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Juul vaporizers
Emma Kate Fittes, The Indianapolis Star

At Jonathan Law High School, a mysteriously large number of students last year spent copious amounts of time in the bathroom.

Noticing students were disappearing for 15 to 20 minutes at a time, teachers at the Milford, Connecticut, school brought the issue to principal Fran Thompson. The bathrooms would become "little tent cities," Thompson said, with kids bringing blankets and sitting on the sinks.

Why were students congregating in the bathroom? After investigating, Thompson found his answer: Students came to "juul."

“It’s truly an epidemic,” Thompson said. “And it’s not just specific to my school, but I know that it’s certainly nationwide. It’s rampant.”

Juuling, or using a type of electronic cigarette that looks like the USB sticks used to save electronic documents and other data, is growing in popularity and racking up revenue. It's also vexing parents and teachers who want to discourage young people from picking up the habit. As the 2018-19 academic year gets underway, teachers and principals are concerned that the popularity will continue to grow. 

With Juul's discreet and odorless nature, teachers have a hard time catching students. Additionally, experts say that the brand's many flavors – such as mango and mint – make it an attractive product for younger users. 

Food and Drug Administration Commissioner Scott Gottlieb on Wednesday declared youth vaping an "epidemic," and said the agency will halt sales of flavored electronic cigarettes if the major manufacturers can't prove they are doing enough to keep them out of the hands of children and teens.

The FDA says it's giving manufacturers of Juul, Vuse, MarkTen XL, Blu and Logic 60 days to submit “robust” plans to prevent youth vaping. If the agency doesn’t think their plans go far enough, it could order their products off the market. Those five brands make up more than 97 percent of the U.S. market for e-cigarettes, FDA says.

Juuls use nicotine salts, which exist in tobacco and contain a higher concentration of nicotine than many liquids in other e-cigarette brands. In 2015, Pax Labs introduced the Juul. Pax spun off Juul Labs in 2017.

Juul Labs raked in over $1.1 billion in retail sales for its e-cigarettes over the 52-week period ending July 14, according to a Wells Fargo Securities analysis of Nielsen data. In July, the company had more than 70 percent of all e-cigarette revenue, excluding online sales and sales at specialty shops, according to Nielsen.

Educators like Thompson and anti-smoking advocates say teenagers and young adults have played a role in puffing up the sales of Juuls and other e-cigarettes. Government data appear to back him up. 

According to the Centers for Disease Control and Prevention's 2017 Youth Risk Behavior Survey, 13.2 percent of high school students reported using electronic vapor products, which includes e-cigarettes, at least once in the 30 days before the survey. Though this is down from 24.1 percent in 2015, anti-smoking advocates said they are concerned that number will rise again with Juul's momentum in the marketplace. The use of traditional cigarettes has declined greatly over the past 20 years. Nationwide, 8.8 percent of high school students smoked a traditional cigarette at least once in the 30 days before the survey – a dramatic decrease from the 36.4 percent in 1997.

Juul Labs says its mission is to get adult smokers to switch to a less harmful source of nicotine than traditional combustible tobacco cigarettes. According to a January report by the National Academies of Sciences, Engineering and Medicine, there is "conclusive evidence" that substituting e-cigarettes for traditional cigarettes "reduces users’ exposure to numerous toxicants and carcinogens."

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In an interview with USA TODAY, Ashley Gould, chief administrative officer of Juul Labs, said that youth usage of the product is “unacceptable.”

But as Juul's business grows, so does the risk that more kids will use the e-cigarettes, said Vince Willmore, vice president of communications for the Campaign for Tobacco-Free Kids.

“We’re concerned that the problem will come back in spades at the start of the new school year,” Willmore said.

Intended for adults, used by more

Founded by two former smokers, James Monsees and Adam Bowen, Juul Labs says it created its product because it is a “public health imperative to create alternatives that work for smokers,” Gould said.

Smokers have struggled to give up traditional cigarettes, though not without trying. According to the CDC in 2015, nearly seven of every 10 smokers indicated that they wanted to quit smoking completely. However, Gould said quitting is "incredibly difficult," as it takes on average 30 attempts before smokers successfully have done so, according to a 2017 article from peer-reviewed medical journal BMJ Open. 

It appears that Juul Labs' stated mission may be working.  A study published this year by the U.K.-based Centre for Substance Use Research found that nearly 50 percent of adults (21 and older) who reported that they were smokers when first using Juul also said that they had completely stopped smoking cigarettes by switching to Juul.

Juul says its efforts show it has tried to keep its product out of the hands of minors. State and local laws currently limit tobacco product sales to people who are at least 18 years old, with some places having a minimum age of 21. The minimum age for users to make purchases on JUUL.com is 21, with customers nationwide having to provide proof of age before purchasing. 

However, Jidong Huang, a professor of health management and policy at Georgia State University, said that Juul's marketing during its initial launch – which included posts on social media of youthful-looking models having fun with the product – appealed to a younger demographic.

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ÒCritics have claimed that JuulÕs youthful looking models in advertisements have encouraged youth usage of the product.Ó
Campaign for Tobacco-Free kids

“What they did with their marketing and promotion is not consistent with what they claim,” Huang said. “If they wanted the product to target adult smokers who want to quit, they should have promoted Juul in channels specifically to those groups.” 

By emphasizing concepts like freedom and sex appeal, Juul Labs "used the same imagery and themes that tobacco companies have always used to appeal to kids, and they fueled it with social media," said Willmore of the Campaign for Tobacco-Free Kids. From July 2017 to July 2018,  #JUUL boasted over 37 million impressions on various platforms, the social-media monitoring firm Brandwatch calculated.

Juul Labs spokeswoman Victoria Davis said the company has "strict guidelines" to make sure its marketing and social media efforts target existing adult smokers.

"Our growth is not the result of marketing but rather a superior product disrupting an archaic industry," Davis said. "When adult smokers find an effective alternative to cigarettes, they tell other adult smokers."

Juul announced in a June press release that it would shift from featuring models to former smokers who switched to using Juul on its social media platforms.

Among its efforts to keep Juuls out of young hands, Gould said the company is actively working to detect illegal online sales – people buying a Juul and re-selling it without requiring age verification – and remove them from online marketplaces. For example, Juul reported 12,010 incidents of illegal sales to eBay between Jan. 1 and July 26 of this year, and 11,502 of the offerings were removed, according to the company.

Gould also noted that Juul Labs is monitoring social media for posts that target minors and request that platforms take these posts down "based on their community guidelines."

Social media "has been part of the problem," Gould said. "It's not something that we control directly, but we're doing everything we can."

Sales and usage going back to school

Over the past few months, Juul Labs has come under siege for alleged sales to underage buyers. Besides the FDA's action, Massachusetts Attorney General Maura Healey in July launched an investigation into Juul Labs marketing its product to youths.

According to Gould, Juul Labs is working to curb underage use of Juuls, partnering with Iowa Attorney General Tom Miller and spending $30 million over the next three years on research and community engagement efforts and a campaign to educate parents and teachers about the product, according to a company press release

However, nobody should be expecting Juul Labs’ sales to slow down anytime soon, according to Huang.

Though he doesn’t have current data to back it up, “The sales of Juul is increasing at an accelerating rate,” Huang said.

The e-cigarette powerhouse is setting itself up financially for growth. In a Securities Exchange and Commission filing in July, Juul Labs said it was seeking to raise $1.25 billion and already collected $650 million of that. This move led the company to being valued at $15 billion, Bloomberg reported in June citing anonymous sources. 

Currently, 10 percent of people aged 15-24 both recognized and have used a Juul at one point in their life, according to a November 2017 survey by the Truth Initiative, a non-profit tobacco control organization. Dr. Mark Rubinstein, a professor of pediatrics at University of California, San Francisco, said that younger people are at a “higher risk of dependence” on these e-cigarettes, which can have detrimental effects on their studies.

“At school, kids won’t be able to concentrate in class because they’ll need nicotine,” Rubinstein said. “They’ll be withdrawing.”

Despite recent efforts to curb youth usage of Juul, Willmore fears that Juul-like products – such as Altria's MarkTen Elite and ITG Brands's myblu – will exacerbate youth usage of e-cigarettes. 

"Juul is our biggest concern right as it is being widely used by kids across the country," Willmore said. "But we are also concerned that the introduction of a growing number of Juul-like products could make the problem even worse."

Follow Ben Tobin on Twitter: @TobinBen