Over the last few years, tobacco consumption has taken a noticeable turn. The slow and steady decrease in traditional tobacco consumption through combustible cigarettes has mirrored the rise in electronic nicotine delivery system (ENDS) use. The $7 Billion global industry continues to grow as some projections believe ENDS sales will surpass combustible cigarette sales as early as 2022. JUUL, the leading ENDS company, has been behind the primary thrust in ENDS sales.

Since its launch in 2015, JUUL has dominated the market. Only 3 years after the product was launched, Altria, who is responsible for the Marlboro cigarette brand, purchased a 35% stake in the company for $12.8 billion. With a valuation of $38 billion, JUUL became the fastest startup company to reach, and surpass, a $10 Billion valuation.[i] In the 12 months leading up to August 2018, the company sold an astounding $1.29 billion in devices and nicotine-flavored pods.

These small handheld devices vaporize the flavored liquid (most commonly made up of vegetable glycerin and/or polyethylene glycol, flavoring and nicotine salts) which is inhaled by the consumer. Discreet, easy to use and flavorful, the use of ENDS has become the newest viral trend among all ages. Just as Google has reached such prevalence that the name of the company has become a verb ("google it"), JUUL’s prevalence across the market has caused the use of ENDS to be most commonly referred to as “juuling.” ‍

No demographic has been more influenced by this new trend than teenagers‍

I will say it again in case you missed it the first time - no demographic has been more influenced by this new trend than teenagers. 5 million youth, kids in middle school and high school, reported to be consuming tobacco products regularly. From 2017 to 2018, during the rise of JUUL, there was a 78 percent increase in ENDS use among high school students and a 48 percent increase among middle school students. The majority of which are using ENDS that have bold flavors like bubble gum, cotton candy, and mango, which are attractive to these younger audiences. The overwhelming majority of high school and middle schoolers are smoking a JUUL as opposed to any other ENDS.

Bathrooms in middle schools and high schools became known as discreet places on campus to use JUULs. So much so that memes started to pop up about the rampant use of JUULs in bathrooms. One meme jokingly questions why there are toilets in the“juul room," while another shows the lopsided use of bathrooms for using a JUUL as opposed to actually needing to use the restroom. While these memes may be funny, the rampant use of JUUL devices by teenagers is not and needs to be addressed.

‍FDA labels the issue an epidemic

In September of 2018, the FDA announced the trend had reached epidemic proportions. FDA Commissioner Scott Gottlieb stated in a public announcement that,

"Unfortunately, I now have good reason to believe that it’s reached nothing short of an epidemic proportion of growth. I use the word epidemic with great care. E-cigs have become an almost ubiquitous ‒ and dangerous ‒ trend among teens. The disturbing and accelerating trajectory of use we’re seeing in youth, and the resulting path to addiction, must end. It’s simply not tolerable. I’ll be clear. The FDA won’t tolerate a whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products."[ii]

Gottlieb could not have been any clearer. This has become a problem that must be addressed. The addictive trend that has been tied to serious health issues needs to be stopped.

JUUL’s marketing to youth and lack of nicotine warnings propelled their early success

Recently, an in-depth research study of JUUL’s advertising tactics and imagery by the Stanford Research on the Impact of Tobacco Advertising (SRITA) scrutinized the ways in which JUUL was able to rise to such prominence, giving special attention to the rise in under-age users. The study finds that even though JUUL’s company mission states that they are “dedicated to eliminating cigarettes by offering existing adult smokers with a better alternative to combustible cigarettes,”[iii] their success has been predicated upon their prominence with youth. Noting that, “a principal driver of JUUL’s explosive growth in sales has been its adoption by youth.” The study showed that 15-17 year-olds were “16 times more likely to be current JUUL users than the 25-34 year old group.”[iv]

The rapid growth in underage use of JUUL products drew the attention of the FDA. They began looking into JUUL’s marketing practices and label warnings. In April of 2018, the FDA opened an investigation of JUUL to determine the drivers of underage use. The following November, the FDA announced that they would allow the sale of flavored JUUL pods, and other flavored nicotine pods, only in age-restricted stores, thus limiting their sale almost exclusively in tobacco and liquor stores. The only exception would be for Mint, Tobacco and Menthol nicotine pods. These regulations would go in tandem with a score of fines for JUUL. As well as several constraints on JUUL’s marketing campaign and use of social media.

Looking at the early advertising of JUUL, SRITA found that their campaigns were dominated by young models in their 20s appearing in casual clothing and “ridiculous enthusiasm” that “resonated with underage teens who aspire to emulate these trendsetting young adults.” They concluded that “the net effect of the initial campaign was to establish a notable youth-oriented brand identity.”[v] Establishing this early presence is one of the significant reasons that JUUL has been able to establish such a hold on the market. They are far and away the top ENDS because of the fashionable wave of JUUL use that swept youth culture.

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Unprecedented growth draws class action lawsuits against JUUL

The extraordinary growth of JUUL drew a lot of attention that was critical of the company. Their marketing tactics and lack of appropriate label warnings were brought into question. Not only did JUUL, as mentioned before, seemingly target underage audiences, they failed to have the appropriate warning labels that notify users of the nicotine level and addictive nature. With a higher nicotine concentration than combustible cigarettes, “juuling” can actually leave consumers more susceptible to nicotine addiction than combustible cigarettes. Neither the high nicotine level nor the addictiveness of nicotine were originally mentioned in the warning labels on the product.

Instead, JUUL knowingly concealed this information from consumers. That is until they were mandated to by the FDA to add appropriate black box labels to their displays and to their packaging. By that time though, the JUUL craze was already well on its way and the addition of label warnings have been unable to curb the upward trend in youth popularity.

In response, legal action has been taken on behalf of the teens that have become addicted to the nicotine from JUUL's lack of warning, their improper targeting of teens and the physical harm that has come from the consumption of vaporized nicotine salts. What was labeled as a product to “improve the lives of the world’s one billion adult smokers” has actually skyrocketed nicotine addiction in youth and caused adverse health issues. We are troubled by JUUL’s inappropriate tactics and are advocating for the teens that have fallen into nicotine addiction because of the marketing and mislabeling of JUUL products.

From addiction to hospitalization

If being responsible for the addiction of hundreds of thousands of youth wasn’t bad enough, there are a growing number of cases of respiratory issues connected to the use of ENDS. Recently, the Iowa Department of Public Health issued a health advisory concerning the recent uptick in teenagers and young adults who have developed “cases of severe respiratory illness.”[vi] The New York Times reported on Wednesday (Aug, 21st, 2019) that there have been “153 cases of serious, vaping-related respiratory illnesses in the past two months, and many of the patients are teenagers or young adults.”[vii] That is an average of over two new reported cases, that we are aware of, each day in the past two months.

Of those reported cases, most of them were admitted for issues related to an inability to breathe. The majority of the symptoms were:

• Difficulty breathing
• Chest pain
• Vomiting
• Fatigue
• Popcorn Lung (Symptoms of Popcorn Lung can be wheezing, coughing, chest pain, shortness of breath and difficulty breathing) 
• Asthma
• Chronic Bronchitis

In addition to dealing with the aforementioned symptoms, several of those admitted are also dealing with even more serious health issues. Some are dealing with lung damage that has required hospitals to place them on forced oxygen breathing machines and left on ventilators for days. They are being told they may have irreversible lung damage caused by their use of ENDS like JUUL. As of August 7th, 2019, “the agency [FDA] has received 127 reports of seizures or other neurological symptoms, such as fainting or tremors.”[viii] 92 of these have been reported between April, 2019 and the beginning of August 2019.

First possible death related to ENDS

Just this past Friday (August 23, 2019) Illinois public health officials announced the death of a patient who was hospitalized after vaping led to them developing a severe respiratory illness.[ix] While it is still early and no conclusive answers have been given about the death of the patient, the Illinois Department of Public Health added that a team from the Center for Disease Control and Prevention (CDC) arrived in Illinois this month and has begun investigating the dozens of patients dealing with respiratory symptoms in Illinois hospitals.

Everyday more young adults and teenagers are being admitted for health issues related to their use of ENDS like JUUL. In the shadow of a $38 billion company lay the underage addicts and hospitalized patients that has predicated the success of JUUL. Their deceit, inappropriate marketing and resulting harm caused to underage smokers must be addressed and restoration sought.

Have you, your son, daughter or loved one been affected?

JUUL must be held accountable for the injuries and damages that have come from the use of their devices. Those who have been adversely affected by the improper targeting of underage users and their lack of proper warning labels may be eligible for considerable compensation.

If you, your son, daughter, or someone close to you has experienced the symptoms mentioned above, been hospitalized in a related health issue or are struggling with a nicotine addiction from a JUUL device, you may be eligible for compensation for the damages caused by JUUL without ever having to step foot in court. Fill out this form for a free case review and to find out if you are eligible.

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Resources:

http://tobacco.stanford.edu/tobacco_main/publications/JUUL_Marketing_Stanford.pdf

https://www.cnbc.com/2018/08/21/e-cigarette-sales-are-booming-thanks-to-juul.html

https://www.bbc.com/news/business-49402054

https://techcrunch.com/2018/12/20/juul-labs-gets-12-8-billion-investment-from-marlboro-maker-altria-group/

https://www.weareiowa.com/news/local-news/warning-iowa-department-of-public-health-issues-health-advisory-concerning-vaping/

https://www.nytimes.com/2019/08/21/health/vaping-marijuana-e-cigarettes.html

Endnotes:

[i]https://www.bizjournals.com/sanjose/news/2018/12/21/juuls-12-8b-deal-is-the-biggest-u-s-funding-ever.html

[ii]https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-new-steps-address-epidemic-youth-e-cigarette-use

[iii] “JUUL Advertising Over Its First Three Years on the Market” Stanford Research into the Impact of Tobacco Advertising. http://tobacco.stanford.edu/tobacco_main/publications/JUUL_Marketing_Stanford.pdf.Pg. 1.

[iv] Ibid., Pg. 2.

[v] Ibid., Pg. 7.

[vi]https://www.weareiowa.com/news/local-news/warning-iowa-department-of-public-health-issues-health-advisory-concerning-vaping/

[vii]https://www.nytimes.com/2019/08/21/health/vaping-marijuana-e-cigarettes.html

[viii]https://www.cnet.com/news/fda-investigating-120-reports-of-possible-vaping-related-seizures/

[ix]http://www.dph.illinois.gov/news/illinois-resident-experiencing-respiratory-illness-after-vaping-dies