Health

Can we stop America's teen vaping epidemic arriving in Britain?


At Grace’s school, it doesn’t matter if you’re the coolest girl in the class or the quietest, when you get up to go to the toilet, you take your Juul. It doesn’t matter if you’re 11 or 16, like Grace was when she first started smoking the sleek black electronic cigarette. Depending on your gender, you’ll tuck the USB-like device into your pocket or your bra, knowingly risking suspension for a hit of mango- flavoured nicotine. Last year, Grace’s school implemented a new policy: if two kids go to the toilet at the same time, they’re automatically assumed to be Juuling.

“It does impact people in school,” says Grace, now 17, who, like all the teenagers in this piece, has had her name changed to protect her identity. Grace is originally from England but attends a private school in Switzerland. “You’ve got kids getting up every five minutes to go to the bathroom because you can’t focus without a hit.”

Like most kids in her school, Grace didn’t smoke cigarettes before she began vaping Juul. The e-cigarette was developed by two American former smokers, Adam Bowen and James Monsees, in 2015. “Juul was created to be a satisfying alternative to cigarettes,” reads the company website, which calls the product “unlike any e-cigarette or vape”. Sales seem to support claims – just four years after it was founded, Juul Labs is valued at $38bn and has a 70% share of the US e-cigarette market. There’s just one problem: Grace, and kids like her.

You must be 18 or over to purchase vaping products in the United States, the United Kingdom and most of Europe, but that hasn’t prevented what the US Surgeon General last year called a “teen vaping epidemic”. In February 2019, America’s Centers for Disease Control and Prevention found that 4.9m teens in the country used e-cigarettes. In July, Juul’s CEO Kevin Burns apologised to parents for the first time. “I’m sorry their child is using the product,” he said. “It’s not intended for them.”

‘It’s clean, it’s satisfying’: but by law you must be over 18 to buy it: Juul.



‘It’s clean, it’s satisfying’: but by law you must be over 18 to buy it: Juul. Photograph: Elizabeth Renstrom/The Observer

Grace and her classmates (who are mostly English, though some are American) think Juul was intended for them. “It’s just too convenient,” the teenager says. “Other brands of vapes are like huge, billowing smoke – you can’t hide that.” There are now a number of e-cigarettes and vape pens on the market, from those with bulky, refillable tanks like Aspire, to the thin black e-cigarette Blu. Yet Juul captured teen imagination – Grace says its discreet size means it is easily kept out of sight. “So I do think they knew what they were doing.”

An American spokesperson denies Juul was ever intended for teenagers and says the product “was designed and developed exclusively with the adult smoker in mind,” adding: “We don’t want anyone who doesn’t smoke or already uses nicotine to use Juul products.” The reason the product is so sleek and small, they say, is to make the experience of switching from cigarettes “as simple, clean and satisfying” as possible.

“We’ve created a product with no buttons or switches, no cleaning or messy juice replacement, as seen in most other vapes with open systems. It’s clean, freeing the adult smoker from smoke, ash and odour that they would usually get from a combustible cigarettes, and most importantly it’s satisfying, using regulated temperature controls, nicotine salts and varying strengths to meet the needs of cigarette smokers looking to switch.”

When Juul launched its first marketing campaigns in 2015, the models in its brightly coloured posters looked young, fresh and cool. America’s Food and Drug Administration is currently investigating whether the company deliberately marketed its products towards young people, something Juul denies. After its UK launch in summer 2018, the brand has steered away from a youth-oriented image. All of the models in Juul ads are now over 30 and users of the product, and the company’s upcoming UK billboards will be 200m away from any schools. Juul UK’s managing director, Dan Thomson, emphasises that this is double the official guidance of 100m.

It’s an encouraging act of self-regulation, but it comes at a time when Juul is facing unprecedented pressure. In June, San Francisco became the first US city to ban the sale of e-cigarettes, despite the fact that Juul owns a 29-storey skyscraper in the city. In the UK, EU regulations mean that Juul’s flavour capsules, known as pods, contain only 1.7% nicotine, roughly a third of the amount in the US. With bad press, bans and binding regulations, will Juul remain a vaping giant, or will its success disappear in a puff of smoke?

“We are switching people in very significant numbers away from combustible cigarettes,” says Thomson, who has worked with the brand for just over a year. When Juul debuted in the UK last July, its products were available in just a few hundred vape stores. They are now sold in nearly 10,000 outlets. Many Britons, who had been ordering Juul from abroad, were excited that the product was finally available at an affordable price at home. On social media, customers declared it “a dream come true” and “amazing” when, in November 2018, the company struck a major deal with Sainsbury’s.

“We are still relatively small in this marketplace,” Thomson says. “There are still millions of smokers out there who are going to have very negative health outcomes if they do not either quit completely – which is what we would recommend – or find an alternative to switch to. In a careful and thoughtful way, and in a way that ensures the product does not get into the wrong hands, we want to continue to expand.”

Cloud nine: nicotine salts in Juul provide what cigarette smokers need.



Cloud nine: nicotine salts in Juul provide what cigarette smokers need. Photograph: Alex Telfer/The Observer

Vaping is a far healthier alternative to smoking – if you already smoke. In 2015, Public Health England found that e-cigarettes are 95% less harmful than their combustible counterparts; there is none of the smoke, tar or carbon monoxide that make cigarettes so dangerous.

“There is widespread academic and clinical consensus that while not without risk, vaping is far less harmful than smoking,” says Professor John Newton, director of health improvement at Public Health England. “There is no situation where it would be better for your health to continue smoking rather than switching completely to vaping. The sooner you stop smoking completely the better.”

Yet Juul pods do, obviously, contain nicotine, and while the substance itself isn’t cancer-causing, it is addictive. Grace didn’t smoke before picking up Juul, meaning she was introduced to nicotine for the first time because of the product. Newton says that in the UK, regular e-cigarette use among young people “remains low”, but in America, worries abound about the 20% of high-schoolers who vape.

“There are concerns about exposure to nicotine at an early stage of life,” says Maciej Goniewicz, a scientist at Roswell Park Comprehensive Cancer Center in New York. Last year, Goniewicz and his colleagues published a study that found that adolescents who use Juul are exposed to nearly as much nicotine as traditional smokers, owing to the product’s use of nicotine salts. “Young people who never smoked are getting this highly effective nicotine-delivery product, and they might get addicted,” Goniewicz says. He also emphasises that we don’t yet know the long-term effects of e-cigarettes. “Even though there is a consensus that e-cigarettes are less risky than tobacco cigarettes, we still see evidence that there is some respiratory cardiovascular risk associated with vaping,” he says.

In 2015, researchers found that some e-cigarette flavours contain a chemical, diacetyl, which has been linked to “popcorn lung”, a disease characterised by irreversibly inflamed airways. Juul does not use diacetyl as an ingredient, but many teens like Grace use off-brand vape juice in their Juuls because it’s cheaper.

Peer pressure: ‘My friends would be harassed to try it’.



Peer pressure: ‘My friends would be harassed to try it’. Photograph: Elizabeth Renstrom/The Observer

“Yeaaaah,” Grace muses when asked if she’s concerned about the effect vaping will have on her health. “But, I don’t know. It’s difficult, because obviously I don’t want to have health problems in the future. But I know that it’s a possibility. And if that does happen, if I end up with a lung condition, which is definitely possible, it’s my own fault.”

A straight-A student interested in extracurricular activities and charity work, Grace understands the risks of vaping. So why does she do it anyway, and how did Juuling get so cool? Over the past year, Grace has supervised school dances for younger kids. At one event for 11 to 13-year-olds, one of her key duties was to stop children vaping in the loos. “Obviously the flavours make it appealing,” says Grace, who spends roughly £24 a week on Juul pods. Pods come in sweet flavours like creme, mint and cucumber. Grace’s favourite used to be mango (“Like, traditional,” she says), but she now buys knock-off flavours including strawberry, watermelon and pineapple.

In response to criticism about youth uptake, Juul stopped selling sweet and fruit-flavoured pods in US high-street shops in November 2018 (the flavours are still available online, where customers must be over 21 and verify their age by submitting ID). Yet in the UK, mango and mint-flavoured pods are still available nationwide.

“I know there has been some talk of flavours. We only have six flavours in the UK,” says Thomson. “We are very conservative in the flavour choices. We are very conservative in the flavour name descriptions that we have.”

Of course it’s not just flavours that make Juul appealing to teens, especially once they’re already addicted. “It is not about the flavours. I can’t stress that enough,” says Andy, a 17-year-old high school student and former vape dealer from Atlanta. “They are trying to ban mango and all of that. That does not matter, we will just buy the next flavour… When they run out of their favourite flavour, all of a sudden the one that they hated is looking pretty good to them because they are addicted.”

Andy began Juuling when he was 15 and, like Grace, attributes his addiction to good old-fashioned peer pressure. “I had a friend who didn’t do it, but my friends would just about harass them to try it,” he says. Both Grace and Andy say Juuling provides stress relief, especially before exams. As he is 6ft 7in and looks mature, Andy was able to buy Juul pods from local shops and sell them on to his classmates. “Every day after school I would have 20 or 30 people meeting me at my truck for pods,” he says, estimating that he made nearly $4,000 in a year.

Another reason teens became hooked on these pods, experts argue, is because of Juul’s social media presence. Last year, Juul shut down its Facebook, Instagram, and Snapchat accounts, and promised to use its Twitter for “non-promotional communications only”. Yet many feared it was too late: teens had already set up their own Juul-based accounts, sharing tricks, memes and jokes, ensuring that Juuling remained a somewhat ironic, but nonetheless addictive, hobby.

“You get a buzz off it, definitely… But it is also just like a fun thing to do. You’ve got like your tricks and stuff,” explains Grace.

Jon-Patrick Allem is a professor of preventive medicine at Keck School of Medicine in California who has researched the impact of Juul’s Twitter account. In a 2018 study, Allem found that 3.6% of all Juul-related posts on Twitter mentioned “school”, while only 0.29% mentioned “quitting smoking”. In a later study, he discovered that even teens who don’t follow the brand are frequently tagged into posts by their peers.

“Teens who are not necessarily signing up to follow Juul and Juul-related media are exposed to it on the social media platform,” Allem says. “In our research and in the literature in general, we know that young people who are exposed to tobacco marketing, nicotine marketing, it raises awareness of the brand, and it changes susceptibility to use such products… Moving forward, the more Juul can do to remove their content from platforms that are popular among young people, the better.”

And yet as quickly as it rose to power, Juul’s popularity is already declining among American teens. In May 2018, the New Yorker chronicled “the promise of vaping and the rise of Juul”, but by November, they released a declaratively titled follow-up, “Goodbye to Juul season”. Meme-based Juul Instagram accounts were disappearing rapidly, the story announced, and teens suggested the trend was disappearing. Andy has already cut down on his personal use, and no longer sells pods.

“I personally do not like Juul any more. I do not like the whole company,” says Andy. “I don’t like what it has done to me.” He does athletics and believes his race times would be better if he had never Juuled. When asked how Juuling has affected classmates, he says: “They are after pods like fools.”

In the UK, teens haven’t fallen in love with Juul to the same extent as their US contemporaries. In 2019, Public Health England reported that only 1.7% of 11 to 18-year-olds in Britain vape weekly – although experimentation is increasing, and Juul has only been available in the country for a year.

“As we launched the business in the UK, front and centre of our strategy was ensuring that we did not replicate some of the earlier issues that we saw in the US,” Thomson says. Juul’s strict measures in the UK include a “Challenge 25” policy in all retail stores; no UK social media accounts; underage mystery shoppers; sanctions against stockists who don’t meet age-verification standards; and only using adult smokers in its advertising.

“I think the policies are working,” Thomson says. “I think the policies are above and beyond any other age-gated brand in almost any other sector.”

British teens don’t really seem to care about Juul – I am variously told that “people tend to go for cheaper vapes off Amazon”; “Juul is primarily a meme”, and “Vapes are usually in year seven – people start smoking weed higher up.” Yet without this extremely lucrative market, and with bans and regulations making life harder for adult Juulers (who now have to buy flavours online in the States, and deal with a lower nicotine content in the UK) will Juul continue to grow?

“If you look at the numbers over the last few years, the number of people switching from smoking to vaping has started to flatten out. I think part of that is a lot of misinformation that surrounds the health impacts of switching,” Thomson says. “I hope that the government, charities and public health bodies continue to be supportive because there is a huge public health opportunity in front of them. There are a 100,000 people who die every year in this country from smoking cigarettes.” Juul is currently fighting the San Francisco ban, instead pushing regulation and enforcement as an alternative.

For many former smokers, Juul is undoubtedly a lifeline. But for teens such as Grace, vaping is an expensive and potentially dangerous new addiction. The 17-year-old has no plans to stop. “A few kids quit, but they normally end up back on it within a week or so, just because so many people are doing it,” she says. “It’s hard to avoid.”





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