[Editor’s note: This column was updated after original publication to include recent data.]
The latest device flooding schools resembles a flash drive but doesn’t store data. Its purpose: delivering a flavored nicotine hit. Called a JUUL, it’s a hipper iteration of the e-cigarette, which debuted a decade ago. Adolescents, who love JUUL’s super-slick appearance, brand magic, and fun flavors, have sparked “JUULing” mania. It’s a terrifying trifecta of teen pleasure-seeking, peer pressure, and trendy tobacco product. Health experts and policymakers — years into youth tobacco prevention efforts—know this battle is big. They’re in it to win it, but they’ll need an army of messengers to help.
Statistics confirm new users look more like Hannah Montana than the Marlboro Man. Just-released N.C. Youth Tobacco Survey numbers show e-cigarette use increased from 1.7 percent to 16.9 percent of high schoolers between 2011 and 2017, an 894 percent uptick; among middle schoolers, use rose from 1 percent to 5.3 percent, a 430 percent rise. National statistics reveal similar trends — but N.C. high school usage is increasing more rapidly.
State officials have been tracking trends closely. “We’re very concerned with the rise in e-cigarette use among middle school as well as high school students,” says Jim Martin, director of policy and programs for the Tobacco Prevention and Control Branch of N.C.’s Department of Health and Human Services.
Young users face long odds of walking away. “JUUL is highly addictive,” notes the American Academy of Pediatrics. “Kids are getting so much nicotine that they’re vomiting at school,” says Martin. E-cigarettes heat e-liquid, creating an aerosol that users inhale; e-liquid in one JUULpod delivers as much nicotine as a pack of cigarettes. That might surprise some. “Many kids we’ve talked to feel like it’s flavored water,” says Martin.
Early research on health effects is concerning. Toxicologist Ilona Jaspers, deputy director of UNC’s Center for Environmental Medicine, Asthma, and Lung Biology, has found a “unique response pattern” in the respiratory immune responses of e-cigarette users. “What is this going to do long-term? Is this reversible? All of these things we don’t know yet,” says Jaspers, adding, “Atypical patterns give me concern.”
Even flavorings, safe to ingest, can be toxic when inhaled. Cinnamaldehyde, used for cinnamon flavoring in e-liquids, “completely shuts down immune cells that are the first line of defense, cells that are patrolling airways and gobbling up invading pathogens,” says Jaspers. Her study of lung cell physiology shows cilia stop beating following cinnamaldehyde exposure. “It’s reversible,” Jaspers says, but one exposure “completely shuts down the ability of cilia for about two hours.”
Kids should know risks. DHHS is educating teachers and administrators, and reaching out to school nurses, PTAs, pediatricians, and others. “It’s going to take a multipronged strategy,” to effect change, says Martin.
Schools need guidance. Along with the Department of Public Instruction, DHHS sent a letter to superintendents and charter school directors, informing them that e-cigarettes are covered under schools’ 100% tobacco-free policies, and aren’t permitted on campus. State statute also prohibits e-cigarette purchases by minors.
Education is critical: DHHS provided schools with information about Catch my Breath, a prevention curriculum, Martin says. For kids caught using e-cigarettes, he recommends Aspire, a program explaining nicotine dangers and ways to quit, as an alternative to suspension.
Jaded teen JUULers are taking action. The “JUULers against JUUL” video, created by two teens, features fresh-faced addicts’ stories. Uploaded in May, the video garnered 50,000-plus views its first week. Parents and kids should watch it. Jaspers, who told me about the video, shared it with her teens. My 16-year-old watched it.
Kids need the truth about e-cigarettes. It’s up to all of us to ensure they get it.
Kristen Blair is a Chapel Hill-based education writer.