Family Medicine Cares: JUUL® and Other Electronic Nicotine Delivery Devices are Bad for Kids

What is JUUL® ?(1 page PDF)
JUUL is a brand of electronic cigarette (e-cigarette) or vaping device.1(1 page PDF) JUUL (pronounced jewel) looks like a USB drive, and is promoted as an alternative to combustible cigarettes and existing e-cigarettes or vaping devices.1(1 page PDF) “JUULing” is the term used when using JUUL.1(1 page PDF)

What is the threat to youth?
Similar to other e-cigarettes, JUUL comes in a variety of flavors, including fruit medley, mango, cool mint, and crème brûlée.1(1 page PDF)  Most youth who experiment with tobacco begin with a flavored product,4(1 page PDF) as the flavors appeal to youth.5(1 page PDF)

Youth are particularly aware of JUUL, as nearly 1 in 5 students age 12 to 17 have seen JUUL used in school.6(1 page PDF) Since JUUL resembles a USB flash drive, it is increasingly used by students in classrooms, hallways, restrooms, and at school sporting events.7(1 page PDF)

Sixty-three percent of JUUL users age 15 to 24 did not know JUUL contains nicotine.8(1 page PDF)

Youth may start using e-cigarettes because they believe they are harmless. Nicotine, a key ingredient in tobacco products, is an addictive drug. Tobacco use by and around children and adolescents is a particular concern due to increased risk for addiction and passive exposure. Smoking is a known cause of cancer, heart disease, stroke, and chronic obstructive pulmonary disease. Young people who use e-cigarettes, such as JUUL, are more likely to transition to combustible cigarettes.9(1 page PDF)

A message from the American Academy of Family Physicians   
Family Physicians: JUUL®: An Electronic Cigarette You Should Know About

Patient Education Resource
What is JUUL® ?

Resources for Physicians
What is JUUL® ?(1 page PDF)
AAFP Tobacco and Nicotine Cessation Toolkit
AAFP Ask and Act Tobacco Cessation Program
AAFP Electronic Nicotine Delivery Systems Fact Sheet(2 page PDF)
AAFP News: Rise of 'JUULing' Among Youth Sparks Sharp Response

AAFP Tar Wars
Tar Wars is a tobacco-free education program for fourth- and fifth-grade students. The program is designed to teach kids about the short-term health effects of tobacco use, the cost associated with using tobacco products, and the advertising techniques used by the tobacco industry to market their products to youth. 

Family Medicine is Not Alone: Additional Resources 
AAFP Partnership with Tobacco Free Kids and Federal Trade Commission Petition( New Investigation Exposes How Tobacco Companies Market Cigarettes on Social Media in the U.S. and Around the World

New York Times in-depth article on the investigation( The tobacco industry says it no longer tries to hook new generations of smokers. So what’s behind the legions of beautiful young people in smoking, vaping and partying posts with the same hashtags?

CDC: E-Cigarettes and Young People: A Public Health Concern(
Scientists are still learning more about how e-cigarettes affect health. However, there is already enough evidence to justify efforts to prevent e-cigarette use by young people. We know that the vapor from e-cigarettes is harmful because it contains harmful ingredients, including nicotine. Nicotine exposure during adolescence can cause addiction and can harm the developing brain.

Know the Risks: E-Cigarettes and Young People(
A message from the Office of the U.S Surgeon General
Adolescent years are times of important brain development. Brain development begins during the growth of the fetus in the womb and continues through childhood and to about age 25. Nicotine exposure during adolescence and young adulthood can cause addiction and harm the developing brain.

National Institute on Drug Abuse: Electronic Cigarettes (E-cigarettes)(
E-cigarettes are popular among teens and are now the most commonly used form of tobacco among youth in the United States. Their easy availability, alluring advertisements, various e-liquid flavors, and the belief that they're safer than cigarettes have helped make them appealing to this age group.