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Health Groups, Lawmakers Sound Alarm on JUUL E-Cigarettes

— FDA is urged to address explosive rise in teen use

MedpageToday

In less than 3 years on the U.S. market, the electronic cigarette JUUL has become so popular among teens and young adults that its name is now a verb.

"This is a phenomenon. Teens aren't vaping, they're 'juuling,' and they're doing it in school bathrooms, hallways, and even classrooms because it is so easy to conceal," said tobacco researcher Robert K. Jackler, MD, of Stanford University Medical Center in California.

Now leading health organizations and lawmakers are sounding the alarm about the explosive growth of the e-cigarette among high school and even middle school kids. With its , it resembles a flash drive and in fact for charging.

On Wednesday, six leading public health and medical organizations including the American Academy of Pediatrics, the American Lung Association, and the American Heart Association sent a letter to the FDA .

Also on Wednesday, Sen. Dick Durbin (D-Ill.) and 10 Senate colleagues sent letters to manufacturer JUUL Labs and the FDA to limit youth use of the product.

The senators asked the company head to commit to no longer selling JUUL pods "in flavors that clearly appeal to children and young people (including Fruit Medley, Creme Brulee, and Mango)."

"Your company's popular vaping device (JUUL) and its accompanying flavored nicotine cartridges (JUUL pods) are undermining our nation's efforts to reduce tobacco use among youth and putting an entire new generation of children at risk of nicotine addiction and other health consequences," Durbin and colleagues wrote.

JUUL unit sales increased more than 600% in 2017 alone, and it now commands over 50% of the e-cigarette market among brands sold in convenience stores and other large retailers, according to the market research organization Nielsen.

The e-cigarettes are also widely sold online, including on the company's own website. While the site does have an "age-verification" pop-up window, critics say the age-gate is easily circumvented by minors.

Robin Koval, CEO and president of the anti-tobacco group Truth Initiative, told ֱ that in a recent poll of under-age JUUL users conducted by the group, four out of five who attempted to buy the product online said they had successfully purchased it from the company's website.

JUUL delivers more nicotine than most other e-cigarette brands, but in another poll conducted by Truth Initiative researchers published this week in the journal 63% of JUUL users between the ages of 15 and 24 did not know that the product contains nicotine.

In response to a request for comment, a spokesperson for JUUL Labs maintained that the company's mission remains "to eliminate cigarette smoking by offering existing adult smokers a true alternative to cigarettes."

"JUUL is not intended for anyone else," the statement read. "We strongly condemn the use of our products by minors, and it is in fact illegal to sell our product to minors. No minor -- or non-nicotine user -- should be in the possession of JUUL. In fact we clearly state on our package labeling that JUUL is for adult smokers only and contains nicotine."

But the company declined to answer several questions posed by ֱ, including whether the company has figures on what percentage of JUUL purchases are made by minors.

The company has vowed to work with school districts and law enforcement to address the problem of under-age use, without specifically acknowledging that there is a problem.

"The company knows that JUUL has become a huge phenomenon among teenagers," Jackler said. "The money is rolling in, and it is coming from teenagers. Educational programs in schools are not going to change that. [The company needs] to take concrete steps to keep teenagers from becoming addicted to this highly addictive product."

Those steps, Jackler said, should include marketing a JUUL product that does not have nicotine, and limiting the flavoring in the version that contains nicotine to "tobacco."

"Kids aren't using this product because it has nicotine. They are using it because they like the fruity flavors and the cool design," he said. "And they are getting addicted to nicotine without realizing it."

Disclosures

The authors of the Tobacco Control article reported having no conflicts of interest.

Primary Source

Tobacco Control

Willett JG, et al "Recognition, use and perceptions of JUUL among youth and young adults" Tob Control 2018; DOI: 10.1136/tobaccocontrol-2018-054273.