The Results of the National Youth Tobacco Survey are in and more teens are vaping. Many are claiming that vaping is attracting youth due to flavor options. However, the details in the 2018 survey show that the chances are much higher for those who had already smoked cigarettes or used nicotine in some form to have used an e-cigarette in the past-month. The odds are 26.8 times higher for a teenager who has smoked 100 or more cigarettes in their lifetime to be a past-month vaper than they are for a never-smoker. Most teens are picking up vapor products as an alternative to tobacco cigarettes or other nicotine products. Of teenage non-cigarette smokers, only 1% are vaping frequently.

Nevertheless, we can all agree that any underage use of tobacco or vapor products is a problem. So why are these teens vaping, and how can we stop it?

America, let’s be honest. Flavored vapor products have been on the market for over ten years. If flavors, labels, and marketing of vapor products are the cause of a “youth epidemic,” then why have we seen our largest increases in teen vaping over the last few years?

Enter the Juul: “The Smoking Alternative, unlike any E-Cigarette or Vape”.

It just so happens that the most commonly used term when referring to youth vaping is Juul. This term has been used so widely that the word Juuling has become a verb. Why Juul? Is it the Flavors? Is it the packaging? The device is extremely popular among minors but it has far fewer flavor options than other vaping products, none of which include “candy”. This particular device produces a very small amount of vapor and many vape users note that when compared to other products in the e-cigarette market, it is one of the worst flavor experiences in vaping. Juul also has some of the most simple and dull packaging of any product on the market. So why are terms like “youth epidemic” and “Juul” so often linked?

The answer is that the increase in teen vaping has nothing to do with flavors or labeling. Sorry parents, your kids have not been corrupted by fruity bubble gum. They are now vaping to get a “nicotine high”, made possible by the fact that a Juul contains up to TWENTY TIMES more nicotine than the most common strength of e-liquids used by adults in traditional vaping.

The Juul was released in 2015 and according to data from Wells Fargo sales of the device soared over 600 percent in 2017. Is it a coincidence that according to the CDC, we have seen some of the largest increases in youth vaping since 2017? The answer is no.

When Juul came to the market they patented a new formula of synthetic nicotine known as “salt nicotine”. Combining the free base nicotine used in traditional e-liquids with an amino acid created a more efficient nicotine delivery. Juul claims that their product delivers nicotine up to 2.7 times faster than other E-cigarettes. This is because salt nicotine is metabolized faster and also is much more palatable at higher strengths than traditional free base nicotine.

On average, a tobacco cigarette contains about 12mg of nicotine, but on average only 1–2 mg of nicotine is absorbed by the lungs. The most commonly purchased flavored e-liquid nicotine strength in a vape shop is 3mg/ml (or 0.3%). Smokers beginning their journey away from combustible tobacco using electronic cigarettes often start out using 6–12mg/ml (0.6–1.2%) and work their way down to 0–3mg/ml. Juul pods on the other hand, are only available in the United States in two strengths, labeled 5% or 3%. Unlike the industry standard, Juul is labelling the percentage of total volume of a single pod and not the quantity of mg per ml. When converted, their numbers are respectively equal to 59mg/ml and 35mg/ml for the 5% and 3% pods.

Let that sink in. Yes, 59mg/ml compared to 3mg/ml. Not only is Juul’s nicotine formula more efficient but the e-liquid inside their pods contains between 11 and 20 times the amount of nicotine found in the most popular nicotine strength of traditional e-liquids. Most Juul users can feel a discernible high or “nicotine buzz” when using the device.

According to the Truth Initiative, the reason kids have coined the term “Juuling” is because “JUUL is so distinctive, it is perceived as its own category”. It seems to be very attractive to teenagers for several reasons: it is easily concealed from parents because of its size; it can be used discreetly without much visible vapor or smell; it can give you quite the nicotine high.

The UK has taken appropriate measures to address this issue and has limited their e-liquid strengths to 20mg/ml or lower. Juul pods in the UK are only available in 9mg/ml and 18mg/ml. A nicotine cap in America would prevent minors from chasing a nicotine high and would still provide solutions for adult smokers.

The USA, on the other hand, is pushing e-liquid flavor bans, both at a national and state-level. You know who won’t be impacted at all by these flavor bans? Juul. This is completely inappropriate and flat-out dangerous, as it does not address the real cause of the rise in teen vaping and will punish adult users by pushing them to a black market or back to cigarettes (which kill about 1800 people per day). Studies show that over 90% of adult e-cigarette users prefer flavored e-liquids. Many believe that flavors are essential when attempting to convert adults away from harmful cigarettes.

So what can be done? Is there a way to reduce the amount of teenagers chasing that nicotine buzz without crushing an entire industry built around tobacco harm reduction? Should a nicotine cap be explored as it has been in the UK? A nicotine cap is a much more sensible policy for reducing underage use. This could help curb teenage vaping without limiting the freedom of adults and destroying thousands of small businesses in America that sell flavored vapor products.

The Vapor Technology Association (VTA) recently called on regulators and legislators to limit the marketing of tobacco products while still making them available to the millions of adult smokers in America. The VTA did not suggest a nicotine cap, but they did suggest that high nicotine products be sold in adult only stores to limit youth access and potential addiction. Here are just a few of the other common sense policies recently proposed by the VTA to protect consumers:

- “Tobacco 21”- Raise the age to purchase tobacco and nicotine vapor products from 18 to 21, instead of restricting flavors.

- Implement strict marketing standards to prevent nicotine vapor products from being marketed to or attractive to youth. The FDA has not given the industry clear marketing guidelines for these products. Providing clear marketing and labeling guidance would prevent issues with these products appealing to minors.

- Close loopholes by banning sales on third-party marketplaces like Alibaba, Amazon, eBay, et al. This will help curb underage sales and also prevent illicit and counterfeit products from being sold.

- Strict punishments and harsher fines including losing the right to sell tobacco products for retailers found violating the law and selling to minors 3 times within a 3 year period. Currently retailers can receive 7 violations in a three year period before losing their ability to sell tobacco products.

Can some combination of these policies help to save this budding industry founded on the hope of helping people quit smoking? This is a complicated issue and many lives, not just those of reformed adult smokers, hang in the balance. The misleading media narrative is paving the way for destructive flavor ban policies that will close thousands of small businesses across America and push adult e-cigarette users to the black market, or worse, back to smoking. If you want to help for the reasons listed above, or for your own personal reasons, we need all of the help we can get. There are several things you can do. The first step, an easy one, is to share this article with friends so that the public can better understand the real reason for the rise in teenage e-cigarette use. You can also help the vaping industry by calling and emailing your legislators to tell them you support sensible regulations that will still allow flavored products to remain on the market in order to help adult smokers. Lastly, do your own careful research and talk to friends and coworkers to educate and spread the truth about vaping. A flavor or vapor ban will do far more harm than good in regards to public health. Together we can stop an entire industry built on saving lives and restoring health from being silenced.