Mil Schooley, an 18-year-old student in Denver, Colo., says most of her friends have a JUUL — an e-cigarette that can vanish into a closed fist. When asked roughly how many, she stumbles a bit. "I wanna say like 50 or 60 percent? I don't know. Maybe it's just the people I know. All my friends in college have one," she says. "It just blew up over the summer."
Schooley doesn't have one herself — at least at the moment. Hers broke due to an unfortunate mishap involving her JUUL and soda water. But the trend to own a vape pen is real, with students bragging on Twitter about using them in class, and researchers saying they're seeing a big spike in use among teens and young adults.
"We're seeing it across college campuses and high schools. I have a friend who teaches high school, and they contacted me last week because they are having a major problem with e-cigs," says Meghan Morean, a substance addiction researcher at Oberlin College.
Devices like these might be introducing a new generation of teenagers to nicotine addiction and leading some vapers to take up smoking tobacco cigarettes, a studyout in Pediatrics on Monday suggests. That would buck a national trend of teens drifting away from certain risky behaviors like drugs, alcohol and unprotected sex.
The Pediatrics study asked 808 students in three Connecticut high schools each year between 2013 and 2015 if they used e-cigarettes or tobacco cigarettes in the last month. The first year, 8.9 percent of students used a vape pen and 4.8 percent of students smoked cigarettes in the last month. "[People] who used e-cigarettes were 7 times more likely to smoke cigarettes by the second survey, and almost 4 times more likely by the third survey," says Krysten Bold, an associate research scientist at Yale School of Medicine and lead author on the study. The third year of the study, 14.5 students had used a vape pen in the previous month, and 8.5 student smoked cigarettes. (JUUL didn't enter the market until 2015.)
The long term effects of vaping e-liquids — a solution of propylene glycol, vegetable glycerine, flavors and nicotine or hash oils – are still not known, says Morean, who is an author on the study. But researchers are skeptical that the vapor is harmless. "You're still breathing in like hot chemicals into your body," she says.
Researchers say the most worrying aspect is nicotine, which is damaging to brain development, and is addictive. E-cigarettes can deliver a very high concentration of the drug, and experts worry that the popularity of vape pens is putting a new generation at risk of nicotine dependence.
"This excellent and important work demonstrates that electronic cigarettes are a path of nicotine addiction for youth," says Dr. Harold Farber, a pediatrician at Texas Children's Hospital and chair of the Tobacco Action Committee for the American Thoracic Society, who was not involved with the study. "It's a short jump from there to combustible cigarettes [which] delivers a better hit."
One reason JUUL and vape pens are so popular among teens currently might be that they can be used indoors without attracting unwanted attention or creating a stench, Morean says. On Twitter, teens post about their usage in school. The most brazen of them fire up their e-cigarettes while their teachers' backs are turned.
"y'all this kid came into my 7th period to get a juul and we all started laughing when he left so the teacher was really confused and we go "that's drug paraphernalia" and he RAN OUT THE DOOR AFTER THE KID," @hyphyybriannaa tweeted.
"Never knew inanimate objects could play hide n seek till I bought a #juul," @jakeraccioppi writes.
Vapers also have a nigh-infinite range of flavors to sample with amusing names like "I Love Blue Raspberry Candy" or unappetizing but intriguing ones like "Beard Vape." Those flavors might be another reason why vaping has struck such a mania among teenagers. "This is really appealing to adolescents," Morean says.
The Food and Drug Administration has banned most flavored cigarettes and tobacco products for this reason, but the agency hasn't banned flavored vapes.
The FDA does have the authority to regulate e-cigarette products as of 2016, says Matthew Myers, the president of the Campaign for Tobacco-Free Kids. "However, the FDA delayed key provisions for an additional four years. That means highly flavored e-cigarettes will go unregulated essentially for years to come," he says. The postponed regulations would require all e-cigarette products, including flavors, to have FDA approval before going on the market.
The potential for e-cigarettes to help get adult smokers off tobacco is one reason why the FDA has been slow to act on e-cigarettes, says Dr. Suchitra Krishnan-Sarin, a psychiatrist at Yale University and the senior author on the Pediatrics study. "I think the FDA wants more evidence and more data. I certainly don't blame them, you want to make the right decision," she says. "The FDA is starting to implement some prevention policies [for youth vaping]." But for now, she says, there is a public health gap where teens are concerned.
The JUUL device, with its sleek design that resembles a flash drive, is a special hit with teens. "It's definitely more discreet," Schooley says. "JUULs are so simple [too]. I think that's why they do so well, because they're so simple and easy." The JUUL also has multiple flavors available – mint, tobacco, mango, crème brulee and fruit.
JUUL has also managed to capture a more mainstream audience than vape pens.
"People who JUUL can be normal people, but people who vape are like a certain crowd," Schooley says. Using the device isn't called vaping, a verb reserved for more complex or modified contraptions, but JUULing. The words give the device a less ominous atmosphere than e-cigarette or vaping. "I know it's an e-cigarette, but I don't like to call it that because you can JUUL and not be addicted to nicotine," Schooley says. "I don't smoke cigarettes, and I don't think I ever will."
A spokesperson for JUUL Labs, the manufacturer for the JUUL device, said that the company wants to "eliminate cigarettes by offering existing adult smokers with a better alternative to combustible cigarettes. No minor should be in possession of a JUUL." Both the design and the flavors offered were intended to make the device more inviting to adult cigarette smokers, not children, the spokesperson said in a statement in an email response. "We are committed to introducing new flavors carefully and responsibly."
While college student Schooley doesn't have strong concerns about nicotine addiction, JUUL cartridges have a high concentration of nicotine. A single pod, which Schooley says would last her a week, has roughly the same amount of nicotine as one pack of cigarettes. Schooley says she didn't realize this.
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