.

The FDA, meanwhile, currently doesn’t regulate the electronic cigarette market and doesn’t plan to until 2022, although it is examining the sales of Juuls after receiving complaints from parents and teachers.

Separately, Juul Labs has committed to spending $30 million over the next three years on research as well as youth and parent education efforts, officials said. The company also has a “secret shopper” program to help enforce age verification at retail outlets.

Juul devices and pods are also available online through the company’s website, requiring buyers to provide name, date of birth, address and last four digits of their Social Security number to verify they are legally able to purchase Juul products.


The Bishop O’Dowd student scoffed at the efforts to restrict access, saying teens can easily purchase Juuls and pods, despite California’s age requirement of 21 to purchase tobacco.

He and his friends, he said, have bought fake California or other state IDs online, sending $40 or $50 money transfers to Chinese counterfeiters. And it’s not hard to get around age verification online, he added.

“It is very easy to obtain any type of vape,” he said.

So easy, that middle school students are buying them too.

At Petaluma Junior High School, administrators say they’ve seen a slight increase in use at school this year, but they are also monitoring online activity where they see even more evidence of use. To combat the problem, they’ve restricted access to certain bathrooms during lunch and breaks, said Principal Renee Semik.

“We know that the students are doing this off campus, at home, on the weekends, based on their social media postings,” she said. “We also know that many of our students are purchasing these online or from other students who bought them online.”

Many of these young students think Juuls or other vaping products are safe because they don’t include include tar. But they do contain toxic ingredients, said Dr. Mark Rubinstein, UCSF professor of pediatrics.

“These are not benign fruit-flavored products that you can just play with and use recreationaly,” he said. “We worry because when the younger kids use nicotine, or any drugs for that matter, we think it causes permanent changes to the developing brain.”

Researchers are just starting to look at the long-term health impacts of e-cigarettes. The chemicals in them could be carcinogenic, especially when heated to levels required to produce vapor, Rubinstein said.

Juul pods include glycerol, propylene glycol, natural oils, extracts and flavor, nicotine and benzoic acid, company officials say, but not diacetyl, a potentially harmful chemical used in other vaping products for flavoring.

Rubinstein is also concerned about excessive use by young people, not only because they come in fun flavors like mango and popcorn — but they don’t smell like smoke, so children can use them at home and school and therefore more frequently than they would regular cigarettes, he said.

“I think this is going to increase the risk of nicotine addiction beyond combustible cigarettes,” Rubinstein said.

Nicotine, an addictive drug, causes the body to release epinephrine, the fight or flight hormone, which could cause the head rush some describe when vaping or smoking.

On a typical day, the graduating senior from Oakland said he might take 40 hits off a Juul. He has perfected his technique to use it in class, inhaling from the easily concealed device and then holding the vapor in long enough to dissipate in his lungs so the teacher won’t see it.

That’s called “zeroing,” he said.

But he “hits” his Juul a lot more if he’s bored at home or during parties, he said, where nearly everyone is vaping.

Without it, the headaches and body aches hit, and then, “that’s all you kind of think about,” he said.

While he was among the first to use a Juul among his classmates and friends, he said he can’t think of anyone who doesn’t have one or use one now.

Parents, he said, have no idea.

“If your kids say they don’t vape,” he said, “they vape.”

Jill Tucker is a San Francisco Chronicle staff writer. Email: jtucker@sfchronicle.com Twitter: @jilltucker

What are e-cigarettes?

E-cigarettes come in many shapes and sizes. Most have a battery, a heating element, and a place to hold a liquid.

E-cigarettes produce an aerosol by heating a liquid that usually contains nicotine — the addictive drug in regular cigarettes, cigars and other tobacco products.

E-cigarettes are known by many different names. They are sometimes called e-cigs, e-hookahs, mods, vape pens, vapes, tank systems, and electronic nicotine delivery systems, or ENDS.

Some e-cigarettes are made to look like regular cigarettes, cigars, or pipes. Some resemble pens, USB sticks or other everyday items.

Source: Center for Disease Control and Prevention

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