One of the most important public health advances in the last 50 years has been the reduction in smoking. Among children and adolescents, this progress has been particularly encouraging, with smoking rates declining among eighth-, 10th-, and 12th-grade students from 28.3 percent in 1997 to 5.4 percent in 2017. These positive trends suggest that the powerful appeal of tobacco and nicotine has been reduced in the younger generations. Unfortunately, this may be undone by emerging high-tech e-cigarettes like JUUL. These products are capable of delivering nicotine at levels comparable to combustible cigarettes. While e-cigarettes do not contain the toxins and carcinogens found in combustible cigarettes, it is becoming clearer that they are just as capable of creating nicotine addiction in those who use them. Many experts believe, and many studies have confirmed, that the use of these products and the creation of nicotine addiction leads eventually to the use of more harmful combustible cigarettes.
Unfortunately, e-cigarettes are not regulated to the degree that cigarettes are. For example, the FDA forbids the use of any flavoring except menthol in cigarettes (although that may soon change. The FDA is considering banning menthol cigarettes). There is no such rule regarding e-cigarettes, which come in many flavors like fruit medley, cool mint, and mango. JUUL Labs, like the manufacturers of other e-cigarettes, claims that their products are not targeted towards children, but rather to adult smokers giving them a “healthier” alternative to smoking standard cigarettes. Left unsaid, of course, is the fact that in a poorly regulated market, even products intended for adults have the potential to attract younger users. The potent nicotine delivery of these products means that along with the potential for harm reduction in adult smokers is the concern of use among young people.
Introduced in 2015, JUUL devices quickly overtook the e-cigarette market and accounted for 65 percent of e-cigarette sales by last June. Sales were estimated to be more than $650 million in the first six months of 2018. One study of adolescents and young adults found that 25 percent recognized JUUL devices and 10 percent had tried them. The device is small and narrow, resembling a USB flash drive. It fits easily in the palm of the hand and can be easily concealed. The manufacturer claims that taking a puff on the device will result in similar nicotine blood levels as a regular cigarette. As I noted above, it comes in many flavors that would be attractive to young users. (At the time this was written, NY State was considering banning flavored e-cigarettes). Although JUUL specifically claims that it targets only adult smokers, there is no doubt that they would welcome the additional revenue from teens and children. It is time that the FDA and the federal government got serious in regulating these products, such as requiring age verification for internet sales and brick-and-mortar sales. Otherwise, it is very likely that smoking rates among young people will reverse their downward trend.
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