The US Food and Drug Administration (FDA) is increasing efforts to help keep young people from using tobacco products, including electronic cigarettes (e-cigarettes). In a statement announcing the new Youth Tobacco Prevention Plan, FDA Commissioner Scott Gottlieb specifically called out JUUL products. JUUL brand e-cigarettes look like a USB flash drive and deliver an aerosol mix of chemicals, nicotine, and flavoring to the user. They are the top-selling e-cigarette brand, and according to news reports and social media posts, students are using them in locations such as classrooms and school bathrooms.
The FDA has sent warning letters to more than 40 retailers that sell JUULs and other similar products, including gas stations, convenience stores, and online sellers including eBay, saying they broke the law that prevents selling the products to kids under age 21. The agency also ordered JUUL Labs to turn over documents about product marketing and research on the health effects, to find out if the company is marketing its products in ways that are misleading or target youth.
Many public health advocates, however, think the FDA isn’t going far enough. Public health and medical groups, including the American Cancer Society’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN), and several pediatricians, are challenging in federal court the FDA’s August 2017 decision to give e-cigarette and cigar makers an extra 5 years before coming under FDA review. The extension being challenged allows the products – including those with fruit, candy, and other flavors that may appeal to kids – to stay on the market until at least 2022 without undergoing an FDA review of their public health impact.
Studies have found that most kids are not aware of the potential risks they face by using e-cigarettes, including JUULs. We talked with the American Cancer Society Vice President for Tobacco Control, Cliff Douglas, to learn more about these issues and what must be done to protect our young people.
A: JUULs are made to resemble flash drives. They have a high tech feel and appearance, and both the product itself and the marketing of it make it look very cool. In comparison with some other e-cigarettes, JUULs are harder to detect. They’re small and can be hidden in the palm of the hand, and they emit little visible aerosol. Kids are known to be using them in school restrooms and even in the classroom. They come in flavors advertised as fruit medley, cool mint, and crème brulee.
A: JUULs deliver a higher concentration of nicotine than some other types of e-cigarettes. Some kids do not even know that JUULs contain nicotine. They don’t understand they are being exposed to an addictive drug that also can harm a young person’s brain development, as reported in the 2016 Surgeon General’s report on e-cigarettes and youth. The brain is still developing well into the mid-20s and even beyond, so health concerns apply not only to teens, but also to college-age users. Some kids are reported to have become physically dependent on nicotine, and are using JUULs not just recreationally, but also compulsively, to sustain what has turned into a drug problem.
A: The public health community, including ACS CAN, is working to require responsible industry behavior. That includes manufacturers, retailers, and online purveyors, while providing better education to the public and decision makers. We don’t want a single kid to use nicotine, but we also have to recognize that the youth smoking rate is at historic lows now, and we have to make sure any action we take doesn’t contribute to stalling or reversing the success we are having in limiting conventional cigarette or other combustible tobacco use among youth.
A: Parents and teachers can communicate to kids in a way that’s informative and respectful in teaching them that the best choice is to not use any tobacco or nicotine-containing products, but if they do experiment, they should understand that combustible (lit and burned) cigarettes are far and away the most harmful tobacco products, producing smoke with more than 7,000 chemicals, at least 70 of which cause cancer. E-cigarettes, in comparison, are harmful for kids but substantially less dangerous than combustible products like cigarettes, cigars and hookah (or water pipe tobacco). We should be honest and straightforward with kids in age-appropriate ways, while keeping in mind that if you just tell kids “no,” some will simply rebel and tune out their parents and other adult mentors.
A: Although JUUL has caught on in a big way, there are a lot of other similar products on the market, such as myblu, KandyPens, and PHIX. This trend is evolving rapidly. It’s JUUL today, and it may be another product a few months from now. We need to look at the big picture and gain a greater appreciation for the very varied and diverse nature of the modern tobacco and nicotine marketplace to inform how we address these different products, educating people and protecting our kids along the way.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.