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"Juuling:" Vaping method exposes teens to a pack a day of cigarettes

Endocrinologist explains cancer causing chemicals

Is Juuling the health problem of the decade?

That's the question CNN recently asked, based on a question from a substance abuse counselor. 

Research from Truth Initiative shows that 25 percent of 15- to 24-year-old JUUL users refer to their behavior as “JUULING.”

The Juul e-cigarettes closely resemble flash drives. So much so that some schools have banned flash drives from their campuses. The vapor cloud from the Juul is "so small and dissapates so quickly that teachers are usually none the wiser," 16-year-old student told CNN.

The scary part is that kids may not even be aware of what they are inhaling when they JUUL.

The nicotine cartridge inserted into the Juul gives about 200 puffs, about as much nicotine as a pack of cigarettes, according to the product's website. In five weeks, that's about 100 cigarettes.

In a survey of 1,018 15- to 24-year olds, the Truth Initiative found that 37 percent of teens were uncertain if they were inhaling nicotine, even though it states on the JUUL website that each pods is equal to 200 cigarette puffs, the equivalent of a pack a day.

The Boston Globe calls Juuling “the most widespread phenomenon you’ve never heard of.”

While you may not know about this form of vaping, there’s a good bet your kids have.

“Juuling in the bathroom” has become so widespread among young people, some school administrators are warning parents about the dangers of e-cigarettes, including the brand called Juul.

BuzzFeedNews describes the Juul as a “portable nicotine-delivery device” designed to mimic the physical and sensory experience of a cigarette, without looking like one.

Men’s Fitness magazine described the Juul as the “iPhone of E-Cigs.” The author of the story said he asked a dozen people to guess what the Juul was, and all of them guessed a USB stick.

The fact that it delivers nicotine designed to mimic the experience of a cigarette, but doesn’t look like one, makes the Juul popular among teens.

BuzzFeed estimates over 50,000 posts under the hashtag #Juul on Instagram alone.

Juul is still too new to have any data specific to its risk as a product, but recent research has shown the dangers of teens vaping. But researchers from the University of California, San Francisco challenge the idea that e-cigarette vapor is safe. They found that teens who use e-cigarettes are in danger of inhaling cancer-causing chemicals, especially in fruit flavors.

“The presence of harmful ingredients in e-cigarette vapor has been established; we can now say that these chemicals are found in the body of human adolescents who use these products,” authors wrote.

The UC San Francisco researchers found that adolescents who smoke e-cigarettes expose themselves to a high levels of the potentially cancer-causing chemicals also found in tobacco cigarettes, even when the e-cigarettes do not contain nicotine.

"Teenagers need to be warned that the vapor produced by e-cigarettes is not harmless water vapor, but actually contains some of the same toxic chemicals found in smoke from traditional cigarettes," said lead author Mark L. Rubinstein, MD, a professor of pediatrics at UCSF. "Teenagers should be inhaling air, not products with toxins in them."

This was the first known study to report on the potentially cancer-causing compounds in the bodies of adolescents use e-cigarettes, according to UCSF. The lists of compounds include acrylonitrile, acrolein, propylene oxide, acrylamide and crotonaldehyde.

Another study from the same institution and also published in Pediatrics found that “e-cigarette use is more likely to encourage youth smoking that to divert youth form smoking.”

The team found those who had ever used e-cigarettes were significantly more likely than never users to have smoked at least 100 cigarettes at follow-up, have smoked during the past 30 days or both.

To learn more about e-cigarettes, we talked to Don Wilson, M.D., an endocrinologist and an Endowed Chair of Cardiovascular Health and Risk Prevention at Cook Children’s.

What do e-cigarettes do?

E-cigarettes are designed to simulate the act of smoking and deliver nicotine without the toxic chemicals produced by burning tobacco. The use of nicotine, however, is highly addictive. Recent research suggested nicotine exposure may also cause the brain to become addicted to other substances. Vapor from some e-cigarettes has also been shown to contain known cancer producing and toxic chemicals, such as diethylene glycol and nitrosamines, as well as small particles of toxic metals. Although not well studied, there is the potential for second hand exposure by others in the environment.

How do e-cigarettes work?

E-cigarettes are smokeless, battery operated devices designed to deliver nicotine mixed with a variety of flavorings (fruit, mint, chocolate, etc.) and other chemicals via an inhaled aerosol. They typically resemble regular tobacco cigarettes, cigars, pipes or everyday items like pins or USB memory sticks.

Most e-cigarettes generally contain three components: a cartridge that contains a liquid solution containing various amounts of nicotine, flavoring and other chemicals, a heating device or vaporizer, and a rechargeable battery. Puffing on the e-cigarette activates the battery powered heating device causing the liquid to vaporize. The vapor is inhaled by the user. E-cigarette vapor may include metals, rubber and ceramics which may be aerosolized and have adverse health effects.

Are e-cigarettes safe?

Although a limited number of studies have been conducted, the safety of e-cigarettes has not thoroughly been evaluated in scientific studies.

Here are a few points to consider:

  • Nicotine is highly addictive and has negative effects on brain development from infancy to teens.
  • Potential consequences of using e-cigarettes among youth include nicotine addiction, withdrawal and the potential for overdose.
  • The use of a variety of flavoring in the liquid solution of e-cigarettes has created concern for accidental ingestion by smaller children.
  • With the rapid increase in use of electronic nicotine delivery systems (ENDS), users and nonusers are exposed to the aerosol product. While e-cigarette aerosol may contain fewer toxins than cigarette smoke, studies evaluating whether e-cigarettes are less harmful than cigarettes are inconclusive.

Bottom line: e-cigarettes are often promoted as safer alternatives to cigarette smoking. Although very little is known about their safety, they are increasingly being used by youth and young adults.

What about second hand exposure?

The potential exists for secondhand nicotine and other tobacco-related toxin exposures to others. Studies have shown that e-cigarettes are a source of secondhand exposure to nicotine but not to combustion toxins. Thus, while use of e-cigarettes in indoor environments may involuntarily expose nonsmokers to nicotine, it does not seem to expose them to toxic, tobacco-specific combustion products.

What does the American Academy of Pediatrics recommend?

To protect the health of youth, the American Academy of Pediatrics has made the following recommendations:

  • Sales of e-cigarettes to minors (under 18 years of age) should be prohibited.
  • Candy and fruit flavored e-cigarettes, which encouraged youth smoking initiation, should be banded.
  • To avoid exposing others to potential harm, laws should mandate smoke-free environments which include e-cigarette vapor.
  • To prevent poisoning, all e-liquids should be required to be sold in child-proof packaging.
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