When Julie Urban started going through her son’s belongings in his bedroom, she wasn’t sure what she was looking for. She only knew that her 17-year-old wasn’t acting like himself.

“He had been acting strange for several months — staying out late, missing classes, getting in trouble at school,” Urban says. “His personality had changed quite a bit. He had gone from very shy and reserved to active, outgoing, and always busy. He was constantly fidgeting and would be caught up in lies from time to time.”

Hidden in a tub of soccer scarves, she and her husband discovered a JUUL, an e-cigarette resembling a flash drive, still in its original packaging.

“If it hadn’t been in the box, we would not have known what it was,” Urban says.

JUUL (pronounced “jewel”) is currently all the rage among both middle school and high school students.        

What is JUUL?

A JUUL is a slender, compact e-cigarette that looks like a flash drive. A small, non-refillable liquid nicotine cartridge (or pod) clicks into the top of the device.

JUUL charges in a USB port. The pod’s e-liquid heats up to create a vapor that the user inhales. According to the manufacturer, a single pod contains 59 milligrams of nicotine per milliliter of liquid, which is equivalent to the amount of nicotine in an entire pack of cigarettes.

“This product has more than half of the e-cigarette market share and is a large reason e-cigarette use is the leading tobacco product among kids,” says Erika Sward, National Assistant Vice President for Advocacy, American Lung Association, Washington D.C.

According to the Centers for Disease Control (CDC), JUUL retail sales increased by 641% in one year, from 2.2 million devices sold in 2016 to 16.2 million devices sold in 2017. (These figures do not include online sales.) In turn, the number of high school students using e-cigarettes has risen by 75 percent.

What’s the Attraction?

From a teen’s perspective, JUUL is “the perfect storm,” Sward says.

The product is sleek and discreet, hidden easily in pockets, sweatshirts, and backpacks. Although it leaves a light, fruity scent, JUUL doesn’t produce the vapor cloud associated with other e-cigarettes (vape pens), making it easy for kids to use, even while sitting in class.

JUUL is also easy to inhale. The product contains nicotine salts in which benzoic acid is mixed with freebase nicotine to lower the acidity, creating a smoother hit to the throat. Most e-juices use freebase nicotine, which is the liquid extracted from tobacco. Because freebase nicotine is high in alkalinity, the stronger the nicotine in a product, the harsher the vaping experience. Nicotine salts bypass that problem for users, enabling them to vape high levels of nicotine.

Candy and fruit flavored e-juices, decorative wraps or “skins,” and social media campaigns add to the appeal.

Is it Safer than Smoking?

E-cigarette makers originally marketed their products as smoking cessation devices, which gave these products a halo effect as healthier alternatives to traditional cigarettes.

Because they don’t look or smell like traditional cigarettes, kids fail to see e-cigarettes are the latest evolution in how tobacco companies are peddling their products.

“We’re seeing a lot of kids who would never in a million years think to pick up a cigarette who are JUULing,” Sward says.

Researchers aren’t sure how harmful e-cigarettes are, but they do know the products emit chemicals into the lungs, including aldehydes (formaldehyde, acetaldehyde, acrolein and acetone); dactyl, a highly toxic chemical linked to lung disease; volatile organic compounds found in car exhaust; and heavy metals like nickel, lead and chromium.

“The bottom line is that NO e-cigarette has been found to be safe and effective by the FDA for helping smokers quit,” Sward says.

How Nicotine Affect Brain Development?

The adolescent brain is particularly vulnerable to the addictive effects of nicotine. The brain’s cortex, the center of decision making and impulse control, isn’t fully formed until around the age of 25.

According to the Surgeon General: “Nicotine changes the way synapses are formed, which can harm the parts of the brain that control attention and learning. Because addiction is a form of learning, adolescents get addicted much more easily than adults.”

Research suggests that kids who use e-cigarettes are much more likely to turn to traditional cigarettes later.

Are E-cigarettes Regulated?

State laws vary. Some states have increased the minimum age to purchase nicotine products to 21, but they’re relatively easy for minors to purchase online. Other states have begun taxing e-cigarettes and prohibiting the sale of flavored products.      

Since e-cigarettes are not regulated by the FDA, there’s no telling exactly how much nicotine is in any of these products, including those that claim to contain zero nicotine.

“The Food and Drug Administration has kicked the can down the road on dealing with JUUL and other e-cigarettes. They’re asking a lot of questions, both directly of JUUL and of the broader public, on the issue of flavors and of e-cigarettes more broadly; but when it comes time to taking meaningful action against the sale of these products and protecting kids, the FDA has failed to deliver in a big way,” Sward says.

The American Lung Association is one of seven other public health organizations, including Campaign for Tobacco-Free Kids, American Cancer Society Cancer Action Network, American Heart Association, Truth Initiative, American Academy of Pediatrics and Democracy Forward, and individual pediatricians, that sued the FDA in March for its decision to delay the regulation of e-cigarettes until 2022.

In October, the FDA conducted a surprise inspection on JUUL headquarters, seizing thousands of documents in an effort to learn if JUUL is deliberately targeting minors. The FDA has given JUUL and four other e-cigarette makers two months to come with a plan to prevent sales to minors or face a ban on the sale of all e-cigarettes.

What’s A Parents To Do?

•  Promote a healthy lifestyle. Talk to your kids about the harmful effects of addictive substances on the body.

•  Remind your kids that like traditional cigarettes, JUUL, and other e-cigs are highly addictive nicotine delivery systems.

•  Contact your child’s middle school or high school to learn how they are educating staff and students about e-cigarettes.

•  Familiarize yourself with what JUUL and other e-cigarettes look like.

•  Contact your state legislators and urge them to protect kids by increasing the minimum age to purchase nicotine products to 21, prohibit the sale of flavored products and put pressure on the FDA to regulate e-cigarettes.

If you or a loved one is addicted to nicotine, call 1-800-QUIT-NOW or visit www.lung.org to learn safe and effective ways to quit.

Christa Melnyk Hines is a freelance journalist and author. She and her husband are the parents of two middle school age sons. Christa’s latest book is Happy, Healthy & Hyperconnected: Raise a Thoughtful Communicator in a Digital World.