USERS

Vaping. The popular trend, the dangerous epidemic, the social drug of the 21st century. The topic of dinner table talk. While teen cigarette use is at an all-time low, vaping has taken its place in high school settings. The long term effects are unknown. It’s prevalence isn’t.
42.2 percent of Clayton High School students have tried vaping. 12.8 percent are currently addicted to nicotine. And almost 80 percent have seen JUULing and vaping on Clayton’s campus–a third of all students report seeing on-campus vaping daily.
“It was my sophomore year,” said CHS senior Catherine*. “A friend of mine had bought a Sorin Drop. I would use it before practice and then I went and bought my own a month after because I just liked getting buzzed I think. I thought it was kinda cool. I don’t really get buzzed anymore, but I remember that it’s like this blackout, dizzy feeling. It’s more of the anticipation of it that’s better than the actual buzz.”
It became a constant part of Catherine’s life quickly. She developed a dependence on nicotine.
“When I would go without it, like on a family trip or something, I couldn’t sleep. I had insomnia. At home I couldn’t go more than a couple hours without hitting it. I would go crazy without it. Summer of junior year I switched to JUUL,” said Catherine.
Catherine is aware of her addiction, but has no plans to stop using JUUL.
“I have no intention of quitting anytime soon,” said Catherine. “My parents know, they’ve been getting on me about it. It hasn’t had any consequences. I rely on it but it’s something I look forward to at the end of the day that can’t be replaced. I’m not scared by what I’ve been reading in the news because it’s false. There’s nothing innately wrong with nicotine.”
Not only are her parents aware of this drug use, but they support it by supplying her with nicotine refills biweekly.
“I don’t spend my own money on vaping anymore,” said Catherine. “My parents buy me a pack of four 3 percent [nicotine JUUL pods] every two weeks. They said that if I got off other drugs they’d be okay with me JUULing.”
She’s used JUUL as a tool to stay off harder, and potentially more dangerous drugs. Her reliance on JUUL allows for distraction, but also dependence that goes beyond solely nicotine addiction.
“When I would do Adderall, I would be so high for so long that when I would come off of it, it was so hard for me to be normal unless I had my JUUL,” said Catherine. “I would be so depressed sometimes that I didn’t have anything, but I had my JUUL. Nicotine has gotten me through cravings for some much stronger stuff. When I don’t have it I feel like I have to use something else.”
Catherine usually uses one JUUL pod, the equivalent of a pack of cigarettes, every two or three days. This forces her to ration her JUUL usage and turn to old pods as the two weeks comes to an end.
“I have a baggie of basically empty JUUL pods and when I’m out I’ll go through all of them. Even though there’s essentially nothing in them. It will make me feel sick but that’s what I do.”

Another CHS student, Isaac*, has a similar dependence on nicotine products, but opts for devices other than JUUL.
“I started about a year ago,” Isaac said. “The first thing I got was a Sorin Drop. And I just haven’t stopped since. I heard about vaping online and just decided I wanted to do it. I paid some minor to get it for me. They bought it from a store that sold to minors.”
Isaac has also tried various THC products, which he purchased illegally online.
“I’ve used dab pens too,” Isaac said. “I would buy [THC cartridges] online. Using the dark web. There’s people at the school that go on the dark web. It’s this special browser that you download onto your computer. There’s all of these encrypted links and you can buy whatever you want. Drugs. Guns. Whatever you want. It’s really easy.”
While JUUL may be one of the more popular devices at CHS, Isaac uses a variety of other products.
“I don’t have a JUUL. I have a Sorin Drop. The Sorin Air Plus. My box mod. This yellow thing and a Boulder. I have all of them on me right now,” Isaac said. “The most I’ve ever spent on vaping was this month. I bought $100 box mod. I have it on me.”
Isaac attributes his continuation of vaping less to nicotine addiction, but to the social aspects and “clout” surrounding the habit.
“It’s definitely a social thing,” Isaac said. “We used to have sessions between classes. One time there were 16 of us in there. Everyday I see squads in the bathroom vaping. Every passing period. I’m a part of that. People vape in class. Whenever the teacher turns their back they just whip it out. It’s everywhere.”

Isaac’s pattern of vaping is heavy during the school day, with a decline in the afternoon when he gets home.
“I usually go overnight without vaping. I usually do it right when I wake up. Going to school. Before first period. Before second. Before third. Between every passing passing period. On my way home. Sometimes I hit it in class, through my sleeve or through my shirt. I’ve never been caught–at school,” Isaac said.
But he has been caught at home. His vaping has had a negative impact on his relationship with his parents.
“My parents have caught me so many times,” Isaac said. “They’ve taken a lot of my stuff. I think it makes them really sad. I kind of feel bad about that. It made our relationship worse. They’ve stopped taking my stuff now. I don’t need to hide it anymore. My mom found my [Sorin] Drop pod on my bed after it had fallen out of my pocket. She just handed it back to me.”
Another student, Noah*, uses vape products as well.
“I probably vape three to four times a day,” Noah said. “It’s gone down cause recently I’m trying to quit. Well, I don’t know if I’m really trying to quit. It could be bad for me potentially so I want to do it less.”
Noah sees a lot of people using dab pens in a school setting and on a regular basis, although he does not use them regularly like some of his friends and classmates.
“I know a lot of people that hit [dab pens] everyday. People will hit them before basketball practice and their performance is obviously worse,” Noah said.
Additionally, THC vaping has been an introductory drug for CHS student Jack*, whose drug use has been extensive.
“I wouldn’t say that vaping is a gateway drug, but dab pens definitely have been,” Jack said. “I’ll go from least illegal to most illegal: nicotine, alcohol, marijuana, THC, cocaine, LSD, shrooms, Xanax, Percocet, Hydrocodone, Robitussin, Adderall, but I take that everyday. And molly.”
While vaping and JUULing have become an obvious trend among teens and young people, it’s a trend adults have taken up as well as a means to replace cigarette smoking.
“I didn’t smoke cigarettes until I was 30 years old,” said Clayton resident Jackson*. “I smoked for ten years, maybe a pack or two a week. I wasn’t a regular smoker, it was more social. Step out and smoke a cigarette with the boys, if I was drinking some alcohol I’d want a cigarette. Some would consider that not a real smoker. I started to get a little self conscious about that. Once I saw less people smoking, combined with the smell, the coughing, I was done with it.”
For Jackson, the final straw was when he caught a cold and went to smoke a cigarette when his next craving hit.
“I stepped outside to smoke a cigarette,” said Jackson. “I’m coughing while smoking and I thought, ‘I’m good’. I stopped right there. I didn’t smoke for a year, until I discovered JUUL. I go through about two, max three, pods a week.”
Jackson’s introduction to JUUL was not love at first sight.
“At first I didn’t like it,” Jackson said. “I was so used to smoking cigarettes and it wasn’t the same. People 21 and under don’t really know the difference. Vaping is their cigarettes. I believe the issue that people are smoking multiple different options of vape. It’s not just JUUL. People hear vape and think of JUUL.”
While the high concentration has been appealing to Jackson, he found that the main draw has been the convenience of vaping over cigarettes.
“I found convenience in not having to smoke a full cigarette,” said Jackson. “When you smoke a cigarette, you step outside and you smoke the full thing. It’s going to take you maybe five or ten minutes. For me, vaping I can literally hit it twice now, set it down and move along. Nobody smokes part of a cigarette. It doesn’t happen. The issue at times is usage for young people. They don’t know the alternative of smoking a cigarette.”
While Jackson has not experienced any adverse side effects from JUULing, he thinks that many abuse the product because of its inherent convenience.
“It comes without a smell,” said Jackson. “I’ve had no health issues. I don’t cough and phlegm in the morning. No chest pain. There are some people that are definitely abusing it, and the answer there is to not carry it with you wherever you go. Nicotine is definitely going to be addicting. Period. I think it’s less about the addiction and more about the convenience. It’s too convenient. I don’t know if you can really control that.”
As a parent, he has experienced vaping as both a user and a father.
“My son at one point has JUULed. My daughter hasn’t,” said Jackson. “I don’t love that, but I understand it. I’m not one to push back on something because I just don’t agree with it.”
As JUUL has been in the media spotlight, Jackson remains skeptical of the recent reports and articles detailing the hospitalizations and deaths allegedly caused by JUUL.

“I think the THC and black market pods have been a bigger issue,” said Jackson. “Let’s say a kid gets sick and goes to the hospital. He becomes one of these articles that we’ve been seeing online. Does this kid tell his parents everything, or does he just say that he’s been JUULing? How does a doctor truly know that it’s JUUL? Do most adults even know you can smoke marijuana out of a vaping option?”
And while Jackson knows that not vaping is healthier than vaping, he finds that moderation surrounding guilty pleasures is inevitable.
“You should be able to put it away,” Jackson said. “You should be able to leave the house without it. Everyone’s always going to have vices, even if you don’t want to hear that. A grandma might drink two pots of coffee a day. You know what? That’s not healthy for you. Someone might eat McDonald’s all the time. You know what? Not healthy for you. Vaping is just another one of those vices.”

JUUL LABS

Jim Isaacson, a mechanical engineer, recently left his position at JUUL after a little over a year of employment.
“I’ve been in the medical device industry for over 30 years. I was approached by JUUL for a quality position, specifically it’s called design assurance. That’s a quality oversight type of position relative to product development in general. A lot of what JUUL was doing, while technically unregulated by the FDA, was putting in a quality system. Policies and procedures for conducting business, mimicking what many of us know from the medical device field. I was brought in to create and build a group for doing that support,” said Isaacson.
Isaacson was drawn by JUUL’s mission and ideals.
“Very simplistically, their mission is to eliminate the cigarette,” said Isaacson. “Their targeted audience is adult smokers. The idea is, and I personally ascribe to this as well, knowing all of testing and such that were done in house, that it does represent a harm reduction in comparison to smoking cigarettes. I will say that putting nothing into the lungs is better than something into the lungs. It should not be used by anybody, be it adults or teens, that aren’t addicted to cigarettes.”
One concern Isaacson has is the black market and counterfeit material being sold that is attributed to JUUL.
“There’s a lot of counterfeit product out there,” Isaacson said. “It’s possible to walk into some places, some convenience stores, and be able to buy what looks like JUUL product but isn’t. It may be a flavor that JUUL never manufactured. You’re buying, by the virtue of the packaging, what looks like a JUUL product. Additionally, there are other companies that make unauthorized pods compatible with the JUUL device. The problem there is that we can’t speak to their safety in terms of testing. The liquid in the pods, the contents, the ingredients, any of those things. That’s where a lot of the problems have come from.”
Additionally, he stated that the hospitalizations and deaths in the media recently are not the fault of JUUL as a corporation.
“My understanding of the recent hospitalizations, much less deaths, is that much of it has been associated with THC, which JUUL does not partake in,” Isaacson said. “Or it’s been very much associated with counterfeit and unauthorized product. I’m not aware of JUUL being associated with any of the hospitalizations.”
These counterfeit products are dangerous, and the effects of these pods are unknown.
“From a toxicological standpoint, JUUL goes through a rigorous amount of testing in terms of the e-liquid,” Isaacson said. “There’s a whole list of potentially harmful constituents that we look for and testing synonymous with what happens in the pharmaceutical industry. We can’t make any claims on chronic or long term usage. We’ve not had the opportunity to perform those tests. More time has to go by.”

While his recent departure fell around the time of JUUL’s media attention, Isaacson’s leaving had nothing to do with the company’s negative publicity. In fact, he supports the mission JUUL has taken on.
“JUUL has a great mission if you push aside the unintended consequences of the youth and so forth,” Isaacson said. “Here in the United States, we’ve done a great job as a society of taking care of smoking and making it taboo. Smoking is far more prolific in Europe and Asia. Those places are behind America in recognizing the ills of cigarette smoke. And secondhand smoke is another big part of that as well.”
Isaacson does acknowledge the obvious effect JUUL has had on youth and teens, but doesn’t think that the benifits of JUUL should be weighed against its cons.
“I don’t know if I’d say that JUUL’s mission outweighs youth use,” said Isaacson. “It’s a very disruptive technology with a lot of heavy lobbying on either side. There can be a lot of manipulation in the government and media if big tobacco feels threatened by e cigarettes and JUUL. Because of the benefits, I wouldn’t want to look at it as a this or that decision, but rather find a way to still eradicate the cigarette but inhibit the ability for youth to use it.”
Isaacson described the recent change in JUUL’s executive team and its newfound involvement in big tobacco.
“In December of 2018, Altria, a big tobacco brand whose big brand is Malboro, bought a third of JUUL At the end of September, JUUL’s CEO Kevin Burns stepped down and was replaced by an executive from Altria. The new CEO [K.C. Crothswaite] comes from Altria, but it still is a job change for him. He resigned from one company and joined another company,” Isaacson said.
Altria is currently the company with the largest share of the U.S. cigarette market, and it now owns 35% of JUUL lab, one of the nation’s fastest growing e cigarette manufacturers. Altria’s shares are valued at around 12.8 billion dollars. Now that big tobacco has a foot in JUUL, this could lead to Altria’s dominance in the nicotine market.
On November 7, JUUL announced its discontinuation of mint pods, one of the most popular flavors among teens. While JUUL will still be producing both menthol and tobacco flavored pods, this ban is yet another step JUUL has taken to combat teen use.

EFFECTS

Many electronic cigarette companies advertise towards teenagers, claiming that their products are safer than traditional tobacco cigarettes in terms of nicotine delivery. However, Farrah Kheradmand, Professor of Medicine-Pulmonary at Baylor College of Medicine, remains skeptical about the effectiveness and safety of electronic cigarettes.
“Despite the fact that there was a lot of unsubstantiated advertising trying to push their product, I did not see any research or any factual information about [electronic cigarettes] being any safer or any less harmful to the body than cigarettes,” Kheradmand said.
As a result, Kheradmand started a project in her laboratory three years ago to find out the true harms behind the supposedly “safe” electronic cigarettes. One of her graduate students at the time, now Dr. Matthew Madison, took on the research and tested the effects of different ways of smoking by comparing four groups of mice. One group was exposed to tobacco cigarettes, one group was exposed to electronic cigarettes with nicotine, another one was exposed to electronic cigarettes without nicotine and the last group was treated with filtered air. The experiment went on for about four months, which was about 20 to 25 years for mice.
“Over this four month period, we didn’t really see the same effect [on mice exposed to e-cigarettes] that we’ve seen in cigarette smoke, meaning that mice did not develop a lung disease or destructive phenotype as [we] had seen in cigarette smoke,” Kheradmand said.
The team discovered that the group of mice exposed to tobacco cigarette smoke developed emphysema, a type of chronic obstructive pulmonary disease that damages the alveoli in the lungs, while the groups that were exposed to electronic cigarettes, independent of nicotine, had no airway inflammations.

Madison then looked at the slide of the cells that he collected from the lungs of electronic cigarette exposed mice and discovered that the cells of the first line of defense in lungs had been damaged, similar to those of the patients who had vaped extensively. In the past few years, there had been patients who had vaped very often and developed infiltration within their lungs that doctors had seen and described as a form of lipid induced pneumonia, or lipoid pneumonia. Since the solvent in most electronic cigarettes is made out of vegetable materials, specifically vegetable glycerin, doctors assumed that the pneumonia was caused by inhaling the fat extracted from vegetables.
“We tested our hypothesis, which was asking whether the oil that’s accumulating within [the] cells in [the patients’] lungs, is coming from an outside source,” Kheradmand said. “And the outside source would be glycerin, right? You should be able to crack the cells open and measure and quantify the amount of glycerin and show that it is or isn’t.”
However, the team discovered that there was no increase in glycerin material inside the cells, which meant that the lipids in patients’ lungs were not from an outside source, but instead were produced by their own bodies. When Madison compared the cells of the electronic cigarette exposed mice to that of mice exposed to filtered air, he determined that the abnormal lipids in the first group of mice was a result of accumulation of many fats that are normally associated surfactants, which is a combination of fats and proteins secreted by the body that allows lungs to mature.

Normally, the human body uses macrophages to recycle the surfactant in the lungs so they can be reused again, but inhaling the e-juice in electronic cigarettes disrupts this recycling system, which causes the excess surfactants to build up in the lungs.
“We discovered that this accumulation of fats are inside the same cells that have been described in patients that had vaped and got sick,” Kheradmand said. “In a way, our animal models copied what happened in patients that were sickened by vaping.”
In short, patients who vaped felt shorter breaths because their lungs were filled up with these cells that were not capable of recycling surfactants.
The team also discovered that the immune system of mice that were exposed to electronic cigarettes, independent of nicotine, was weaker than that of normal mice.
Since solvents used in the vape solution disrupt lipids that are part of the surfactant in the lungs, macrophages within the patient’s body removed and stored the dissolved lipids in themselves, which caused those macrophages to fail to provide protection against the influenza virus.
Kheradmand warned that inhaling second-hand electronic smoke might be just as bad as vaping itself, just like how long exposure to second-hand tobacco smoke is still very harmful for the body.
“We absolutely do not advise people to switch from e-cigarettes to regular cigarettes because regular cigarettes are just as harmful in a different way,” Kheradmand said. “They actually cause destruction of the lungs, and that particular destruction is irreversible. Time will tell whether the lung problems [from e-cigarette smoking] are reversible.”
Kheradmand advised people struggling with addiction to seek help early and consult with psychology counselors.
“Discuss with doctors and try to understand that there are always ways of medically dealing with addiction,” Kheradmand said.

PSYCH

“Youth e-cigarette use has skyrocketed, so much so today that I am officially declaring e-cigarette use among youth an epidemic in the United States,” Jerome M. Adams announced at a press conference in December of 2018 concerning the use of electronic cigarettes in the country’s youth.
Adams has held the role of the United States Surgeon General since 2017.
“I don’t want there to be any misconceptions about this… I do not use [the word ‘epidemic’] lightly,” Adams said.
This bold statement was a response to the staggering results from the 2018 MTF (Monitoring the Future) survey, a study funded by the National Institute on Drug Abuse, with goals to observe and report trends of drug use in the teenage and youth population in the US. It was found that 37.3% of 12th graders had used a vape product in the past year, a large spike in data compared to 27.8% in 2017. With that, the percentage of 12th graders who had used a vape product in the month prior to when they received the survey was 20.9%, compared to 11% in 2017.
Dr. Erin Morrison from the child and adolescent psychiatry department at Washington University believes that one of the main reasons for the prevalence of the use of electronic cigarettes in teenagers is companies specifically targeting young people, as is elucidated by the variety of flavors that electronic cigarette come in.
“There’s a large percentage of teenagers that just smoke the vape juice that doesn’t even have nicotine in it,” Morrison said. “It’s just the flavoring.”
However, Morrison also observed that vaping may be a way for high schoolers to socialize or “fit in”. Teenagers may sometimes feel that using electronic cigarettes will help them to have social interactions that they wouldn’t have had otherwise, prompting them to use them.

As soon as that first cloud of vapor hits the tongue, the highly addictive product begins its work in the body.
“[The chemicals] can mimic neurochemicals that you already had in your brain,” Morrison said. “It’s a lot like the neurochemical acetylcholine.”
E-cigs also spark a feeling of pleasure in the user, due to its dopamine-mimicking stimulation of the brain’s reward center. Similar to alcohol, users who become addicted and subsequently quit vaping will begin to experience withdrawal symptoms, such as irritability, anxiety and nausea or sickness.
The addictiveness of electronic cigarettes is especially dangerous to people struggling with mental health. A study conducted in 2014 by a group of researchers at UCSD found that 30-50% of all electronic cigarettes used in the US were consumed by people with self-reported mental illnesses.
“We know that people who have mental illnesses are more likely to be tobacco users than people who don’t have mental illnesses. And part of that is because some of the effects of nicotine on the brain is being perceived as helping them feel calmer or less stressed out,” said Dr. Mark Myers, a professor in the department of psychiatry at UCSD who contributed to this study observing the connection between mental state and electronic cigarette use. “[Sometimes] the anxiety or depression is really a product of nicotine withdrawal… [Some] can’t really tell the difference. To them, it just feels bad and nicotine makes them feel better.”
Electronic cigarettes were originally created with the intention of helping people get off of tobacco cigarettes and onto something less harmful. However, Myers believes that the chances of a young person who had never smoked a cigarette before getting hooked onto e-cigs are higher than the chances of a smoker getting off of cigarettes and onto e-cigarettes. In fact, he has reasonable suspicions that electronic cigarettes actually prompt teenagers to begin using tobacco cigarettes further down the road.

“Cigarettes deliver nicotine very, very rapidly,” Myers said. “If you were to take a puff of smoke off of a cigarette, the nicotine would get to your brain in about seven seconds. It’s a very efficient drug delivery device.”
When one inhales cigarette smoke, it is a result of combustion. It goes directly to the lungs, from which nicotine in the blood is then pumped to the brain. However, with electronic cigarettes, the nicotine takes a longer time to arrive at an individual’s brain due to vapor inhilation, which ends up in the airways and must be absorbed to get to the brain.
For a young person who is addicted to nicotine, the faster nicotine delivery time of tobacco cigarettes might be more appealing than an electronic cigarette.
However, a single pod of JUUL e-liquid contains as much or more nicotine than about twenty cigarettes, delivers nicotine more rapidly than its competitors and has a much higher potential for addiction.
Students are constantly being reminded of the dangers of electronic cigarettes at school, whether it be by listening to stories in health class about addiction or seeing posters discouraging individuals from using them. So why is it that the number of students still vaping is so large?
Dr. Morrison believes that this is due to the lack of available information about electronic cigarettes. Because electronic cigarettes haven’t been around for as long as other prevalent drugs, there is still a lot left unknown about just how bad electronic cigarettes really are. And when there is less data backing up a claim, that claim is taken more lightly.

Research in this area is not only limited, but also difficult to conduct.
“The problem is that research, it costs money. It’s a lengthy process, particularly with something like this,” Morrison said. “The other problem is that a lot of these products evolve very quickly… These sorts of things evolve quicker than the Food and Drug Administration and our government… The amount of nicotine has gone up significantly in the last three or four years. It’s difficult to study something that’s evolving in real-time.”
The mental effects of vaping are not its only significant impacts. In recent months, 47 people have died from vaping, and this number is one that continues to rise every day.
Most people, when they first start vaping, do not notice what is happening to their bodies. Going beyond the enormous amounts of nicotine that most JUUL pods contain, vaping itself is harmful to the human body.
These effects are not always noticeable at first. A cough or a bit of trouble with breathing here and there is something that would seem minor to the average person. However, these minor issues do not reflect all of the catastrophic damage that is occuring inside of the lungs.
A study by the University of Pennsylvania showed that from the very first time that someone uses a vaping device, their body will be affected. After just 16 3-second uses of a vape device, participants showed a stunted flow-mediated dilation. Flow-mediated dilation is the widening of one’s arteries so that blood can flow through it. This is something that is an essential element of maintaining nutrient transport and other critical bodily functions, and, after only a few hits, is negatively impacted.
As this trend gains popularity among teens and comes under fire in the media, research on the subject will increase. However, until then, the impact of JUULing and vaping on culture and the human body will remain a dangerous unknown.