The Potential Health Hazards of Juuling

What the Research Says

A type of e-cigarette that has been gaining popularity among young adults and teenagers is called the Juul. It doesn’t look at all like a cigarette—it is small and rectangular (resembling a USB flash drive). The Juul is small and inconspicuous enough for adolescents to easily hide from parents and teachers. 

Interestingly, the Juul can be charged on the computer (like a flash drive is charged) by inserting it into the USB port of a laptop. People who use a Juul get an instant buzz by inhaling the nicotine charged device. When their Juul runs out of juice, they can quickly and conveniently charge up their tobacco-less apparatus on their laptops.

What is the impact of Juuling, especially on the younger generation? Is this popular device safe? 

What Is an E-Cigarette?

An e-cigarette (short for electronic cigarette) is a battery-powered device used to produce a heated vapor.  The nicotine-filled vapor can be inhaled—thus, the name “vaping.”

The very first e-cigarette was launched in China back in 2003. Since that time, the tobacco-less devices have continued to grow in popularity. The Juul is one type of e-cigarette; it was originally designed for adult smokers to help them kick the habit. However, now Juuls are said to be the most popular device for vaping among adolescents.

What Is Juuling?

Juuling is a method of vaping or turning vapor into a nicotine-filled mist, allowing a smoke-free option for getting nicotine into the body. The Juul contains nicotine extracts (taken from tobacco), but it does not contain the tobacco itself. It uses flavors made up of various chemicals—many of which are thought to be harmful to a person's health. The National Cancer Institute says, “It contains a solution of nicotine, flavorings, and other chemicals, some of which may be harmful.”

Although Juuling does not involve the use of tobacco, it’s said to deliver nicotine as efficiently as a traditional cigarette, causing the nicotine to quickly enter the lungs and travel to the brain. 

Juuling is only legal for those who are 18 and older; however, just as cigarettes have always wound up in the hands of younger people, so has the Juul. In fact, the Juul is considered very trendy in the middle and high school student population. In fact, according to Business Insider, “the Juul, is catching the attention of high school staff and public health experts who call its high nicotine content 'scary'."

Juuling vs. Vaping

Many people wonder if there a difference between vaping and Juuling. One of the biggest differences between vaping and Juuling is that Juuling is said to deliver a much higher dose of nicotine at a faster rate than vaping. 

Most vaping products use propylene glycol and glycerin to deliver the nicotine, but the Juul has organic nicotine salts—a combination of nicotine and organic acid—to allow for the absorption of nicotine.  

Health Hazards of Nicotine

Although nicotine may seem innocuous, the substance is highly addictive and can potentially cause negative effects on the brain (particularly for adolescents because the brain is still developing until age 25). Nicotine is said to have an impact on the area of the brain involved in decision making, emotions and impulse control.

Juuling Among Teens

The Juul is considered the most popular type of e-cigarette available, and it has approximately 45.7 percent of the e-cigarette market. The National Institute of Drug Abuse reports that teenagers are more likely to use e-cigarettes today than they are to smoke traditional tobacco products.

Those who use e-cigarettes were found to have a high likeliness transitioning to smoking tobacco products. 

Among high school and middle school kids, the prevalence of e-cigarette use increased to 3.5 million minors who reportedly vaped at least one time from 2017 to 2018. This translates to 77 percent of high school kids and 50 percent of middle-school kids who have used e-cigarette products. 

Statistics gathered from a one-month survey of adolescents reported by the National Institute of Drug Abuse include many stats about traditional cigarette use and e-cigarette use by eighth graders through high schoolers. E-cigarette use was much higher than traditional cigarette use.

Traditional cigarette use was 3.6 percent among 8th graders, 6.3 percent among 10th graders, and 11.4 percent among 12th graders.

E-cigarette use was reportedly 11 percent in high school seniors in 2017; that number jumped to a whopping 20.9 percent in 2018. Two times as many boys use e-cigarettes compared to girls. 30.7 percent of e-cigarette users started smoking traditional cigarettes within 6 months, compared to only 8.1 percent of non-users who started smoking.

Two popular social media platforms for teens are YouTube and Instagram—both are saturated with videos depicting teenagers Juuling in the classroom, even in the presence of teachers. On the east coast, Juuling has become so popular among teens, that teachers are reporting extensive problems. “Dozens of teachers report confiscating Juul devices disguised as Sharpies and other classroom items,” says Business Insider. 

Why Does the Juul Appeal to Teens?

The Juul’s features are another aspect of the device that makes them popular with young people. It is small, with a slim, high-tech design. The Juul uses nicotine cartridges, referred to as Juul pods, that are available in several different flavors like mint, mango, fruit, and creme. 

The Juul’s vapor is reported to feel less harsh on the throat and lungs compared to other types of e-cigarettes. This makes the use of Juul more enjoyable, particularly for new users.

Not only is the Juul stylish, inconspicuous (easy to hide), discreet to use (having little smell and no vapor), it is also reportedly easy to get. Up until late 2018, the Juul was available in convenience stores, gas stations, and smoke shops. However, federal mandates have recently resulted in a tight restriction on where the Juul can be sold.  

Starter kits cost between $29 to $49, making the Juul affordable for young people. Middle school and high school students reported that the device was ”fairly easy” or “very easy” to get, said the National Institute of Drug Abuse

American Cancer Society and E-cigarettes

A 2018 guideline was published by the ACS that read, Smokers who can’t or won’t quit should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products.”

Although the ACS recommends using aids such as vaping devices to quit smoking, the organization does not recommend e-cigarette use for minors. 

The ACS encourages those who do use vaping devices, such as the Juul, to cease the use of the device as soon as possible. “Clinicians support all attempts to quit the use of combustible tobacco and work with smokers to eventually stop using any tobacco product, including e-cigarettes."

The Society goes on to say, "the ACS strongly recommends that every effort be made to prevent the initiation of e-cigarettes by youth.”

Potential Health Hazards

According to a 2018 article published by Dr. Josh Axe, certified doctor of natural medicine and clinical nutritionist, there are several potentially serious health hazards associated with Juuling, including:

  • long-term use may be more damaging than smoking conventional cigarettes
  • high risk of addiction (particularly among adolescents)
  • may result in an increased risk of starting and long-term use of tobacco products (particularly for young people)
  • higher risk for heart disease (due to an increase in blood pressure from nicotine)
  •  possible DNA damage, which could increase the risk of cancer
  •  respiratory/lung damage (from chemicals created by artificial flavoring—the type of e-cigarette that is preferred by young people who vape)

Research Studies

Heart Disease

A 2017 study discovered that the use of e-cigarettes may result in narrowing of the arteries and other blood vessels, as well as stiffening of the primary artery that supplies oxygenated blood to the body (called the aorta). Aortic stiffness is an early warning sign of heart disease, such as stroke, aneurysm, and atherosclerosis (hardening of the arteries).

DNA Damage

A recent research study at the Masonic Cancer Center at the University of Minnesota found that vaping may change the DNA in the cells of the mouth. The study discovered that increased DNA damaging compounds (including acrolein, formaldehyde, and methylglyoxal) were found in the saliva after the study subjects used e-cigarettes. The medical experts say that these chemicals are harmful and may increase the risk of cancer.

Respiratory and Lung Damage

survey conducted at the University of Michigan found that teenagers preferred the sweet flavored e-cigarettes, over those that contain nicotine but no flavor. These flavors were found to combine with the fluid in the Juul, causing what the researchers referred to as undisclosed chemicals. The flavor compounds included chemicals such as diacetyl, acetoin, and 2,3-pentanedione, said to cause potential damage to the lungs. These chemicals were also found to lead to severe respiratory conditions, as well as causing irritation of the mucous membranes of the lungs.

A report published by the American Physiological Society (APS) found that the chemicals emitted by Juuling, such as propylene, propylene, plus nicotine and flavoring seem to become embedded in the lungs. This resulted in inflammation, an increase in mucus production, and altered lung function.

Potential Harm of Flavoring E-Cigarettes

In a report by the National Institute of Drug Abuse, 25.7 percent of 12th grade high school students say they were vaping “just flavoring,” unaware of the high concentration of addictive nicotine they were inhaling when Juuling. Most e-cigarettes (including the Juul) do not offer a nicotine free option.

Even if e-cigarettes, such as the Juul, offered a nicotine free, flavor-only option, there are still potentially harmful chemicals in flavorings.

  • Diacetyl: A chemical used to add a buttery flavor, linked with bronchiolitis obliterans (a severe respiratory disorder involving obstruction of small airways)
  • Acetoin: A chemical that is associated with eye, skin and mucous membrane irritation in the lungs—acetoin is toxic when inhaled (even in small amounts) and is being reviewed by the National Toxicology Program for its reported risk of lung damage
  • 2,3-Pentanedione: A flavoring agent that has been reported as damaging to the respiratory tract by the National Institute for Occupational Safety and Health—inhaling this chemical is said to cause fibrosis of the lungs as well as genetic changes in the brain in animal studies

Public Concern

The vaping craze has caused some serious concern and deliberation by public health officials as well as medical professionals, who say that the health effects of the e-cigarette may be more impactful than the use of tobacco products. For one, it is more convenient to use than e-cigarettes (because users can smoke anywhere, including indoors).

The Juul also results in getting double the concentration of nicotine as compared with regular cigarettes and other vaping devices.

"The Juul is a new trend I'm afraid," Nicholas Chadi, a clinical pediatrics fellow at Boston Children's Hospital, said at the American Society of Addiction Medicine's annual conference. "We get calls from parents across Boston wondering what to do about this."

New Federal Mandate

In November of 2018 the FDA announced new restrictions on the sale of flavored e-cigarettes (including Juuls), in an effort to interrupt the popular use of the sweet-flavored smoking apparatus and prevent a new generation of young people who are addicted to nicotine. 

The sweet flavored varieties will only be sold at age-restricted stores and via online companies that verify the age of customers. The decision was based on the inability of manufacturers to prove that they could keep these products away from minors.

Conclusion

Although the harmful effects of Juuling on teenagers are still being studied by the experts, one thing is certain: the prevalence of use in teenagers and underage kids is on the rise. A big concern is the fact that many kids are unaware of the addictive nature of the products they are inhaling. 

This has led health experts and organizations, such as the American Lung Association, to be concerned about the number of kids who unknowingly become addicted to nicotine—and many of whom switch to using conventional tobacco products—raising the incidence of a new generation of smokers. 

The key to prevention may lie in a dual effort on the part of government agencies to ban the sale of these products, coupled with a national education program to inform parents and kids of the potential dangers of Juuling.   

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