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Juul – electronic cigarettes particularly attractive to the youth

Sharp increase in tobacco use among high school students caused a great concern in the United States threatening to erase decades of progress in tobacco control. For this increase in tobacco use electronic cigarettes (e-cigarettes) vaping has been blamed, particularly Juul, a commercial product that is mostly sold in the US.

Recently published report by the Center for Disease Control and Prevention found that in 2018 27.1% of high school student (4.4 million) and 7.2% middle school students (840,000) used some tobacco product. E-cigarettes and particularly Juul has been the mostly used product by 21% of high school (3.05 millions) and 4.9% of middle school students (570,000). No significant difference has been observed between boys and girls. Over the course of a year vaping Juul has increased for 77.8% among high school students, and 48% among middles school students. Therefore, in 2018, 1,5 million more middle school and high school students vaped than in 2017, all together 3,6 million.

What is of special concern is that about 40% of high school students use two or more tobacco products, a 23% increase, which indicates a fast development of nicotine dependence. All these facts are very unfavorable and indicate possible serious consequences of nicotine dependence in future generations.

As it is already stated, Juul is an electronic cigarette, battery-powered device that can deliver nicotine to the user in the form of an aerosol (vapor is an aerosol). Besides nicotine, e-cigarettes contain different flavors, such as fruit medley, mango, cool cucumber or mint. Flavoring makes them more attractive to youth who also think that they are less hazardous.  Apart from nicotine, aerosol contains propylene glycol, glycerol, aldehydes, solvents, polycyclic aromatic hydrocarbons, metals, tobacco-specific nitrosamines, silica particles, dicarbonyls, acetol, etc. Some of them are toxic and health hazards. What significantly contributes to Juul’s attractiveness is its shape in the form of USB flash drive.

Due to the addiction to nicotine from e-cigarettes young people are more likely to go on to use regular cigarettes. It is also known that nicotine harm the brain development until the age of 25. Juul contains high concentrations of nicotine, and according to the manufacturers a single Juul pod contains the same concentration of nicotine as a pack of 20 cigarettes. There is also secondhand and thirdhand exposure to e-cigarette aerosol.

Many professional associations made their statements and warnings regarding increased use, even epidemic, of e-cigarette use, such as American Academy of Pediatrics.  They specified all facts on e-cigarettes and preventive measures that should be undertaken to reduce their use among youth. They specifically emphases the weak control of their manufacturing and sale. A research in Australia showed that more than 50% of all samples of e-cigarettes contained nicotine although purchased as nicotine-free products.

In Serbia in 2017 10.7% adult persons used e-cigarettes at least once, and double percentage of youth 13-15 years of age – 21.6%.  Electronic cigarettes are poorly regulated in the country, except that the Law on Advertising states that advertising is forbidden in same way as other tobacco products. Unfortunately, this emerging problem has not been addressed by the stakeholders.