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The stealthy reinvention of youth nicotine addiction by Juul proves hard to combat

By

Editor’s Note: Chris’ is referred to by his first name only due to fear of potential retaliation. Sam is a pseudonym for a student who requested anonymity, citing social stigma and potential retaliation. 

Chris ’20 started “hitting” a close friend’s Juul two years ago. By the time his friend left to study abroad six months later, Chris realized he’d become addicted to nicotine. So he bought a pack of cigarettes.

Juul argues that its products are smoking-cessation devices intended to help adult cigarette smokers switch to a less harmful form of tobacco. The company has recently faced pushback from the Food and Drug Administration (FDA) for some of its advertising claims. In the wake of reports that hundreds of people have been hospitalized with vaping-related lung diseases — mostly linked to products containing THC made by various e-cigarette companies — Juul has also faced increasing opposition from public health officials and lawmakers.

San Francisco is banning e-cigarette sales entirely this year, following the defeat of Proposition C, a ballot measure that would have restricted sales rather than impose an outright ban, in the November 2019 city elections. The city is taking the lead in what seems to be a nationwide legislative shift aimed at reducing youth vaping. The FDA recently announced a partial ban on flavored vape products, and this week California legislators introduced a bill that would prohibit flavored tobacco sales throughout the state.

On Oct. 1, Juul withdrew its support for Proposition C, a sudden change in the company’s stance that came as a surprise to many. Juul had fought back hard against San Francisco legislation passed in June 2019 to suspend e-cigarette sales within the city until the devices go through FDA review. The company spent almost $12 million from June to October 2019 on a campaign to overturn San Francisco’s e-cigarette ban in favor of a policy to restrict sales. Some of the money funded advertisements that read, “Protect adult freedom of choice.”

“I don’t think anything short of California banning vape products would stop young people from smoking,” said Sam, another Stanford senior who Juuls.

Preventing vaping

Ralph Castro, associate dean of students and director of the Office of Alcohol Policy and Education (OAPE), said students are not allowed to Juul in dorms. 

“RAs educate and enforce this policy in the dorms and other students set residential norms to discourage smoking indoors,” Castro wrote in an email, adding, “We have been tracking nicotine and marijuana use over the past few years. This past year we saw a spike in vaping of nicotine.”

Even so, that spike could be underreported. Vaping in dorm rooms generally does not set off smoke detectors, several students interviewed by The Daily said.

“During staff training, we shared that the recommendation is for people to stop using e-cigarettes,” Castro wrote. Castro said that OAPE continues to post updated information on the developing lung illness on its website to address the increasing number of students who vape.

Drugstores have also struggled to combat what many see as a vaping crisis. CVS removed tobacco products from all of its stores in September 2014 in an effort to create a “smoke-free generation.” Their campaign began the year before vape pens reached the hands of “Gen Z.”

“We don’t get many people coming in asking for cigarettes anymore,” said Brayan Garcia, store manager of the CVS in the Town and Country Village shopping center in Palo Alto. “It’s pretty well-known that we cut off selling tobacco.” CVS has never sold vape products, either.

But Juul pods are widely available at gas stations, smoke shops and on the Internet. Two of the students interviewed by The Daily said they typically buy pods at the gas station, the most convenient place to purchase them locally.

Juul is strict about its age requirements for online sales — customers must upload an ID and wait for the company to verify that they are at least 21 before making a purchase. Gas stations and other retailers also check IDs, but older students often buy pods for those under 21, Chris said.

Juul’s rise

What would become a nationwide controversy began in part with Stanford product design grads Adam Bowen MS ’05 and James Monsees MFA ’06, who founded Juul Labs, Inc. in 2015. Their e-cigarettes quickly gained popularity — especially among young people. From 2017 to 2018, e-cigarette use rose by 78% and overall tobacco use by 27% among high school students, according to the 2018 National Youth Tobacco Survey. Juul controls over 70% of the U.S. e-cigarette market.

“Rather than reinvent the wheel, they followed the template that was successfully used by the tobacco industry to advertise their products,” said Dr. Robert Jackler, the principal investigator at Stanford Research Into the Impact of Tobacco Advertising. 

That template included appealing to the young. Advertisements for 2015 Juul launch parties feature smiling 20-somethings in trendy clothes — an updated version of the glamorized 1950s illustrations that showed wasp-waisted, red-lipped young women puffing Lucky Strikes.

People ages 12 to 19 are most likely to start smoking, Jackler said. It makes financial sense for tobacco companies to target teens.

Juul created a product that is more discreet than traditional cigarettes, yet just as addictive. One 5%-strength Juul pod contains the same amount of nicotine as a pack of cigarettes, according to the company.

Cigarette smoking is “a more inconvenient habit” than vaping, Chris said. He bought his own Juul after a few months of smoking cigarettes because of the oft-cited downsides of the habit — the smell, the stained teeth and the social stigma.

“I was trying to be a good example,” he said. He worked as a frosh dorm resident assistant at the time, and the Juul made it easier to smoke in his room — or in his fraternity house, away from frosh and residents.

E-cigarette critics often cite vaping’s popularity among young people, and Juul has struggled to adequately address their concerns.

“We can aggressively tackle the largest causes of youth access — lax or ineffective ID verification and legal-age customers reselling products to underage peers — which [sic] recognizing the nearly 100,000 adult smokers in San Francisco deserve access to alternatives” to conventional cigarettes, Juul spokesman Ted Kwong wrote in a statement to the San Francisco Chronicle in August 2019, when Juul still supported Proposition C.

Among other changes, Proposition C, the defeated measure, proposed to limit the number of e-cigarette products a person can buy to two devices and 20 pods per transaction in stores, and two devices and 86 pods per month online.

Juul changed its tune in the fall.

“I am committed to seeing that JUUL engages productively with all stakeholders, including regulators, policymakers and our customers,” K.C. Crosthwaite, Juul’s new CEO, wrote in a statement on the company website after Juul withdrew financial support for Proposition C.

As more San Francisco voters and policymakers across the country have moved in favor of restricting vape sales, Juul has had to follow suit.

Contact Jasmine Kerber at jkerber ‘at’ stanford.edu.