Last year, Stanford developmental psychologist Bonnie Halpern-Felsher, PhD, who studies how adolescents make health-related decisions, received a piece of research advice from someone with firsthand knowledge of teenagers' behavior.
Her daughter Karin Felsher, then 17, tipped off Halpern-Felsher about a vaping device called Juul that she was seeing many of her high school classmates use. Karin thought her mom should incorporate questions about Juul into her research on teenagers' tobacco and e-cigarette use.
'I was surprised and concerned that so many youths were using Juul more frequently than other products,' said [Halpern-Felsher.] 'We need to help them understand the risks of addiction. This is not a combustible cigarette, but it still contains an enormous amount of nicotine -- at least as much as a pack of cigarettes.'
The data show a worrisome disconnect between teens' perceptions of their Juul use and actual addiction, the researchers said. 'We ask, 'Do you feel addicted?' And they say no, but a series of questions on a validated scale for assessing loss of autonomy over nicotine show that they're dependent,' said the study's lead author, Karma McKelvey, PhD, a postdoctoral scholar.
The researchers surveyed 445 California teens and young adults. Although the study participants believed that Juul e-cigarettes were less harmful than conventional cigarettes or other types of e-cigarettes, those who had tried Juuls were almost twice as likely to report recent use of the product as those who tried other nicotine-containing products.
Better public education about the potential risks of Juul is needed, Halpern-Felsher said. She has developed a free online toolkit to educate young people and their parents and teachers about the risks. She also wrote a commentary, publishing today in the Journal of Adolescent Health, about the problems with a curriculum developed by Juul, which does not follow best practices in health education.
Finally, in a study published online in late August in Addictive Behaviors, the researchers examined teens' views of e-cigarette advertising. The U.S. Food and Drug Administration has recently stepped up enforcement actions against Juul for allegedly marketing the product to minors. Although the company denies targeting its advertising to young people, Halpern-Felsher's team found that most of the 255 teens included in her study believed that ads for flavored, nicotine-containing liquids used in e-cigarettes were intended for their age group.
"Teens are very attracted to the flavors and to the gadgets Juul has," Halpern-Felsher told me. (Juul's devices are small and colorful, resembling USB sticks.) Although the company promotes itself as an aid to help adult smokers switch away from using combustible cigarettes, Halpern-Felsher worries that something quite different is happening among young people. "We think we're seeing initiation of e-cigarette and particularly Juul use among youths who would probably never have smoked a cigarette," she told me.
Photo by Itay Kabalo