This week, the United States effectively banned Juul after the Food and Drug Administration ordered the e-cigarette maker to pull its popular products from the market.
Experts hailed this decision as significant. But they also worry that these efforts will fail to keep pace with a rapidly changing vaping industry – one where young people are rapidly switching from one product to another.
The FDA ban ends years of controversy for Juul, whose stealthy vapes have been blamed for helping hook a whole new generation to nicotine. In 2020, the FDA ordered mint and juice flavored e-cigarette pods, hitting many of Juul’s products. This week’s escalation came because regulators said Juul failed to provide sufficient evidence to assess the toxicity and dangers of their tobacco-menthol flavored e-cigarettes, leaving the FDA unable “to assess the potential toxicological risks associated with the use of Juul products”.
Juul, meanwhile, argued that his vapes help regular smokers quit and said he would fight back. On Friday, an appeals court temporarily suspended the ban while Juul appeals.
The ban is still momentous, says Lauren Czaplicki, a researcher at the Johns Hopkins Bloomberg School of Public Health, because it’s one of the first marketing pushbacks for a brand with a substantial market share in the United States and for a product. flavored with menthol. She points out that other brands like Vuse, Logic, and NJOY have received marketing authorization for various tobacco-flavored e-cigarette products and systems, but Juul has been denied.
Research shows banning flavored cigarettes makes a difference – a 2020 study from George Mason University analyzed a 2009 FDA ban on flavored cigarettes and found it reduced smoking among underage youth by 43% and young adults 27%.
“It’s likely that the FDA’s marketing denial will have an impact,” Czaplicki says. “Juul is still a popular product among young people who use e-cigarettes, and Juul has a certain level of brand recognition and cultural cachet among young people who may be sensitive to nicotine use.”
But while Juul still has a dominant share of the US market, its popularity among young people has declined in recent years, says Dr. Devika Rao, a pediatric pulmonologist at UT Southwestern. A recent federal survey found Juul to be only the fourth most popular product among middle and high school students: the Puff Bar disposable e-cigarette bar came in first, with Vuse and Smok the second and third most popular.
“We know from the data that Juul is not the most commonly used,” Rao says. “Today’s teens favor disposable vapes, devices that can be purchased online or in stores.” They cost as little as $10 each for a single-use device and don’t fall under the 2020 flavor ban, even though they use the same technology as Juul.
Teens often jump from one product to another, creating a whac-a-mole prevention strategy, says Stanford researcher Monica M Zorilla. When the FDA prioritized enforcement of flavored e-cigarette devices like Juul in 2020, it exempted disposable e-cigarettes and menthol-flavored e-cigarette products, Zorilla says. A Stanford study found that teens then switched to exempt e-cigarettes. “Young people have gone from pod [like Juul] to disposable products like Puff Bar,” says Zorilla. “As one young person told me, ‘anything with fruit’ is popular among their peers. This was partly due to law enforcement and partly because disposables continued to come in many flavors.
Rao points out that social media marketing is clever enough — and insidious — to get teens to switch vaping products before adults even notice. She points out that the new trend is so-called wellness vapes that aren’t even marketed as e-cigarettes. “You can vape things like melatonin or vitamins to feel better and fall asleep faster,” she says. These are really vaping devices in disguise, and companies aren’t required to list the strength or what’s in these products. “New products present a whole new level of risk.”
More action is needed, says Czaplicki. She says the FDA should immediately issue an order to remove all vaping products that are sold without marketing authorization from retail shelves and online. This would include Puff Bar. “Reducing the number and type of flavored e-cigarette devices on sale in the United States will likely have a substantial impact on reducing youth vaping,” she says. “At the same time, tobacco-flavored e-cigarettes are unlikely to reduce the utility of helping adult smokers quit smoking altogether.”
Vaping is exposing a new generation to nicotine addiction, Rao says — and researchers are still trying to figure out how to treat nicotine addiction in children rather than adults.
These products are often perceived as less harmful than smoking, but they still carry a risk because adolescents are programmed to become dependent on substances. Rao, who cares for patients at Dallas Children’s Medical Center, says Juul figured out how to make nicotine more potent to deliver a more powerful hit to the brain – allowing for greater enjoyment from vaping.
“It may only take a few puffs of a vape before they become addicted, and it affects things like school performance, athletic performance, and can lead to serious consequences like lung damage,” Rao says. Studies also show that vaping causes an increase in heart rate and blood pressure.
She says vaping rates fell for two years during the pandemic, but doctors now fear that restoring social media and easing restrictions means those rates could rise again.
“When I talk to my patients, they’re either vaping or all of their friends are vaping and they may feel pressure to start using these products,” Rao says. “Parents and educators need to have these conversations about the harm they may be having.”