Shumaker: To Juul is not cool

E-cig device packs a dangerous nicotine punch

This image provided by Juul Labs on Tuesday, April 24, 2018 shows the company's e-cigarette device.

Have you seen your teenager studiously staring at his or her laptop, with a long flash drive plugged into the side? Are you excited they are so serious about their school work that they can't look away? You might want to look again. That USB-style flash drive might well be a new e-cigarette device that is all the rage among teenagers.

This device - called JUUL (pronounced jewel) - has surpassed all other e-cigarettes on the market and is easily concealed in a fist or pocket. It resembles a flash drive, doesn't emit much vapor and doesn't smell like a cigarette. Unfortunately, this device contains about twice the amount of nicotine of other e-cigarettes on the market. For the developing teenage brain, any nicotine is too much.

photo Dr. Nita Shumaker

Fortunately, the growing popularity of this device and other e-cigarettes comes just as the Hamilton County Department of Education announced a new policy preventing e-cigarette and tobacco use on all school grounds and related events. This change came about after students from local schools asked the Board of Education for change. The previous 13-year-old tobacco policy was outdated and didn't take into account new "smoking" technology.

The crux of the problem centers on what nicotine does to the human brain - especially in an area called the prefrontal cortex, which plays a key role in emotional control, decision making and impulse regulation.

Like other drugs such as marijuana and alcohol, nicotine has a different impact on a developing brain than on the brain of an adult. The prefrontal cortex of teenagers is still rapidly changing. So are the cell endings and chemical connections that link the cortex to parts of the brain associated with gut impulses and impulse control.

Brain imaging studies of adolescents suggest that those who begin smoking regularly at a young age have markedly reduced activity in the prefrontal cortex and perform less well on tasks related to memory and attention compared to people who don't smoke. According to the 2015 Youth Risk Behavior Survey, 22 percent of Tennessee high school students say they use e-cigarettes (vaping), while 12 percent say they use traditional cigarettes. In 2009, before the popularity of e-cigs, the study showed that 21 percent of high school students smoked cigarettes. Ninety percent of all smokers started before age 18.

Despite being marketed as a safe alternative to smoking, e-cigarettes are not safer and they never have been. They have simply been marketed that way. As a result, many people believe trading a traditional combustible cigarette for vaping is going to make them healthier, and that the vaping or e-cigarette use is far less damaging health-wise.

While it's true that products like e-cigs and vaping do not contain tobacco, they do contain nicotine and a massive list of ingredients that are known carcinogens and toxic chemicals which users could be exposed to. The Food and Drug Administration detected in e-cigarette cartridges marked "tobacco-free" a toxic compound found in antifreeze as well as tobacco-specific compounds that have been shown to cause cancer in humans. One study looked at the 42 different types of liquid e-cig cartridges and found they contained formaldehyde, another chemical known to cause cancer in humans. Poison centers are also seeing a spike in nicotine exposures, including among children who play with the devices.

Research shows that our bodies react to traditional cigarette smoke with health problems such as long-lasting inflammation, which in turn leads to chronic diseases such as bronchitis, emphysema and heart disease. Since e-cigarettes and vaping products contain many of the same toxic chemicals, they won't reduce the risks for these diseases, thereby ruining the marketing argument that e-cigarettes and other non-combustible nicotine products are safer for your health.

These marketing whizzes are targeting youth with wild creativity. They're designing products to look like the latest and greatest technology toys. For a parent who doesn't know much about vaping and JUUL products, they could very well overlook the device, thinking it's just yet another add-on to their child's technology suite.

Despite its sleek technological look, a JUUL device delivers as much nicotine as a pack of regular cigarettes, which can cause a host of health issues, including nicotine toxicity. Symptoms of nicotine toxicity include nausea, vomiting, tachycardic dysrhythmias, and potentially seizures, with large exposures. All of this from a product that is being marketed to younger demographics all the time.

Most parents don't realize that possession of the device is a Class C misdemeanor and could result in their child ending up in juvenile court. Principals are mandated to hand out citations and coordinate with police to assure young offenders are appearing at juvenile court. Even possession is a big deal.

We pediatricians need parents to be the catalyst to prevent their children from using these products. Trust but verify. Peer pressure is amazingly hard to resist at this age, especially in light of the "this isn't harmful and doesn't contain nicotine" attitude our children are taking. The most important action we can take as parents is to discuss this with our kids and to ensure that your child does not have one of these devices.

Dr. Nita Shumaker, a local pediatrician, just completed a one-year term as president of the Tennessee Medical Association.