Health Alert
DPH WARNS OF NEW E-CIGARETTE TREND "JUULing"

The Delaware Division of Public Health (DPH) is issuing this health advisory to provide schools and family physicians/pediatricians within the healthcare community, with information about a new e-cigarette trend among pre-teens and teens called “JUULing”.

Summary

JUUL is a brand of e-cigarette that looks similar to a flash drive and can be charged in the USB port of a computer. JUULs can be appealing to youth for a variety of reasons. Pods come in a variety of fruit and candy flavors, the devices can be difficult to distinguish from a real flash drive, and the vapor dissipates quickly instead of hanging in the air like a smoke trail. This has caused concern among school administrators across the country as youth have taken to “JUULing” on school property, even in class.

Background

Among teenagers, experimentation with electronic or e-cigarettes became popular in 2015. According to the 2015 Delaware Youth Risk Behavior Survey (YRBS), 23.5 percent of public high school students had used e-cigarettes in the past month, and 2.3 percent were smoking or "vaping" e-cigarettes daily. Dual use of tobacco products is also a concern. In Delaware, 32.5 percent of high school e-cigarette users reported also using cigars, and 27 percent reported also using cigarettes. In addition, 37 percent of e-cigarette users reported never smoking cigarettes before starting to use e-cigarettes.

In 2014, Delaware banned the sale of e-cigarettes to minors, and a year later the state expanded the Delaware Clean Indoor Air Act to include prohibiting the use of e-cigarettes and other electronic vapor devices in workplaces and indoor public place.

While research is under way to determine the health effects of e-cigarette usage, the aerosol from e-cigarettes contains harmful substances such as nicotine, lead products and cancer-causing agents, according to the Centers for Disease Control and Prevention (CDC).

According to the product label, just one pod used in a JUUL allows for 200 puffs and contains the same amount of nicotine as one pack of cigarettes. Nicotine is highly addictive and can affect the developing brains of youth. In less than five years, e-cigarettes and vape products have become the fastest-growing sector of the American tobacco industry. Nationally and in Delaware, e-cigarettes are the most commonly used tobacco product among youth.

Recommendations:

•  School administration staff are encouraged to share information on this trend with parents. A Truth Initiative study found that 37 percent of 15 to 24-year-old JUUL users are uncertain whether the product contains nicotine. The study also found that JUUL users don’t refer to use of these products as “e-cigarette use” or “vaping” but rather as “JUULing”, which leads them to believe it is safer.
•  Schools should share this health alert with staff, particularly school nurses, teachers, school resource officers and wellness center staff.
•  School staff are encouraged to engage students in open dialogue about this trend, their awareness, and knowledge of any activities occurring on school property.
•  Healthcare providers who serve children and families are encouraged to make discussions about “JUULing” a part of their dialogue during well and sick visits. It is particularly important for those with minor patients with asthma to incorporate this topic into the discussion.

Additional Information

• Tobacco-Free Kids on “JUULing”: https://www.tobaccofreekids.org/assets/factsheets/0394.pdf
• CDC link on e-cigarettes: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/index.htm
• Delaware links on e-cigarettes: http://www.thedirtytruth.com or https://www.healthydelaware.org/Individuals/Tobacco/Vaping

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