The latest device flooding schools resembles a flash drive but doesn’t store data. Its purpose: delivering a flavored nicotine hit. Called a JUUL, it’s a hipper, younger iteration of the e-cigarette, which debuted a decade ago. Adolescents, who love JUUL’s super-slick appearance, brand magic, and fun flavors, have sparked “juuling” mania. It’s a terrifying trifecta of teen pleasure-seeking, peer pressure, and trendy tobacco product. Health experts and policymakers — years into youth tobacco prevention efforts — know this battle is a big one. They’re in it to win it, but they’ll need an army of messengers to help.
Statistics confirm new users are looking more like Hannah Montana than the Marlboro Man. State data show e-cigarette use increased from 1.7 percent to 16.8 percent of high schoolers between 2011 and 2015, an 888 percent uptick; use among middle schoolers rose from 1 percent to 6.99 percent of students, a 600 percent increase. National numbers reveal similar trends. “We’re very concerned with the rise in e-cigarette use among middle school as well as high school students,” says Jim Martin, director of Policy and Programs for the Tobacco Prevention and Control Branch of N.C.’s Department of Health and Human Services.
Young users face long odds of walking away. “JUUL is highly addictive,” notes the American Academy of Pediatrics. “Kids are getting so much nicotine that they’re vomiting at school,” says Martin. E-cigarettes heat e-liquid, creating an aerosol that users inhale. E-liquid in one JUULpod delivers as much nicotine as a pack of cigarettes. That might surprise some. “Many kids we’ve talked to feel like it’s flavored water,” says Martin.
Early research on health effects is concerning. Toxicologist Ilona Jaspers, deputy director of UNC’s Center for Environmental Medicine, Asthma and Lung Biology, has found a “unique response pattern” in the respiratory immune responses of e-cigarette users. “What is this going to do long-term? Is this reversible? All of these things we don’t know yet,” says Jaspers, adding, “Atypical patterns give me concern.”
Even flavorings, safe to ingest, can be toxic when inhaled. Cinnamaldehyde, used for cinnamon flavoring in e-liquids, “completely shuts down immune cells that are the first line of defense, cells that are patrolling airways and gobbling up invading pathogens,” says Jaspers. Her study of lung cell physiology shows cilia stop beating following cinnamaldehyde exposure. “It’s reversible,” Jaspers says, but one exposure “completely shuts down the ability of cilia for about two hours.”
Kids need to know about risks. The Department of Health and Human Services is working to educate teachers and administrators, and is reaching out to school nurses, PTAs, pediatricians, and others. “It’s going to take a multi-pronged strategy,” to effect change, says Martin.
Schools need guidance. Along with the Department of Public Instruction, the Department of Health and Human Services sent a letter to school superintendents and charter school directors, informing them that e-cigarettes are covered under schools’ 100 percent tobacco-free policies and aren’t permitted on-campus. State statute also prohibits e-cigarette purchases by minors.
Education is critical: The Department of Health and Human Services has provided schools with information about Catch my Breath, an e-cigarette prevention curriculum, Martin says. For kids caught using e-cigarettes, he recommends Aspire, a program explaining nicotine dangers and ways to quit, as an alternative to suspension.
Teens, already jaded JUULers, are taking action themselves. The “JUULers against JUUL” video, created by two teens, features the stories of fresh-faced addicts. Uploaded in May, the video garnered more than 50,000 views its first week. Both parents and kids should watch it. Jaspers, who told me about the video, shared it with her teens. I had my 16-year-old watch it.
Kids need the truth about e-cigarettes. It’s up to all of us to make sure they get it.