The Epidemic: How nicotine infiltrated teen culture

“Is it okay if I hit it right now?”
With an expression of sincere relief, 16-year-old Nash* reached into the left pocket of his jeans and pulled out his Juul, a flashy brand of e-cigarette that was invented to wean heavy smokers off cigarettes. He was sitting in the front seat of a car during an interview with the Pepperbox. He purchased his Juul about two weeks before.
“I used to be really against [Juul] before I ever used them,” he says after taking a hit. “I was just like, ‘that’s dumb.’ It’s like a fancier cigarette.”
Yeah. Smoking cigarettes seemed to have lost its alluring, rebellious reputation by the time our generation hit high school.
Two years ago, if you were to ask the average Arcata High student about their opinion on nicotine, his or her answer probably would have been something along the lines of “disgusting.”
Obviously, though, times have changed.
Nash is one of about 3.6 million teenagers that has picked up a vaping habit. That’s one in five, and the numbers are increasing rapidly. E-cigarette use among teens doubled in the last year, according to the Associated Press.
This epidemic is old news to teenagers. But despite the glaring statistics, questions remain unanswered. Why did this happen? And, more importantly, what now?
Juuls are sleek; they look like a USB flash drive. They’re also sweet; popular flavors include mango, mint, and creme bruleé. They’re social; “#juulgang” is not rare in Instagram captions. They’re seductive; just consider what they’re called for a second. And, (a crucial characteristic) they’re secretive; there have been reports of teens using them during class, unnoticed.
Are Juuls symbolic too? Representative of teenage culture and rebellion?

Seduce
Juul pitched a brilliant ad campaign. They had it all: sexy 21-year-old models posing with their Juuls in front of brightly-colored geometric shapes with an Instagram feed to match. The word “vaporized” in bold lettering dominated their ads, and that scary addiction warning that is found on most nicotine products was nowhere to be seen. Since then, Juul changed its advertising strategy after the FDA began investigating the industry for maybe targeting teens (Read about it on page 20).
It’s a common opinion that the company had ill-intent. AHS math teacher Kay Wozniak pointed out an especially ridiculous but clever factor of Juul’s marketing strategy. “[Juuls] come in like 50 different flavors. They come in fruity tootie. They taste like bubblegum and stuff. What adult is gonna want strawberry daiquiri [flavored nicotine]?” Wozniak questioned. “It’s really consumerism at its best – or worst.”
Even though Juul ads look different now, the product is the same as it’s always been. Same tasty vapor, same fashionable shape. “It’s so compact and small and just fits in your hand. You can get it decorated. It’s like it is meant to addict teens. It’s a cute accessory, almost,” Ruth,* a student Juuler, said.
This may be what hooked the first teen Juulers, but now most get reeled in by something else – something that Juul manufacturers aren’t directly responsible for. Juul was cool for materialistic reasons, but now it’s cool for social reasons too, and that is arguably the main reason vaping has become an epidemic.

Spread
Every single student that talked to the Pepperbox about their Juuling said that they started because their friends were doing it, and two said that they only Juul “socially.”
“I don’t think I’ve ever seen one person [vaping], actually. It’s always two or more,” said Junior Tia Franklin, a student who does not Juul but regularly encounters Juulers in the school bathrooms.
Teens roll their eyes when they hear the term “peer pressure,” but we must question whether such social coercion is playing a role, even if it goes unsaid. After all, Juuling seems to hit teens in groups rather than individually. Tave,* an AHS student who started Juuling last summer, splits her time between two friend groups. One group Juuls, the other does not, and Tave matches the habits of whoever she is with. But Tave said that she didn’t start Juuling because of pressure; she was just curious. “I think it was definitely my choice to do it,” she explained. “I’ve never felt [peer pressure] with a Juul. Other things, yeah. But not this.”
Ruth had a contrasting opinion. “There’s this pressure of everyone having it and everyone doing it. This pressure is put on you,” she said. “Just like weed and all the other things.”
But in retrospect, do all the “cool” kids really have that much influence? Isn’t that such a cliché? Ruth put the situation in perspective: “[Students] have their circle of friends and all they do is Juul in their car at break and lunch,” she said. “If you don’t Juul, you’re not gonna be in that car.”

Supply
Fay* doesn’t own a Juul, but she’s thinking about getting one. They’re illegal to buy under the age of 21, and Fay is only 17; but that’s not a problem. Fay said she would have no trouble getting one through someone at school. “Some people have fake IDs,” she said. “I don’t know how people at school get [Juuls and pods-replaceable cartridges that contain nicotine salt juice], but they have them to sell.”
Ruth, who does own a Juul, doesn’t need to buy pods from peers. There’s a local business that doesn’t ID her, so it’s easy to stay stocked.
But just because buying Juul products is easy doesn’t mean the habit is cheap. The actual device costs about $50, and Nash estimated that he spends about $20 a week on pods (which covers about four pods a week. For context, one pod contains about as much nicotine as one pack of cigarettes, according to Juul). When cash is tight, though, Nash just refills old pods from a vial of nicotine salt liquid, which is far cheaper than buying new pods. “You could fill a hundred for ten bucks, probably,” he said.
But refilling pods poses a whole new health concern. Arcata High Nurse Johnny Kell expressed distress over the solution of refilling pods, as the juice can be highly harmful if it makes contact with the skin or lips. “[This is] when it should be scary,” he said. “[Nicotine salt juice] is able to go through your skin . . . it is not controlled. Exposure to these highly concentrated nicotine sources [could be dangerous because] we just don’t know what the outcome is gonna be.”

Stick
“It’s just a headrush.”
“It’s really short, like five minutes of this . . . feeling.”
“It’s just like a satisfying feeling, hitting something and then getting this mind-numbing feeling for 30 seconds or so.”
“I hit it, I got the headrush. You feel like you’re floating for a little bit.”
“It’s like stimulating at first and then relaxing after like five minutes. It’s relaxing [but at the same time you find yourself] wanting to hit it again.”
“It’s just fun.”
According to pretty much everyone, hitting a Juul gives you a headrush. “I didn’t even like it,” Nash said, in reference to his first hit. Most people don’t like it the first time. Tave didn’t like it either, but she kept trying because she “wanted to see what all the hype was about.”
Same goes for most. There’s probably a psychological reason to explain why people gravitate toward certain things even after having a negative initial experience, but we’re not going to get into that now. The point is, somehow, Juul stuck.
Tave thinks it stuck because the effect is so fleeting. “It’s such an epidemic now probably because of the short amount. You keep wanting it and wanting it,” she said.
Fay expanded on this by pointing out how convenient the short-lasting feeling is.
“That’s what’s nice about it for parties. If you don’t wanna get high or drunk, but you wanna do something, you can still do it,” she said. “And I think that that’s the attraction for a lot of people; that it’s fast.”
Nash likes that it’s fast too; so fast that he can sometimes get away with using it in class. He demonstrated during an interview. He hit the Juul and waved his hand through the vapor. “Four seconds it’s gone,” he said.
Junior and non-Juuler Cece Eagleston said that she’s seen people Juuling in class before. “A lot of them just have it out, on their desk, and I’ll see people taking it in and out of their pocket, or charging it in their Chromebooks,” she added.
This is largely possible because many teachers simply haven’t caught up with the trend. In a poll of 12 teachers at Arcata High, 63% didn’t know what Juuls look like, and 27% had never heard the word “Juul.”
For some teens, the fact that older generations are for the most part uninformed is not only convenient; it’s also, for lack of a better term, cool. Our generation has come to identify with vape. Teens seem to like that it’s ours and not theirs. “It’s like a relatable thing. Like a millennial child thing,” Ruth explained. “This is our new thing, like clout glasses. It’s a new trend that everyone likes.”
Fay agreed, and expanded. “Each generation needs something to separate them from the generation before. Now that teen pregnancy is down, birth control is normalized, weed is normalized, we don’t have as much [ . . . ] to rebel,” she explained. “That’s why more teens Juul. I think that maybe from a subconscious point of view, like psychologically, that could be. [It’s] one of the reasons so many people do it, including me.”
This generational determination to be different coupled with a generational carefree attitude has perfectly primed our age group for Juul. “[We’re allowing] something like a Juul [to] jeopardize our health in the future because most of this generation cares more about what is happening in the now over what is going to happen,” Tave said. “We don’t care enough because we have this mindset of ‘f*ck it.’”
It’s almost as if Juul has become a mighty symbol of rebellion for our generation. The way rock and roll shaped boomers, social media shaped millennials, trends like Juul are shaping us. Is that extreme? Hopefully. But vaping is a classified epidemic, and there is no indication that teens plan to slow down any time soon.

Addiction
Let’s rewind. Juuls were invented to wean heavy smokers off cigarettes. Their website reads, “We envision a world where fewer people use cigarettes, and where people who smoke cigarettes have the tools to reduce or eliminate their consumption entirely, should they so desire.”
Since the device was only founded in 2015, little is known about their long-term health effects. As there is no actual tobacco in Juul pods, it’s true that they do not deliver tar into the lungs in the same way that cigarettes do; however, it is unknown whether Juul has any correlations to cancer.
“It’s probably safer [than cigarettes],” said Nurse Kell in reference to Juuls. “But safer isn’t safe.”
Juul is young, but nicotine is not. Humans have been smoking nicotine from tobacco for hundreds of years, and they’ve likely known that it’s addictive for almost as long.
The active ingredient in Juuls are nicotine salts, which have a higher concentration of nicotine than cigarettes, thus making Juuls far more addictive than both regular cigarettes and other brands of e-cigarettes, which use freebase nicotine.
As this epidemic gains national attention, more people are becoming aware of the addictive qualities of Juul. But is the threat of addiction alone enough to stop teenagers from vaping?
All of the students who the Pepperbox interviewed about Juul knew they were inhaling nicotine the first time they hit one, but the prospect of addiction didn’t make any of them hesitate. None of them think they’re addicted, except Nash – kind of.
He described what it’s like to have an addiction. “Like tapping my foot in class, like I showed up five minutes late ‘cause I was hitting it, and then I need to leave ‘cause I need to hit again,” he said.
Nash uses his Juul all the time. He admitted that, “at times,” it’s a problem. At one point, when he couldn’t get pods, Nash said he got “visibly angry.” So earlier this month, he planned to stop. “I was like, ‘I’m gonna stop tomorrow,’ and then . . . I just had a sh*tty day,” he said. But Nash said that since then, he’s been using his Juul more sparingly. “I won’t use it when I don’t need to. It’s been more of a choice,” he said.
Fay, Ruth, and Tave didn’t express the same dependency.
“Over break I didn’t have it, and I just kind of thought about it, but I never got angry,” Fay said. “For me it’s not as much of an addiction as it is for other people.”
Tave also said her Juul habit is far from addiction, but “if there’s the opportunity to do it, it’s hard to back down.”
Even though Juuls may not pose the same threats as cigarettes, they’re equally addictive, and addiction is bad; there’s no sugar-coating it.
“You’re modifying your brain by becoming addicted at a young age,” said Nurse Kell. “This is a seriously strong chemical to be introducing into your system.”
Nash knows this. “It’s definitely both mentally and physically addictive,” he admitted.
Once brain physiology is changed by repetitive nicotine intake, the body will experience withdrawals (a negative physical reaction) if nicotine intake is stopped. Quite often mental addiction develops alongside this physical addiction, which causes emotional cravings.
Nash pointed out another alarming risk of Juuling and addiction. “It does make you more able to get addicted to other things later, if you develop that type of habit and need for a release,” he said.
Outside of school, addiction looks like keeping a Juul at your fingertips all day, mindlessly raising it to your lips every two minutes for a hit. At school, addiction looks like thinking about it constantly, getting angry without it, and leaving class for a hit – developing this distracting dependency that will be so hard to kick when you finally want to stop. Addiction is not something to brush aside.

School
Arcata High saw its first e-cigarette about five years ago, according to Principal Dave Navarre. Until about a year ago, they popped up once or twice more, but the occasion was rare. But recently, the school has “seen a rapid spike in the number of students [vaping on campus],” Navarre said.
There have been about 12 students disciplined for vaping at school over the 2018-2019 school year, according to Arcata High School Vice Principal Jim Monge.
In response to these increasing numbers, the school began printing a notice in the AHS bulletin to remind students that owning the device is illegal. On January 8, it urgently read, “STUDENTS!! Vape pens are illegal to have at school. If you are caught with a vape pen, you will be suspended or possibly expelled. Do not bring vape pens to school.”
The administration found that kids continued to vape at school despite the message, so on Monday, January 13, they changed the tone. The replacement notice read: “Students, if you have a nicotine addiction, we encourage you to meet with our school nurse, Mr. Kell. There will be no school disciplinary action taken. Your social/emotional/physical health is our number one priority.”
Nurse Kell confirmed that students have visited him since the notice went out. When kids ask him for help with addiction, Kell discusses how to quit with them. “It has to be your choice,” he said. “Even if you wanna go in with some friends, [and] try to do it together, it still needs to be personal.”
Kell suggested planning ahead, picking a specific and significant day to quit, and to have a strong support system. “Wherever you can find reliable help, because you can’t really do it alone,” he said. Kell also pointed out that “you may have to switch up your friend composition, [because Juuling] continues in groups.”
In alignment with the new bulletin notice, the school is trying not to be “reactionary,” according to Navarre. But both owning a vape pen under the age of 21 and vaping at school is illegal; it’s classified as a misdemeanor. “[Students] would not be disciplined for visiting the nurse, but if a student is caught smoking in the bathroom, they have to be disciplined,” Navarre said.
The school tried to eradicate the problem as quickly as possible by asking teachers to help. “Part of it is an awareness campaign, talking to teachers, asking them to visit the bathroom more,” Navarre said. “In all of these cases, almost, it’s the teachers catching the students.”
But ultimately, administration has found that there is no quick fix. As the problem continued to proliferate, administration somewhat shifted their response, as seen in the updated bulletin notice. “This is a compassionate school,” Navarre said. “The idea is not to get kids in trouble. If these kids are getting addicted, [ . . . ] that’s our number one concern. How we can help them with that?”

What next?
In early January, Principal Navarre received an email from the California Department of Education, California Tobacco Control Program, and the Centers for Disease Control and Prevention, which he shared with the Pepperbox. The email acknowledged that vaping is a rising trend in California schools and added that “each school is trying to develop creative ways to halt this behavior.”
The CDE, CTCP, and CDC are working with Arcata High and other California schools to understand “what works, what doesn’t work, and what kind of resources [schools need] to reduce youth vaping.” They plan to distribute the results in order to help schools move forward with the problem.
In the meantime, administration is working to educate themselves and the AHS faculty. “Nurse Johnny Kell is getting educated, [and] sharing resources,” Navarre explained. “I’ve shared some curriculum [about e-cigarettes] with [health teachers], so they’ll probably look at that and see how to fit it in.”
But Navarre knows that, with limited resources and little information from the medical community, there’s only so much the school can do. “We’ll do our best with counseling and working with our nurse and curriculum,” he said. “Is that gonna be enough? I suspect not.”
Our generation was nearly in the clear. Few of us so much as dreamed of picking up a cigarette, but now 20% of us can’t stop lifting a toxic flash drive to our lips. We’ve been cheated, and we should be mad. But instead, we’re decorating our Juuls with cutesy stickers, posting vape tricks on Instagram, and passing it around at parties, only to get our friends hooked as well.
Ultimately, our parents will continue to beg us to stop, our school will continue to discipline us for vaping in the bathroom, and our doctors will continue to remind us that nicotine and addiction are dangerous. But nothing is going to change until we, the teens, finally decide that Juul isn’t cool.

*These students’ names have been changed to protect their privacy.

JUUL kahleedoniah day vee (dragged)

Health facts collected by Caledonia Davey from Information from the National Center for Health Research, John Hopkins University, JUUL, and the US National Library of Medicine

We do know that the nicotine salt juice used in Juuls is made out of three main ingredients: 5% nicotine, 5% benzoic acid, and 90% propylene glycol and glycerine. With these ingredients, scientists can predict the health effects of Juuling.

Nicotine:
Highly addictive
Toxic to fetuses
Irritation and burning sensation in the mouth and throat
Increased salivation
Nausea
Abdominal pain
Vomiting
Diarrhea.
Impairs brain and lung development in adolescence
Reduces activity in the prefrontal cortex which controls a human’s decision making and cognitive behavior, increasing one’s sensitivity to other drugs.
Stimulates properties consistent with cell transformation and the early stages of cancer formation
Juuls contain twice as much nicotine as other e-cigarettes and use a type of nicotine called “nicotine salts” which allow the nicotine to be more readily absorbed into the bloodstream, compared to the nicotine of other e-cigarettes known as “freebase nicotine.” This makes Juul much more addictive.

Benzoic Acid:
Causes:
Coughs
Burning or irritation of the esophagus
Abdominal pain
Nausea
Vomiting
Juuls contain 44.8mg/mL of benzoic acid which is about twenty-two times more than that of other e-cigarettes’ 2.2mg/mL.

Propylene Glycol and Glycerine:
swelling of the liver
Hepatocyte vacuolization (liver injury)
These symptoms occur only when PG and glycerine are mixed with nicotine. They are more common in women.

Another main cause of health effects is the heating coil within the battery of the Juul. Though there have been no tests on Juuls specifically, there have been tests on the heating coils of other e-cigarettes. These coils can contain toxic levels of metals such as lead, chromium manganese, and or nickel. The health effects of inhaling these metals are:
Lung damage and/or cancer
Liver damage and/or cancer
Immune system damage
Cardiovascular damage and/or cancer