By Jack Rusley, MD, MHS

Imagine a high school classroom, where a teacher looks away from her students for a moment, and several reach into their sweatshirts, backpacks, or hoods, inhaling and exhaling a puff of vapor that the teacher cannot smell. This scene is playing out each day in schools across the United States, as youth use of electronic cigarettes like JUUL and other brands has exploded.

Because electronic cigarettes — or “e-cigs”—deliver the highly addictive drug, nicotine, young people who use these devices can find it difficult to quit. A growing number of studies show concerning links between e-cigs and cancer, as well as e-cigs leading to use of traditional cigarettes.

A 2017 University of Pittsburgh study found young adult e-cig users were four times more likely to begin smoking traditional cigarettes within 18 months than their peers who did not use e-cigs. After the historic drop in teen cigarette use during the past 20 years, the threat of a new generation of youth becoming addicted to nicotine and transitioning to traditional cigarettes is concerning.

Most e-cig users think the vape “juice” they use in their device contains water and flavoring, when in fact nicotine and cancer-causing chemicals are in most of these liquids. Unfortunately, these products are not regulated like medications, so teens can buy e-cig products from websites or vape shops, influenced by a tidal wave of marketing which sends messages that vaping is safe, fun, and cool.

The Massachusetts House of Representatives on May 9 passed a bill to raise the age to buy tobacco and vaping products from 18 to 21 statewide, as well as setting other limits. The bill must now be considered by the Senate.

Flavored e-cig products — think mint, mango, and crème brulee — are very appealing to young people. According to the Centers for Disease Control and Prevention, eight out of 10 teens and nine out of 10 young adults who use e-cigs report using flavored products.

Most e-cig advocates and companies agree with medical and public health officials — including the American Academy of Pediatrics, the Society of Adolescent Health and Medicine, the CDC, and the Surgeon General — that e-cigs are not intended for youth and shouldn’t be used by them.

The most recent e-cig product to gain popularity among teens is called JUUL. It does not fit the image of a typical vape pen or device – it’s long and flat, like a flash drive. The ingredients are activated by a heating element with a battery that is charged through a computer’s USB port.

Like other e-cigs, JUUL cartridges contain nicotine and chemicals known to cause cancer, and youth-friendly flavors, but what sets JUUL apart is its low profile and high addiction potential. The JUUL is easy to conceal with its USB-like appearance and minimal, quickly dissipated vapor. Teachers and school administrators have struggled to keep up with the increased use of JUUL in schools nationwide.

The “juice” in a single JUUL cartridge contains 5 percent nicotine, which is equivalent to one pack of cigarettes. Most vape juices contain much less nicotine than a JUUL pod, and users can adjust the nicotine content, unlike the fixed concentration in JUUL.

What Parents Can Do

If you suspect your child is using e-cigs including JUUL, talk with them about your concerns. Important points to keep in mind about this conversation include:

Educate yourself about the facts, using reliable sources of information, such as the CDC and Surgeon General. Your pediatrician can also help provide this information.

Do your best not to criticize or judge, and instead focus on your commitment to helping your teen be healthy and happy.

Ask lots of questions and then listen. If you are talking more than your teen, it is a lecture, not a conversation.

Work toward becoming tobacco-free yourself, which sets a strong positive example.

Reach out for help. Work with your pediatrician, or other positive adults in your child’s life, like coaches, teachers, faith leaders, or family members.

For more about teens and vaping, including a tip sheet for parents, visit the U.S. Surgeon General’s website on the topic: https://e-cigarettes.surgeongeneral.gov.

Jack Rusley, MD, MHS, is a board-certified adolescent medicine specialist and adolescent health researcher. He provides primary care and specialty care to adolescents and young adults ages 12 to 26 at the Adolescent Healthcare Center at Hasbro Children’s Hospital.