How Juul Hooked Kids and Ignited a Public Health Crisis

19 September 2019
Jamie Ducharme, Video by Ang Li 

In the Scheetz household, back-to-school anxiety reached new heights this fall.

Jami Scheetz’s 15-year-old son Devon, who has severe asthma, kicked a brutal vaping habit over the summer, with help from a nicotine patch. But as soon as school started and he was once again around kids vaping, his habit returned. On Sept. 12, Devon vaped at school and immediately began sweating and vomiting. Though Scheetz, who lives in Sellersville, Pa., says her son is now fine, she can’t shake thoughts of kids who have been hospitalized or died after using e-cigarettes. “Vaping scares me more [than smoking], because they don’t know what’s really in it,” she says.

To a remarkable degree, a single company is front and center in one of the biggest public-health crises facing the country: the sharp rise in vaping among teenagers and young adults. In 2018, 30% of the nation’s 12th-graders reported vaping nicotine at least once in the past year, according to a January 2019 study sponsored by the National Institute on Drug Abuse. The study said the increase in vaping last year was “the largest ever recorded for any substance in the 44 years” that it has tracked adolescent drug use.

Photograph by Jamie Chung for TIME

Though Juul is not the only e-cigarette for sale in the U.S., it is largely blamed for the vaping explosion and controls about 50% of the market, putting a sharp focus on the company. On Sept. 9, the Food and Drug Administration sent Juul a warning letter accusing the company of violating federal regulations by promoting its e-cigarettes as a safer option than traditional cigarettes and threatening the company with fines and product seizures if it continued. Two days later, the Trump Administration said it planned to pull from the market flavored e-cigarettes such as Juul’s mango, creme and mint pods. In the Oval Office, with First Lady Melania at his side, President Trump said, “We can’t allow people to get sick. And we can’t have our youth be so affected.” He added that the First Lady, who tweeted a warning about vaping, feels “very, very strongly” about the issue because of their teenage son Barron. Just days later, New York banned most flavored e-cigarettes statewide, following in the footsteps of Michigan and Juul’s home city of San Francisco, whose mayor signed an ordinance effectively banning e-cigarettes. The recent moves were prompted by U.S. Centers for Disease Control and Prevention (CDC) reports of almost 400 serious lung illnesses and six deaths it linked to vaping, which a congressional committee is also investigating. While Juul products have not been implicated in the deaths, the CDC in September advised Americans to “consider not using e-cigarette products” while its investigation is ongoing. The American Lung Association went further, saying in a statement that “no one should use e-cigarettes or any other tobacco product.” Huge international markets, including India and China, are also restricting the sale of e-cigarettes.

Given the possible risks to the nation’s youth, Juul’s rapid growth has been accompanied by remarkably little oversight or regulation. And while there is a legitimate debate over whether e-cigarettes are safer for adult smokers than traditional cigarettes, and whether they can help addicts quit smoking, critics argue that Juul has assiduously followed Big Tobacco’s playbook: aggressively marketing to youth and making implied health claims a central pillar of its business plan. Juul maintains that it is not Big Tobacco 2.0. In eight months, unless e-cigarette companies can prove to the FDA that vaping is “appropriate for the protection of public health,” the products could be pulled from the market. That would curtail youth use, but some fear it could also cut off adult smokers’ access to a potentially beneficial product.

E-cigarettes vaporize a potent liquid packed with nicotine, flavorings and other chemicals

E-cigarettes vaporize a potent liquid packed with nicotine, flavorings and other chemicals

 

Photographs by Chris Maggio for TIME

Juul, which was valued at $38 billion by its investors before the Trump Administration’s crackdown, is now facing what CEO Kevin Burns in July called an “existential” threat, due to rising levels of youth use. Lobbyists, staff scientists and PR experts are working feverishly to respond to the growing public outrage. “Sh-t happens,” Burns told TIME in July, foreshadowing the rocky summer to come. “We’ve got to respond. I would love it to be less dynamic here than it is, because it’s not easy on the organization. But I think the organization understands that we’re at the forefront here and it’s going to be volatile.” Juul says that it does not make health claims and that it has never marketed to youth. The company has taken recent steps to make it harder for young people to illegally buy its products, both online and in stores.

Nobody hates Juul more than parents, many of whom are watching their children fall prey to the “epidemic on speed” that is Juuling, as New York parent Erin Mills puts it. She blames her son’s two-year addiction to Juuls for causing his grades and social life to plummet, while she says she and her husband watched helplessly. It’s “like this tsunami,” she says, “and I see my child going under.”

To help parents like Mills, New York City mothers Meredith Berkman, Dorian Fuhrman and Dina Alessi formed the advocacy group Parents Against Vaping E-Cigarettes in 2018. It has grown to about a dozen chapters across the country. Berkman argued at a congressional hearing in July that today’s kids are becoming “an entire generation of nicotine addicts” and “human guinea pigs for the Juul experiment.” Filmmaker Judd Apatow made his opinion clear on Sept. 9, tweeting, “Juul is some evil sh-t … Keep your kids away from it. It’s a scam to get you addicted.”

Hundreds of U.S. school districts have installed electronic vape detectors in their bathrooms–or “Juul rooms”–and one in Alabama went further, removing some bathroom doors to make it harder to vape in secret. But the product’s design has complicated that task. Juul’s $35 sleek slate gray and silver e-cigs are often compared to flash drives or iPhones, in sharp contrast to the clunky, tank-style devices that preceded them. They’re small enough to fit in the palm of your hand and subtly vaporize pods of liquid containing nicotine, flavorings and other chemicals. A four-pack costs $16, and each 200-puff pod delivers as much nicotine as a pack of 20 cigarettes.

Photographs by Jamie Chung for TIME

Halving cigarette-smoking rates since the 1960s remains one of America’s biggest public-health triumphs, even though smoking–which is responsible for more than 480,000 deaths annually–remains the leading cause of preventable death in the U.S. Teen cigarette smoking, too, had seen historic declines in recent years. Now that hard-won success may be in peril.