Over the past decade use of e-cigarettes, known as “vaping,” has increased, with 3.2 percent of American adults using such products in 2016, according to the Centers for Disease Control and Prevention. E-cigarettes are electronic devices that simulate cigarette smoking by releasing nicotine, the active component in tobacco, via a vaporizer that users inhale. The devices have been marketed as a “healthier” alternative to tobacco products, and as a way to help smokers quit the habit.
The proliferation of e-cigarettes has sparked controversy as they’ve become increasingly popular with youth, despite a U.S. Food and Drug Administration ban on sales to those under 18. The CDC reported that young people are more likely to vape than adults; in 2016 more than two million middle and high school students had used an e-cigarette in the past 30 days. Among consumers aged 18 to 24, 40 percent weren’t regular cigarette smokers.
In April, the FDA issued a Youth Tobacco and Prevention Plan that focuses on curbing childhood access to e-cigarettes, especially those made by JUUL Labs. The FDA sent warning letters to 40 retailers related to sales of JUUL products to minors in the wake of an undercover operation that’s still underway. The FDA also requested that by this month JUUL provide details of its marketing practices to enable it to better understand the device’s appeal to youngsters.
“JUUL products may have features that make them more appealing to kids and easier to use, thus causing increased initiation and/or use among youth,” an FDA letter to JUUL stated. “Similar to other electronic nicotine delivery system products, JUUL product use during adolescence may lead to cigarette smoking or use of other tobacco products in the future. Their appeal may be related to different aspects of the product, including the product design, promotion, or distribution, and CTP [Center for Tobacco Products] seeks information to further understand the appeal and use.”
A number of companies produce mass market e-cigarette devices. However, JUUL Labs is a top selling brand, reaching 60.1 percent market share in April, up from 35.7 percent last year. JUUL’s products became available for retail purchase in 2015; they stand out from other devices because they more closely resemble a tech gadget, such as a USB flash drive, than a vaporizer or cigarette. A JUUL “starter kit” costs $49.99.
“JUUL is a very discrete form of vaping,” said John Borg, who has lived or worked in Dogpatch for almost 30 years. “It’s high tech and cool, which specifically targets kids and has been wildly successful. JUULing has become a verb. They’ve been successful at marketing to both kids and adults. It’s a nefarious product that’s attractive to kids who wouldn’t smoke cigarettes because it’s cool, techy and easy to hide.”
Borg is a parent of two teenagers who attend schools in Marin County, where campuses are grappling with a surge in vaping by students. He knew about the extent of the problem because of his close relationship with his kids and their friends; when he picks them up from school it’s common to see students JUULing outside and in their cars. Marin public schools have established strict policies on vaping as a result of rampant underage usage, particular in bathrooms; one reportedly displays a large bowl of confiscated JUULs in its front office.
Borg is concerned about vaping given that University of California, San Francisco research links e-cigarette smoking to exposure to carcinogenic chemicals. He was especially dismayed when he learned that JUUL Labs occupies newly renovated space for its corporate office at 560 20th Street in Pier 70.
“After three decades worth of public process to get renovations done, we knew tech companies would come in, but it’s a bit of a disappointment that JUUL is there,” said Borg.
Orton Development, developer of Historic Pier 70, leases two buildings to Restoration Hardware and Tea Living Inc, which has a clothing company, Tea Collection. According to an Orton Development spokesperson, JUUL is a subtenant of Tea Living.
Another UCSF study found that daily vaping doubles the risk of heart attacks. The Endocrine Society published a paper in ScienceDaily suggesting that e-cigarette use could increase the danger of developing non-alcohol fatty liver disease.
“Teenagers need to be warned that the vapor produced by e-cigarettes is not harmless water vapor, but actually contains some of the same toxic chemicals found in smoke from traditional cigarettes,” said Mark L. Rubinstein, MD, a UCSF professor of pediatrics. “Teenagers should be inhaling air, not products with toxins in them.”
The JUUL e-cigarette was originally developed by PAX Labs. JUUL Labs emerged as its own company last year. A 2015 TechCrunch profile of PAX Labs and the newly created JUUL e-cigarette reported that though many tobacco smokers had used a vaporizer, few got hooked. In contrast, JUUL’s e-cigarette has performed better in the market in part because of the associated nicotine “juice” developed through a patented salt separation process.
“By extracting and using those salts, Pax is able to create an experience that is more like smoking than other e-cigarettes on the market,” wrote TechCrunch reporter Ryan Lawler. “That includes offering up to two times the nicotine strength and three times the vapor quality of competing products.”
JUUL e-cigarette products have trendy features, such as devices that’re equipped with a USB charger, with interesting flavors available, including Virginia Tobacco, Cool Mint, Fruit Medley and Creme Brûlée.
JUUL products’ popularity with youth prompted Tamalpais High School principal, J.C. Farr, III, to send a letter to parents warning them about the potential cancer risks, high nicotine levels and clandestine delivery system. He included statistics compiled prior to JUUL’s entering the market by the California Healthy Kids Survey that showed 25 percent of ninth graders in Marin County and 39 percent of eleventh graders had vaped.
Sir Francis Drake High School alerted students’ parents to recent rises in incidents involving vaping in school bathrooms and around campus. Lavatories are now patrolled multiple times an hour during the school day.
In 2014, the San Francisco Unified School District updated its tobacco products prohibition policy to include e-cigarettes. As part of SFUSD’s Tobacco Prevention Education and Intervention program, tobacco and e-cigarette prevention education is required in each grade starting in kindergarten. Schools also cover substance use issues, including vaping, in health classes, train peer educators, offer quit groups and hold annual anti-tobacco/anti-vaping public service announcement contests, with a $300 prize. Citations are issued for policy violations on campus.
Results from a Youth Risk Behavior Survey show that both tobacco and e-cigarette use declined among SFUSD students between 2015 and 2017. The percentage of students who smoked cigarettes on school property was 1.9 percent in 2017, down from 4.3 percent in 2015. The fraction of students employing a vaporizing device was 13.3 percent in 2015 and fell to a still high 7.1 percent in 2017.
JUUL Labs maintains that its products are for adult use only and are designed to help existing tobacco smokers quit. In response to the FDA probe, JUUL announced a strategy to combat underage use and raise the legal minimum purchase age to 21. The minimum age to purchase directly from JUUL’s website is 21.
“Our company’s mission is to eliminate cigarettes and help the more than one billion smokers worldwide switch to a better alternative,” said JUUL Labs Chief Executive Officer Kevin Burns. “We are already seeing success in our efforts to enable adult smokers to transition away from cigarettes and believe our products have the potential over the long-term to contribute meaningfully to public health in the U.S. and around the world. At the same time, we are committed to deterring young people, as well as adults who do not currently smoke, from using our products. We cannot be more emphatic on this point: no young person or non-nicotine user should ever try JUUL.”