Bonnie Halpern-Felsher, PhD, Professor of Pediatrics at Stanford University School of Medicine talks about juuls and their impact on the youth that use them.
Interview conducted by Ivanhoe Broadcast News in November 2018.
What is juul and why is it so dangerous?
Halpern-Felsher: Juuls are the latest vaping device for inhaling nicotine and tobacco. It’s what’s considered to be a pod-based form of nicotine use, pod-based form of a vapor and electronic cigarettes. It’s dangerous for a number of reasons. First of all, it’s got an incredibly large amount of nicotine compared to other vaping products. So while other vaping products range from around 0 to 36 milligrams of nicotine per package, per volume, this has about 41, 42 milligrams of nicotine per pod. So that’s equivalent to one to two packs of cigarettes within that pod. So that’s an incredibly high amount of nicotine that a young person can use. Or anybody’s using. It’s also a problem because flavors by themselves – and juul does come in a number of different flavors, there are a lot of studies showing that when you heat up a flavor – like butter or cinnamon, cinnamon aldehyde, that when you heat these up, while they may be fine if you just eat them and ingest them (that is considered GRAS — generally recognized as safe for eating by the federal government), they are not made to be heated and inhaled. And when you do heat these flavorings and inhale them, you’re more likely to get lung problems.
So would it be a greater risk than cigarettes?
Halpern-Felsher: It’s hard to compare the two products. Currently, cigarettes do not have flavors in them, with the exception of mint. So in terms of the comparison of flavors, it’s not really a comparison that we can make because of the fact that cigarettes don’t have the flavor and the vaping products do. As far as whether electronic cigarettes or juuls are more or less harmful compared to cigarettes, probably ounce for ounce, cigarettes are going to be less harmful. The problem is when you’re talking about for new users – particularly youth who probably were never going to pick up a cigarette in the first place – then there’s really not a comparison between vapes or juuls and cigarettes. The comparison is really between juuls and them not using anything in the first place. And we know that many youth started using a tobacco product through some form of electronic cigarettes, whether it’s juul or another another e-cigarette.
Tell me about the study.
Halpern-Felsher: We’ve done a number of different studies looking at vapes over the last couple of years. Most recently, in October we published a study in JAMA Network Online, looking at adolescents’ and young adults’ use of juuls and the flavors that they’re using and then the addictive potential of those products. And what we showed is that about 15 percent of the participants in our study were using juuls – of adolescents and young adults – between the ages of 17 and 22 – were using juuls. And amongst those who were using juuls, they were using it more often, both more often per day and more often per week, than were youth who were using other forms of electronic cigarettes, as well as cigarettes. Amongst those who were using juuls, they were using it more often than those who were using other forms of vaping products or cigarettes. So more specifically, we found that they were using it more often in a day and more often in a week. We also found that adolescents and young adults who were using juuls reported being more addicted compared to those who were using other forms of vapes or using cigarettes. And this is based on an objective scale that we have, a ten-point scale called the hooked on nicotine checklist scale. And that is anything above zero. So if you endorse any of the items, like do you use it as soon as you wake up? Do you find that you need it throughout the day? Is it difficult to quit? We found that adolescents and young adults who were using juuls endorsed those items more often than adolescents and young adults who were using other products. The bottom line is adolescents and young adults were showing significant signs of addiction amongst those who were using juuls.
Why is juul the most popular e-cigarette when there’s some that are also flavored and some that are stronger?
Halpern-Felsher: Not necessarily stronger. That’s not true. Phix and Suorin do have more nicotine per pod. But it is one of the highest levels of nicotine of the vaping products that are out there. Why are they so popular? It’s a good question. One of the reasons why they’re popular was that they look like a usb stick and they’re very easy to hide. In the first generation of vaping products or electronic cigarettes, they looked like cigarettes. Most youth weren’t going to use something that looked like cigarettes. Adolescents know that cigarettes are bad. Very few adolescents now are using conventional cigarettes. We, in California, we have the lowest rates, 7,8 percent of youth using cigarettes, lowest across the country than we’ve ever had. That’s good news. So if you give youth a vaping product that looks like a cigarette, they’re not going to use it. The next generation and the next generation of that were cooler. They look more like gadgets. They were more of a box for, or some interesting shape to them. But they were big. And if you look, youth are not going to use those because it’s very hard for them to hide them. Along comes juul. We’ve already had this craze of vapes. We’re already seeing increases, 13 percent across the country, of youth using vapes. Then you bring something in that not only is cool, has the flavors, but it’s also small. It looks a usb. We know in talking to teachers and talking to parents, they didn’t realize what these products were. So kids can very easily palm them, basically using them in palm, go ahead and take a puff, and then hide it – or hide the puff or hide the aerosol that comes out of it, what looks like a plume of smoke, in their sleeve or in their jacket or something like that. So you’ve got the flavors. You’ve got the fact that they’re cool. They’re new. They’re full of gadgets. They have skins. Things that you can slide – like a cover you can slide onto them to make them pretty colors. You can change them by the day. They come in different colors. So they’re cool. They are full of gadgets. So those are all really exciting to young people. That coupled with the fact that they have so much nicotine that within a very small amount of usage, we’re seeing that adolescents are becoming addicted. And then they’re continuing to use them.
Are they the only ones that look like a USB?
Halpern-Felsher: Currently, they are the only product that looks like a usb. There are others that look like teardrops, look like sharpies, sort of a teardrop shape that looks like a highlighter. There are others that are box shape. But this really is very thin, very small and easy to hide.
That makes more sense to me. Juuling – it’s like a verb now.
Halpern-Felsher: It is a verb.
Do you think they really realize what they’re getting themselves into?
Halpern-Felsher: No. In fact, in that same study I was referring to, we actually found that adolescents perceive juuls to be less risky than other forms of vaping products or even cigarettes. And so they’re really not clear about how much nicotine is in there. And they really don’t know anything about the effects that flavors could potentially have on their lungs. So youth are not aware. And part of the problem is this product came on the market a couple of years ago. We really started hearing about it about a year ago. And we were not going out in the public health world and educating young people about it. So by the time we’ve caught up with our public health messages, they’re already using them and addicted.
This boy that we met today, he didn’t really care that it was dangerous. He said, it’s not like a cigarette. Cigarettes are nasty.
Halpern-Felsher: There is this notion in the U.S. and globally about harm reduction. So is one thing less harmful than the other? That statement is showing that he said, well, it’s not cigarettes. It’s not weed. It’s probably healthier. And I want to use something. And I think that we’re perpetuating a mistake right now in our messaging across the country in the U.S. and the FDA is doing this. The FDA keeps saying, well, we understand that we need vapes, Juuls or others, to allow adults to quit smoking. We understand that we need flavors to help adults quit smoking cigarettes. And the problem is, by having that, you’re really giving this persona, this idea that vapes are less harmful than cigarettes. And therefore are ok. And again, with adolescents just like the boy you were talking about, they’re not going to use cigarettes. And really if you ask, well, comparatively, maybe they’re a little bit less harmful. But there is no comparison for somebody who’s a young person. They’re not using cigarettes. So it really is “are juuls or vapes less harmful than air? Than nothing?” Of course not. They’re magnitudes more worrisome. The other thing is when it comes to something like marijuana, marijuana has lots of harms and is concerning to me as well. We’re doing research on that. But doesn’t have nearly the addictive potential that does a juul and nicotine. Nicotine is still much, much more addictive than any other product out there.
We’re talking about the short terms. So the long term, I hear that it can do damage to the developing brain?
Halpern-Felsher: Correct. Well, and the damage to the developing brain is not necessarily long term. That’s going to be short term. So what happens is when you’re an adolescent, up until about age 24, 25, your brain is continuing to develop. And as it’s developing, you are much more likely to become addicted to any product that you add to your brain, any substance. So basically, the analogy I like to use is a freeway system. If you think about it if you have, like, the LA freeway system, very crowded. You’ve got roads going different ways. You’ve got a lot of on ramps and off ramps going on, that it’s very crowded, you can still get from a to b. But it’s a little slower, a little more crowded. During adolescence, we basically prune away or slough away the on ramps and off ramps and the roads that we don’t need. So everything is smooth – is faster and has fewer roads to get through. Plus we go through myelinization. So basically it’s as if we’re adding tar or adding a wrap-around these different freeways or these different neural connections to make things smoother. So that’s great. During adolescence while this brain development is happening, while it’s great. Young people can learn so much more. They can take in information. It’s a great time for them, great time of learning. It also means that anything we introduce actually chemically changes their brain. So you introduce nicotine. We already have nicotinic receptors in our brain. It’s a perfect lock and key. You introduce this nicotine. We already have receptors. The receptors come up and say, I recognize you. I’m made for you. Come on in and sit comfortably in my receptor. And then that’s great, but then once we metabolize out or basically we’re done, you know, the body flushes out that nicotine, these nicotine receptors are still here. This cup is still here. I need more. Stay. So the receptor says I’m still here. I don’t have any nicotine. So now I’m going to go through cravings and withdrawal. And then that happens again. If you wait until you’re in the mid 20s, while you can still have some of the other effects like lung disease, then the nicotine addiction is significantly less likely to happen once your brain development is finished. So that can happen fairly quickly. There are some studies by Defranza for example that suggest that this brain change happens even with one or two cigarettes. I don’t think he’s done the studies on juuls. The longer term effects are the lungs and cardiovascular health. We don’t have a lot of data yet. Juuls are very new. And these studies often take years to really get a true understanding of the health effects. But there are early studies suggesting that like I said the flavorings are causing problems with the lungs, that they’re causing cardiovascular problems. And we don’t know what’s going to happen in the long term. But we also didn’t know about what cigarettes would do for 50 years. So I’m not willing to chance it.
Juul has all these new self-imposed regulations. What do you make of that? You think it’s going to help anything?
Halpern-Felsher: It’s interesting. Juul came out just a few days before the FDA with similar self-imposed regulations. You’re right. And there is concern that they did this to be preemptive, knowing that the FDA was going to come out with similar regulation and that makes them look good. Right now juul is trying very hard to look good. There’s something called corporate social responsibility that they are trying to do. So one of the things is, is that they come out with these self-imposed regulations. They’ve also been coming out with ads saying that they’re only for adults, warning parents about it. But if you actually look at the ads, where they’re saying to parents, make sure your kids aren’t using these products, it’s an advertisement. There’s a huge juul right in the middle of this full-page New York times ad. So they come out with that. They come out with regulations saying that they’re going to do age restrictions. That would be fantastic if it would work. We don’t have good evidence that any online age restrictions work. Currently, you can go on and just say that you are 21 and that you’re willing to be age verified. What does that mean? And what does that look like? So while it may sound good, it’s still pretty suspicious. And this is true with the FDA regulations too – that they’re going to regulate or basically ban these products in convenience stores and drugstores. We published a paper a couple years ago showing pretty clear evidence that adolescents are getting vapes and other products, that they’re getting them in vape shops or smoke shops. And they’re getting them online. And they’re getting them from friends. They’re not getting them from gas stations. And they’re not getting them from convenience stores. So while it may look good, it’s a little bit of window dressing right now.
That’s what I heard today. One of the boys said he bought them at a smoke shop. He was under 18. And the other one, he was 18. But I guess it’s now 21.
Halpern-Felsher: It’s 21.
He said he was getting them from friends.
Halpern-Felsher: Absolutely. I mean, you could buy a 4 pack of pods. You can put them in there. You could share them. They’re very inexpensive if you buy a four pack. And you can share them. So it’s very easy to get somebody who either is 21 or looks 21. And there are plenty of vape shops who are not abiding by the rules. And you could very easily go in and get these for somebody else. Youth are very creative. Youth get alcohol. We’ve had pretty good restrictions for alcohol for a long time. So it may cut down or make it a little bit more inconvenient for a young person to get these products, but if they want them, they can get it pretty easily.
I was reading that said juuls sales have been up in the past year 300 percent. It’s like huge.
Halpern-Felsher: Huge.
Why is it exploding? That’s what I was trying to figure out when this boy was telling me, oh there’s other ones out there. I mean is it just the flash drive concept that’s making it go 300 percent?
Halpern-Felsher: I don’t think we have good evidence on that yet. We’re actually doing studies on that now. But everything’s so new. I think it is partly the flash drive. And I think it’s partly because it’s cool. I think maybe because the addictive potential, there are so many young people there who are addicted and who are telling me – I don’t have publications on this – but in talking to youth, that it’s one or two pods they’re going through in a day. That’s a huge amount. Once you’re addicted, you’re going to keep using it. There are also questions about their social media and their advertisements. So I was reading – I didn’t do the research myself (some was done by my colleague Rob Jackler here are Stanford), but reading that juul probably spent the lowest amount on marketing compared to any other tobacco company. But they’ve done a really good job in getting youth to advertise for them or to get users to advertise for them. So basically, they’ve done social media, which doesn’t cost anything. They have great ads on social media. They have great ads on instagram that come through. And young people are creating memes and creating ads and basically doing the work for them. I recently saw an instagram post – I think it was instagram – of somebody who strung up a bunch of juuls as Christmas lights, put it across. Now is it juul doing that? Or is it truly just some people having a good time and wanting to show off what they’re using? We don’t know. Juul themselves have not done a huge amount of advertising. They’ve done it. But it’s been quieter. It’s been more under the radar. The ads that are out there are cool. They’re neat. They’re fun. They’re pretty. They’re flashy. That’s going to get use attractions as well. But nowadays, you just take a few youth, try something, show a plume of smoke, say it felt really great, it made them feel good. It tasted good. And off it goes and gets retweeted and reposted and whatever it is. So it really self-perpetuates.
There’s also some mixed messages with juul and the founders, juul itself, saying we started juul as a tool to get people off of cigarettes. And it’s for adults.
Halpern-Felsher: It may be that the two people who founded juul, their initial intentions were to help adults quit smoking. If that were really true, that’s great. But there are several problems with that. First of all, pre-juul with the other vaping products, there’s really no good evidence to show that adults who use conventional cigarettes were able to quit using cigarettes by using vapor products. If anything, what we see, sure there are a few people who quit, and you hear those anecdotes. But most adults who were using cigarettes wind up using both products, a cigarette and a vape. So you’re getting more nicotine not less. And actually, the flavor suggests that adults wind up using more nicotine not less. So really to make the argument that also the FDA keeps making, that vapes are important for the adult population, is absolutely wrong. There’s no evidence. Second, if juul’s founders really were trying to get adults to quit then – and not attract youth – then why do you have the flavors? Why do you have a product that can so easily be hidden? And then why do you have such high levels of nicotine and don’t have a step-down program? If you really want to help adults quit, fine. Go ahead and start with the amount of nicotine that’s in a pack or two packs of cigarettes. But then go down to lower and lower amounts of nicotine to help adults taper off of all products. Because really, what you’re doing is creating a dual use of both products or you’re just switching one for the other. Then you get the question of harm reduction. But again, it’s not that these products are harmless. So that’s part of the problem. There is no step down. Now – they did recently do a 3 percent. So right now, it’s 5 percent, which is the forty two milligrams. They recently did come out with a 3 percent, which is closer to about 26 milligrams of nicotine. The problem – milligrams per milliliter. The problem there is they only came out with the 3 percent for tobacco and mint, not for the flavors that youth are most likely to use. Now in our study, actually, we had almost – right around about 28 percent of youth were using mint. So they were using the mint juuls. But most of them were using the fruit flavors. Juul did not come out with a lower percent nicotine for those flavors, for the youth-oriented flavors. Plus if you look at their ads, it’s a young person with a ponytail. They have somebody who looks like Emma from the shootings in Florida. You’ve got look-alikes in their advertisements that are very attractive to young people. So you take these altogether, and it’s just really hard to believe that juuls really truly only want to attract adults and do not want to attract youth.
They have lookalikes?
Halpern-Felsher: I could show you one in the other room. I can show you one last thing I want to say about that. If you also look at the package – and I can show you a package – if you look at the package, the original juul package, it says five percent nicotine. What does that mean? There’s no way. Most adults don’t know what 5 percent nicotine means. And certainly youth don’t know. They don’t realize that that translates into – really translates into fifty nine milligrams per milliliter. Juuls are point seven milliliters, so it’s out – it comes out to about 41, 42 percent. So you look at 5 percent and it looks like it’s a small amount. Oh, great. I’m not using a lot of nicotine in there. They don’t realize what it is. So again, if you’re really going to create something that’s going to help adults quit and not be attractive to youth, then you wouldn’t have mis-leading packaging. Ok, so let’s go on to the tobacco prevention kit.
Can I clarify something before you do? If five percent is the juul, what’s a cigarette? How can you compare?
Halpern-Felsher: A pack of cigarettes is about 40 milligrams, is about the same amount in a pack of cigarettes. But there is some evidence suggesting that really, in terms of functionally, because cigarettes burn down, you’re not actually getting all the nicotine. That’s another important point. Cigarettes, you put it down, it smolders, right? So you’re not constantly using it. In all of the vaping products including juul, it’s only on when you press the button or take a puff. Most of the drops of nicotine are being inhaled. So if you look at a pack of cigarettes and you really take into account the absorption, and you take into account the smoldering, the fact that they’re burning down without being used, each cigarette has roughly one to two milligrams of nicotine in them. There are 20 cigarettes in a pack of cigarettes. That’s about 20 plus milligrams of nicotine that you’re ingesting in a pack of cigarettes. If you use the math on that, then juul really has equivalent to closer to two packs of cigarettes worth of nicotine in them. Did that help?
The tobacco prevention kit.
Halpern-Felsher: The tobacco prevention toolkit is something that our lab developed about two years ago. The explicit goal of the Toolkit is to be given to health educators, health education teachers, p.e. teachers, all educators, parents as well, people who want to talk to young people – particularly middle and high school age youth – to talk to them about not using various tobacco products. And when we started this, we first started this toolkit, we didn’t even have electronic cigarettes. They started about a year or two after the research that we started doing. So we went back to the funders and got additional funding to add electronic cigarettes. So it really is a curriculum, a very extensive curriculum with modules that focus on hookah, smokeless tobacco, cigarettes, the nicotine plant itself. And then now of course an entire section – entire module just focused on electronic cigarettes or vapes. We also have information on nicotine addiction. And then we have lots and lots of resources for parents, for youth, for educators and for health care providers. It was started because at the time and still, now, there really weren’t toolkits or curriculums out there for use in middle and high schools where – that were beyond just PowerPoints and lectures. And there really wasn’t a lot of getting youth up and active and doing activities and quizzes and learning together. So using all the good principles of teaching. So this toolkit has all that. We do have power points that have teacher talking points. So if you’ve got an educator who doesn’t know much about tobacco, they’ve got their cheat sheet there. And we have worksheets. And we have things that you can project to teach. We have animations. We have quizzes. We have games in there. And so lots of lots of things that educators can use to be able to really more innovatively teach young people about these products. The other thing that’s unusual that we have is an entire section on nicotine, including the brain, what nicotine is and the effects of nicotine on the brain and what addiction is. Most curriculums out there don’t really go deep into that. Then a year ago we were already looking at juuls. Thanks to my daughter. She told me about juuls. She was 17 at the time, in high school. And she said, mom, she’s always anti-tobacco, very concerned about it, did some research herself on it with a professor here. And she said, mom, I’m really worried about this new thing. It’s called juuls. Everybody’s juuling. And people are calling the nicotinic nic. And I said are they aware of the levels of nicotine? Yeah I think they are, and they’re doing it on their sleeves the minute the teacher turns around. The other thing by the way that is attractive about these products is they don’t smell like tobacco. So I always tell parents, if you walk into your child’s room, and it smells like blueberry, maybe they’re not eating blueberries. Maybe they’re using a blueberry vape. And so young people can get away with these in their classes because they don’t smell bad. So my daughter brings this to my attention. And so very quickly, we started working on a juul power point. While this was happening, I get a call from the California Department of Education and the California Youth Advocacy Network, who were both alerted to juuls being used in schools. And they basically said to me, we need to get something – and the California Department of Education helps fund the toolkit – you need to get something up there, please, as fast as you can. And the main reason, which is very concerning that they wanted me to get something – curriculum on juuls up on our website as soon as we can, is that we had heard that juuls themselves was creating a curriculum. Our curriculum is totally free, available online. We don’t charge for any of it. And we do free trainings. But when we found out, we got very worried because there’s such a history with the tobacco industry as a whole, particularly Philip Morris doing their own prevention curriculum, and really what they’re doing is advertising. And so it became very important to our lab to, fast as we can, create a part of the toolkit that focuses on juuls and help prevent it. So very quickly, within a few weeks, we put up a new PowerPoint with teacher talking points on the web site. And the California Department of Education sent an e-mail to all of the schools throughout California saying, it’s illegal, you’re not allowed to use the Juul curriculum (because Juul was incentivizing schools with money to use their curriculum, and schools cannot take tobacco money if they are funded by California). Instead, we encourage you to use the Juul prevention curriculum within the tobacco prevention toolkit. Since then, we have added onto that portion of our toolkit. We broadened it not just to be juuls but all pod-based vaping devices. And now it includes quizzes and activities and information to help you dissect marketing, to understand how you are being targeted by the industry through marketing and through the flavors.
Has there been feedback from educators?
Halpern-Felsher: We’re currently doing a formal randomized controlled trial evaluation to look at whether our toolkit, and particularly the vaping curriculums, change adolescents’ knowledge, attitudes, intentions and actual use. But we don’t have that ready yet. But in early analyses of just giving a survey, doing the curriculum and giving another survey or – in where we’ve given the survey, done the curriculum and then given a post or pre-post survey, we are seeing that adolescents are more knowledgeable and changed their attitudes and increased understanding and decreased their misunderstanding of juuls and all tobacco when we go in and give the curriculum. Important to note, we don’t generally give the curriculum. We teach teachers, and then they teach. We actually just did a calculation today that we have reached over 170,000 youth throughout the country. And we think that’s a conservative estimate, through the – through the toolkit. So a tremendous number of youth have been exposed to our – to our teachings. We also have a lot of teachers who find us through googling or through word of mouth. We do a lot of dissemination and promotions ourselves. And people are saying, there’s nothing else out there right now. And this is so much better than anything else. Plus, it’s free. A lot of curriculums charge.
Beyond that, what else do you recommend?
Halpern-Felsher: This is exactly what the FDA is trying to understand right now. They were supposed to have a meeting this week that got canceled because the funeral. But the FDA is really trying to understand what do we do with and about young people who are addicted to vapes, including juuls. The hard part is we have no currently FDA approved cessation pharmacological agents. Nicotine replacement therapies — they’re not FDA approved for under 18. So doesn’t mean that doctors are not prescribing these nicotine replacement therapy drugs. But when they do prescribe NRTs, that’s off-label for anybody under 18. So we have no good research to allow anybody to give young people these medications. We also don’t have a lot of therapies for young people who are addicted to vapes because they’re so new. So we have a brief intervention, which includes motivational interviewing, sometimes cognitive behavioral therapy, mindfulness training, goal setting. We have those. And they will – they did pretty well coupled with medications for people who are addicted to cigarettes. People are applying the same methods and models to vapes. But we don’t really know if they’re affective because it’s all so new. So what people are doing – and actually, they’re using our toolkit for cessation as well – is they’re feeling like part of the problem is that young people have so little knowledge about these vapes. And if we can really explain what they are, explain how they actually are harmful, that they’re really not much better than cigarettes, that maybe we can also help them set goals to quit by educating them and then turning that education into motivational interviewing, which is them setting goals and steps towards quitting. It’s really a blackbox right now. I’m asked this question weekly, almost daily. My colleagues are too. How do we help young people get off of vaping products? And we just don’t have a lot of good data yet.
My question is just related to what the teens said and how it makes them dizzy. Is that a thing that all e-cigarettes do?
Halpern-Felsher: honestly, I’ve not heard that. And I don’t know. The only thing I can think is that there is such a high level of nicotine. Nicotine can make you dizzy. And maybe they’re just using it so much that they just have an incredibly large amount of nicotine in their system. Or maybe they’re feeling dizzy when they’re not using it. But it sounds like it’s when they’re using. So the only thing I can think of is that it has to do with a very large amount of nicotine. But I’m not sure.
It doesn’t get you high like pot does. And we should clarify that and make sure the viewers know. Why risk in your classroom sneaking a puff?
Halpern-Felsher: Right. It doesn’t make them high like marijuana. But it still gives the buzz that you would get, like, smoking cigarettes. You still get that nicotine feeling, that nicotine rush that they’re using. Some do think that helps them concentrate more. And in reality there’s no evidence that using any sort of nicotine or vaping pen or cigarettes helps you concentrate. It’s more if you don’t use it, then you’re going to have problems concentrating. And that we have heard from young people, say all I can think about is when I can have my next hit of a vape when they’re sitting in class and they can’t use them. So it’s a big problem. The other problem is we’re hearing about a lot of schools, there’s the joke going around that, how come there are urinals in my vaping room? Because all the youth are going in to the bathrooms and vaping or using juuls. And so the issue there is a lot of schools have come to me and said, we’ve just decided to close down the bathrooms. It’s not really the best way to go about doing this. Really, we need to educate. And we need to do education to young people. And we really need to help them understand what they’re using and help them not use them anymore.
That’s crazy. You can’t shut down a bathroom.
Halpern-Felsher: Most young people today are not using electronic cigarettes, vapes, juuls, whatever you want to call them in tobacco flavored. That is not what they’re using. They don’t like tobacco flavors. They like the mint and they like the fruit, and they like the dessert flavors, which is also why it’s really important when people say, well, we don’t need to worry about flavors. We don’t need to worry about bans on flavors. We do. If we ban all flavors and only have tobacco and non-flavored or unflavored vapes, we’re going to significantly reduce the number of youth who both initiate and continue to use these products. They’re using it largely for the flavors. There actually used to be ads out there saying to – particularly women, very scary ads saying don’t eat your dessert. Vape your dessert. And that’s a really big problem right now. So they’re using it for the taste. We have qualitative data showing youth are saying oh, if it smells like raspberry, blueberry or apple, or mint, who’s going to get me in trouble? And I just feel like having a taste of something. That’s why they’re using them.
One of the boys liked fruit punch, and the other liked the creme, which really used to be called creme brulee.
Halpern-Felsher: It was creme brulee. And I think that they changed it to creme because of the criticism that they were getting, big criticisms that they were getting about youth flavors. Right now I got an e-mail today that juuls is trying to shut down the flavor ban. I don’t know if you know, in California Jerry Hill and colleagues just put forth a bill in California to ban all flavored tobacco products throughout California. I gave them data and helped him with that legislation. That’s great. Juuls is currently trying to get popular groundswell to go against that ban.
It seemed like they’re talking out both sides of their mouth of thing.
Halpern-Felsher: It’s all about corporate social responsibility, looking good. It’s the whole thing for the curriculum. If you look at the curriculum, the paper we published, it’s a terrible curriculum, theirs. It never talks about juuls, talks about vapes. Young people don’t call juuls vapes. They see them as different things. And it talks about nicotine. But it doesn’t talk about nicotine in depth. It doesn’t explain that nicotine is bad. And by the way, juuls have nicotine in them, they keep them in separate pieces. Doesn’t talk about flavors, doesn’t talk about marketing. They’re doing things to look good. They’re doing things that sound good. They’re doing things because they know parents are mad at them, and they don’t want to be in trouble. But in reality, if you really dig into what they’re doing and their changes, they’re not effective. And they’re really taking a page out of the philip morris and other big tobacco industry play books.
END OF INTERVIEW
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