Medically reviewed by Andy Tan, MPH, PhD
JUUL is a brand of electronic cigarette, or e-cigarette, that enables users to inhale vapor infused with nicotine, flavorings, and other compounds. Introduced in 2015, JUULs work much as other e-cigarettes do, but because they’re small and sleek — resembling a USB flash drive — and come in a variety of flavors, critics have charged that they’ve been specifically targeted to young people.
Research by the Centers for Disease Control and Prevention shows them to be the most popular brand of e-cigarette on the market.
Because they deliver a hit of nicotine — an addictive drug that provides a pleasurable sensation — without the cancer-causing tar found in tobacco products, JUULs (pronounced “jewels”) have been touted as a safer alternative to smoking. Juul Labs, Inc., the maker of JUULs, defines its mission as “improving the lives of one billion adult smokers by eliminating cigarettes.”
Research shows, however, that not only do most e-cigarette users continue to smoke traditional cigarettes, but that e-cigarette use can actually make young people more likely to take up smoking, according to the American Lung Association.
JUULs consist of a battery-powered vaporizer that connects to a cartridge, or “pod,” filled with liquid containing nicotine salts, flavorings, and other substances such as glycerol, propylene glycol, and benzoic acid. One of the features that distinguishes JUULs from similar products is their small size — easily enclosed in the palm of the hand — compact design, and relatively small plume of vapor. They initially gained notoriety for the high nicotine content in their pods, although other manufacturers have largely caught up, research by investigators at Stanford University has shown.
The cancer risk question
The absence of tar in e-cigarette vapor means it poses far less of a cancer risk than cigarette smoke, but that risk may not be zero. A 2018 study by the National Academies of Science, Engineering, and Medicine reported that most e-cigarette products contain and emit potentially toxic substances, such as formaldehyde and acrolein. While not all brands contain these compounds, and the concentrations tend to be very low, the long-term effect of exposure to them is unclear, according to the National Institute on Drug Abuse.
Most of the concerns surrounding JUULs and other e-cigarettes have to do with the health risks of nicotine itself. Nicotine is not only addictive but also can have harmful effects on the body, research shows. These include:
- An increased risk of blood clots
- Atherosclerosis (hardening of the arteries)
- Peptic ulcers
- Changes in heart rhythm
- Lung spasms
Dentists report that patients who vape may experience more cavities and tooth damage, especially to the enamel. A recent study by researchers at Stanford School of Medicine suggested that the liquids in e-cigarettes could increase a person’s risk of heart disease. And there’s evidence that nicotine can alter the development of the brain in teens and other young people.
To address some of the concerns about use among teens, Juul Labs suspended the sale of most of its flavored pods in retail stores in late 2018 and shut down its Facebook and Instagram accounts. The company has also advocated for raising the minimum legal age for purchasing its products to 21, even as it reportedly has expanded its lobbying operations at the state and federal levels. (Currently, the minimum age for buying e-cigarettes ranges from 18 in some states to 21 in others.)
Federal regulators vow to maintain strict vigilance over e-cigarette use. “We cannot allow the next generation of young people to become addicted to nicotine because of e-cigarettes,” Acting Commissioner of the Food and Drug Administration Norman E. Sharpless, MD, announced in a statement issued in July 2019. “The FDA stands ready to accelerate the review of e-cigarettes and other new tobacco products. And we remain committed to tackling the epidemic of youth vaping using all available regulatory tools at our disposal.”
In September 2019, Massachusetts governor Charlie Baker ordered a four-month ban on the sale of all vaping products.
Tips for quitting
While e-cigarettes are of dubious value in helping people quit smoking, other techniques may prove helpful. These include:
- Pharmacotherapy such as nicotine patches, lozenges, gums, and sprays that allow the bloodstream to gradually absorb small amount of nicotine to reduce craving. Some prescription medicines may also be helpful.
- Behavioral counseling about how to avoid triggers and deal with situations that may prompt one to smoke.
- A combination of pharmacotherapy and behavioral techniques has been shown to be especially effective.