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Teens are crazy about “Juuling,” and with sales of e-cigarettes soaring, the U.S. Food and Drug Administration is vowing to announce a new action plan in November to "confront and reverse" youth addiction.
"We have hard data to support that public health tragedy that is now underway," said FDA Commissioner Scott Gottlieb in a statement on Oct. 31, noting he has met with executives of five tobacco companies to discuss how they intend to stop the trend.
The FDA made a surprise visit to Juul headquarters in late September to look for evidence about the company's marketing practices. It collected more than a thousand pages of documents during the inspection.
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 new study by the Rand Corporation found.
In September, the FDA called youth e-cigarette use an "epidemic" and said it was considering a ban on all flavored e-cigarettes.
A hit with teenagers
While the FDA said it was going to crack down hard on sales to vaping products to teens, 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 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.”
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.
"We cannot allow a whole new generation to become addicted to nicotine," Gottlieb said.
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.
“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 are 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.