Q&A: What Juul settlement means to future of teen vaping epidemic
On Tuesday, electronic cigarette maker Juul Labs agreed to pay nearly $440 million to settle claims that it marketed its products to teens, contributing to an epidemic of teen vaping use in recent years.
Dr. Laura Crotty Alexander, a researcher at the University of California San Diego School of Medicine joined Midday Edition Tuesday to talk about the settlement, and what the research says about the impact vaping has on young people. The interview below has been lightly edited for clarity.
So what was your reaction to the settlement that was announced yesterday?
Crotty Alexander: I was very surprised and in a positive way, really glad that Juul is being held accountable for its practices from years ago, where it aggressively tried to engage adolescents, teenagers (and) youth in its nicotine containing products.
You co-authored a study earlier this year about e-cigarette use, focusing on Juul products. What did your research find?
Crotty Alexander: Surprisingly, my research team found that mice that inhaled different types of aerosols produced from the Juul devices developed a lot of different changes across their body. Particularly, they developed inflammation in their brain in the areas where we control our mood and our emotions, and even memory. And beyond that, we actually found changes in the immune state and inflammation in the GI tract and the lungs.
Even the flavor of the cartridge had an impact on health, didn't it?
Crotty Alexander: That's absolutely right. I think a lot of people don't understand that all these different flavors, that not only do they act to appeal to people to get them hooked on the e-cigarettes, such as a kid picking up a strawberry mint e-cigarette because it sounds and looks really cool. But that inhaling the chemicals that have been added to those e-cigarettes to create those flavors can actually directly impact their health.
How widespread is teen vaping today?
Crotty Alexander: It's actually better than it was pre-COVID-19 pandemic. We were really in a terrible place in 2019 — where in California in some places 50% of high schoolers were vaping and 25% of middle schoolers were vaping. And it has decreased over the last couple of years. One reason for that might be that with all the shutdowns of schools, there was less exposure across peers and less availability of getting these devices from peers. Another thought is that with the e-cigarette or vaping associated lung injury, also called EVALI, epidemic of 2019, where we had over 80 deaths and thousands of people affected, that young people became aware of some of the risks associated with vaping.
Do you think this settlement will help to further decrease the number of teens vaping?
Crotty Alexander: I hope so, because I think it again shines a light on the fact that this company intentionally worked to engage youth and get them hooked on these devices. And I think getting that word out there is important for parents and teachers and society in general to understand that nobody wants to target our kids in this way. I'm hopeful that it helps us that way. The second thing that I think it will help is that a lot of cities and states are working to ban flavors. And one of the main reasons that we want these flavors banned is because of their appeal to our young population.
Can you explain what's in these products? Do they actually contain nicotine, or is the harm caused by these products from something else entirely?
Crotty Alexander: All e-cigarettes contain a couple of base chemicals such as propylene glycol and glycerin. They contain these chemicals because it's the only way to get nicotine into solution so that these e-cigarettes can heat that solution and pull it through a mesh to create this aerosol. A lot of people don't understand that it's not like water vapor that contains nicotine. It's a chemical composition with nicotine added. And that most modern e-cigarettes, of which Juul is one, they have been designed specifically to contain very high levels of nicotine. So, for instance, one Juul is the equivalent of an entire pack of cigarettes worth of nicotine. And another popular e-cigarette on the market called the Flum, actually contains the equivalent of 13 packs of cigarettes worth of nicotine. So that's another thing that policymakers are working towards, is to have our government set limitations on the amount of nicotine that's allowed in these e-cigarettes.
In a statement yesterday, Juul said they are focused on helping to "transition adult smokers away from cigarettes." Is there evidence that e-cigarettes can help smokers quit? What does the research say about that?
Crotty Alexander: The early generations of e-cigarettes really did not help smokers quit tobacco. And, in fact, a lot of people ended up being dual users, meaning that they continued to smoke cigarettes, but they also vaped e-cigarettes. So, they potentially could have the worst of both worlds of the health effects of both types of inhalers. However, the newer generation of e-cigarettes, of which Juul is one, the studies that have come out so far suggest that they might work a lot better at helping people quit conventional tobacco, but it's not convincing yet that they are actually able to help people quit the nicotine addiction.
What do you want families and teens to understand about vaping that they may not be fully aware of?
Crotty Alexander: I mainly want them to understand that use of an e-cigarette can very rapidly lead to a nicotine addiction that is incredibly hard to break. I think all of us know that people who started smoking cigarettes decades ago that have struggled to quit, and some people just never can quit because nicotine is so incredibly addictive. It's one of the top three addictive substances of all time. And with the high concentration of nicotine in these e-cigarettes such as the Flum and Puff Bar and Juul, for kids and young adults whose brains are still developing until their mid-20s. It is easier for them to become addicted with even just one use or two uses, or three uses. And that becoming addicted at that age fundamentally alters your brain so that for the rest of your life, your responses to other substances will be completely different.