JUUL®: An Electronic Cigarette You Should Know About

A new brand of electronic cigarette (e-cigarette) has become one of the most popular vaping devices, particularly among youth. 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

Most e-cigarettes work in a similar manner. They use cartridges filled with a liquid that contains nicotine, flavoring, and other chemicals. The liquid is heated by the e-cigarette device, turning it into a vapor that is inhaled.

Unique Features of JUUL

JUUL works similar to other e-cigarette devices, but has several features that make it different and potentially more dangerous. Features that distinguish JUUL from other e-cigarettes include:

  • JUUL resembles a USB drive. It can be concealed as a USB drive and used in public spaces, such as schools. It is charged in the USB port of a computer or laptop.
  • The liquid in JUUL pods contain nicotine salts from tobacco leaves. The nicotine salts are absorbed into the body at almost the same rate as nicotine from a combustible cigarette. Inhaling vapor from nicotine salts goes down smoothly and doesn’t produce the irritating feeling in the chest and lungs that combustible cigarettes do.2
  • JUUL has more than twice the amount of nicotine concentrate as many other brands of e-cigarettes. This has raised concerns that it may have a higher risk of addiction than other e-cigarettes. One cartridge, called a pod, has roughly the equivalent amount of nicotine as one pack of cigarettes.1

In response to the concerns about the rise of the use of JUUL by youth and adults, the American Academy of Family Physicians (AAFP) developed two short fact sheets to help physicians and patients understand this new product.

Youth Concerns

The ease of concealment and variety of flavor options make JUUL a popular tobacco product among the youth. Most youth who experiment with tobacco begin with a flavored tobacco product,3 as flavored products appeal to them.4

Once youth and young adults use e-cigarettes they are more likely to move to combustible cigarettes. The National Academies of Sciences, Engineering, and Medicine (NASEM) concluded that there is substantial evidence that e-cigarettes use does increase the risk of ever smoking combustible cigarettes among youth and young adults.5

Health Effects

Since e-cigarettes have been on the market for just longer than a decade, long-term health effects are unknown. However, more studies are beginning to show an adverse impact on the short-term effects. For example, such effects as rapid deterioration of vascular function, increased heart rate, and elevated diastolic blood pressure have been noted by researchers in recent years.6

Tobacco Cessation

Scientific studies have not shown that e-cigarettes help people quit smoking combustible cigarettes. In fact, the opposite is often true. The NASEM concluded that there is insufficient evidence about the effectiveness of e-cigarettes as cessation aids to quit smoking combustible cigarettes when compared with no treatment or proven cessation treatments.6 In many cases, individuals trying to quit smoking combustible cigarettes by using e-cigarettes as a cessation aid will become dual users of both products.7

Call to Action

Family physicians should advice patients against using JUUL or any other e-cigarette to quit smoking combustible cigarettes. The AAFP’s Quit Smoking Guide offers steps, techniques, and medicines to help patients quit smoking. Encourage patients to use the evidenced-based measures outlined in the guide located here: www.aafp.org/dam/AAFP/documents/patient_care/tobacco/stop-smoking-guide.pdf.


References

1.    Public Health Law Center at Mitchell Hamline School of Law. Public health concerns about youth & young adult use of JUUL. www.publichealthlawcenter.org/blogs/2018-02-19/public-health-concerns-about-youth-young-adult-use-juul(www.publichealthlawcenter.org). Accessed June 25, 2018.

2.    Belluz J. Juul, the vape device teens are getting hooked on, explained. www.vox.com/science-and-health/2018/5/1/17286638/juul-vaping-e-cigarette(www.vox.com). Accessed June 25, 2018.

3.    Ambrose BK, Day HR, Rostron B, et al. Flavored tobacco product use among US youth aged 12-17 years, 2013-2014. JAMA. 2015;314(17):1871-1873.

4.   Feirman SP, Lock D, Cohen JE, Holtgrave DR, Li T. Flavored tobacco products in the United States: a systematic review assessing use and attitudes. Nicotine Tob Res. 2016;18(5):739-740.

5.  The National Academies of Sciences, Engineering, and Medicine. Public health consequences of e-cigarettes. Consensus study report. Highlights. www.nap.edu/resource/24952/012318ecigaretteHighlights.pdf(www.nap.edu). Accessed June 25, 2018.

6.   Qasim H, Karim ZA, Rivera JO, Khasawneh FT, Alshbool FZ. Impact of electronic cigarettes on the cardiovascular system. J Am Heart Assoc. 2017;6(9).

7.   Glantz SA, Bareham DW. Annual review of public health. E-cigarettes: use, effects on smoking, risks, and policy implications. www.annualreviews.org/doi/pdf/10.1146/annurev-publhealth-040617-013757(www.annualreviews.org). Accessed June 25, 2018.