Talking To Teens: Expert Tips for Parenting Teenagers

Andy:
You got this whole book on Juul and the vaping industry, really the rise of e-cigarettes. I wonder what inspired you to do this research and to write this.

Jamie:
In my day job, I am a health and science reporter at Time Magazine. Around, I want to say, 2018 we started to notice that a lot of our readers were really interested in vaping and specifically Juul. There was a ton of search interest, like on Google. We were just hearing a lot about it. So I just did a very, very basic story about what Juul is essentially and what vaping is. That story blew up. So many people read it. So many people wrote to me about it. After that, I kind of kept on the story. I found it pretty interesting. It just sort of grew to a point where it became more than a health story. I was interested in the people behind the company and how the company got as big as it did and how it interplayed with the cigarette industry. So I decided to just turn it all into a book.

Andy:
What was that original article? It was just about what Juul is.

Jamie:
I honestly think the title was something like, What is Juuling? What is Juuling and what should you know about it? It was incredibly basic and straightforward and then just kind of snowballed.

Andy:
But I am curious. What should we know about it?

Jamie:
Juul is an e-cigarette. As a category, e-cigarettes are just what they sound like, an electronic version of a regular combustible cigarette. They heat up a fluid that contains nicotine and nicodine to an aerosol that you can inhale so there's no combustion, nothing's lit on fire. The idea is that this is less dangerous than smoking but still delivers nicotine. So intended as a way for adults to stop smoking cigarettes, but as you know and the reason I'm on a podcast called Talking to Teens, it ended up becoming very popular also with people who did not already smoke including underage users. Especially maybe three, four years ago now it really blew up among high school and middle school students, just incredibly popular. Something like a third of teenagers vaped or almost a third of teenagers vaped in 2019. So it's just this really interesting story of a product that was meant to do something good and be good for public health really spiraling in a way that people did not expect.

Andy:
You go way right back to the beginning of the whole story and this project at Stanford where these two dudes put together this idea for creating this product as part of this project for their thesis, I guess. That's interesting because you say that part way through their presentation asked the question of, what if smoking were safe? They say, "Our goal was to basically create a whole new experience for people that retains the positive aspects of smoking, the ritual and everything, but that makes it as healthy and social acceptable as possible." So even from the beginning it seems like that was framed as trying to help people quit smoking but that maybe there was more to it than that. It was really a different version of smoking and a whole new experience that retains the positive aspects of smoking that makes it as healthy and socially acceptable as possible.

Jamie:
One of the things I like to point out is that the two founders of Juul, James Monsees and Adam Bowen, they were both former smokers. They made Juul not because they hated smoking but because they liked it. They liked to smoke, and they were just smart enough to realize that if they kept smoking it would kill them. So the Juul was really something meant to scratch that itch. It is not founded by people who hate the tobacco industry. It's just founded by people who wanted a way to keep a habit that they actually did enjoy but didn't want to die from.

Andy:
They said that actually that a lot of the smokers they talked to expressed those kind of sentiments that they didn't necessarily want to not smoke. They just wanted to not die-

Jamie:
Exactly.

Andy:
...and it not be bad for them.

Jamie:
Exactly. They included videos from their classmates at Stanford in their thesis presentation when they made the prototypes that went on to become Juul. It was really interesting to listen to people describe kind of lovingly their relationship to smoking and how passionately they felt about it. Obviously these are smart people. They're at Stanford. They all knew that they shouldn't be smoking, but they enjoyed it. That was the void, I guess, that Juul ended up filling for some people.

Andy:
Part of what they did early on in their company was trying to chip away at the stigma around nicotine. What do you mean by that, and how did they do that?

Jamie:
Nicotine is incredibly stigmatized in the US, I think, in some ways because public health has been so successful on the issue of smoking in this country. Kids today grow up knowing that cigarettes are terrible for them. They know that you shouldn't smoke. It's actually to the point that a lot of teenagers I've interviewed in the course of my reporting have said, "I would never smoke. It's disgusting. It's bad for you. It's gross. No one does it." The argument within the vaping community or within the e-cigarette industry is, yes, cigarettes are bad for you and gross and you shouldn't use them, but the nicotine in them is not the problem. It's the combustion process of lighting a cigarette on fire that's actually bad for you. So what Juul and other companies in this space have tried to do is argue that it's not inherently bad to use nicotine. You just should do it in a smarter and safer way. They argue that is where Juul fits in to the equation.

Andy:
What's the research on nicotine? Is that true?

Jamie:
It is and it's not, I would say. It is objectively true that nicotine is not the thing in a cigarette that gives you cancer. That is something that's very closely tied to the combustion process. But I would argue and many researchers would argue that addiction unto itself is a health problem. You-

Andy:
It's not great.

Jamie:
Yeah, it's not great. You don't want to be dependent on any substance whether it's anything really. Nicotine is addictive. I don't think that is really up for debate at this point. There is some research to suggest that it can be bad for brain development among younger people, specifically people under 25 whose brains are still developing. There's some research to suggest it can affect some aspects of brain maturation. I think it's an interesting point on one level because it is true that there are safer and less safe ways to consume nicotine, but it's also a bit of an oversimplification, I would say, to say that nicotine is totally harmless because there's always going to be that addictive element to it.

Andy:
Even in terms of the safer and not safer ways to consume nicotine, that seemed like you were pointing out some sort of conflicting evidence in terms of that. Like, some people are saying, "Oh, Juul seems pretty on the safe end of the spectrum," and others are saying that they don't. What does that look like?

Jamie:
There is an incredibly fierce debate within the public health world about how useful e-cigarettes are. There are some experts who, just like you said, would put them pretty close to cigarettes on the spectrum of dangerous things you can consumer, and there are other people who would put them much lower on that risk continuum.

Jamie:
I think the way I think about it is obviously if your choice is breathing fresh, clean air into your lungs or inhaling the vapor from an e-cigarette, a hundred times out of a hundred, you should choose fresh, clean air. But if you are smoking a cigarette, which is one of the most dangerous consumer products ever sold, an e-cigarette probably is better for you than that. To me, there's no credible argument for why somebody who does not already use a tobacco product should start vaping, but I do think there's an argument to be made that if you are currently smoking, at least on a short-term basis, switching to an e-cigarette is better for you or less bad for you, I guess, I should say. There have been some studies that show that vaping does damage your lungs but less than smoking. So that, to me, is the linchpin. If you are smoking, you could see improvement. If you are not, of course it's going to be worse for you than not using any tobacco product.

Andy:
There are some interesting stuff in here from Adam's co-chemist. It's talking about early on when they were developing the product, they started to get worried about the potential for addiction because unlike traditional cigarettes have a built-in off switch, they burn out. You smoke one of them, and then it goes out. Whereas the Juul doesn't have that. It can last for 200 puffs and deliver about as much nicotine as an entire pack of cigarettes really conveniently. So they started to get worried that maybe they were making it too easy to consume that could have negative repercussions.

Jamie:
Early e-cigarettes, by and large, people did not like. The reason for that is because the kind of nicotine that they had to use in the liquids that they use was very harsh. It hurt your throat. It tasted gross. It was not fun to inhale. Then Juul comes along. They have this really sophisticated chemistry and formula to it specifically designed to give you a little bit of a kick, sort of similar to what you get smoking a cigarette, but nowhere close to as harsh and as disgusting as the earlier models had been. So this was, in some ways, a selling point for the product, that it was much better to use. But some of the people on the inside developing it did have concerns that it was too easy to use because it does contain quite a lot of nicotine. The fact that you can just drag on it all day long without having coughing fits and feeling disgusting is a bit of a concern that you're going to drive people to just consume way more nicotine than they even perhaps know that they're consuming or want to be consuming.

Andy:
It kind of makes me think of energy drinks compared to drinking coffee. You can drink one energy drink; it's like four cups of coffee in one can. It tastes like fruit, and it's delicious.

Jamie:
Exactly. I feel like everyone's had that moment where you realize you've gone too far with coffee or caffeine. You're jittery and shaking, and you didn't mean to get to that point but you're there. I think a lot of people experience something similar with Juul because it's not harsh but it is really strong. So all of a sudden you're like, "Wow, I've consumed a lot of nicotine in one sitting."

Andy:
It's just too easy, and it tastes like fruit flavors.

Jamie:
Not anymore but once upon a time. Now they can't sell any fruit flavors.

Andy:
You said they originally had four flavors.

Jamie:
Correct, they did. When they launched they had mango, crème brulée, fruit, and mint. Then over the years the FDA has regulated the industry much more closely. Now they cannot sell any flavors except menthol and tobacco.

Andy:
What's interesting was as they started to market the product, the marketing didn't seem to be in line with what their mission of helping people to quit smoking because if they were really looking at the demographic of people who were smokers and wanted to quit, that would be a middle-aged adult from a fairly low socioeconomic class, often a person of color. But they were really appealing to much more to Millennials, like targeting influencers and really trying to make it seem trendy and cool. It seems like there's a disconnect or something.

Jamie:
Juul launched in 2015 with a campaign called Vaporized. This campaign was bright colors, young, fashionable models dancing around with Juuls in their hands. If you see these ads, they look very much like the way you would expect any startup to market a cool, trendy tech product to Millennials. In many of these ads they didn't even disclose, or at least not in large type, it was in fine print at the bottom, that this was a product that even included nicotine.

Andy:
Wow.

Jamie:
So a lot of people did not realize that's what they were seeing ads for in the beginning. I think as soon as that campaign came out people in the tobacco control world were nervous because it clearly looked like this was a brand that wanted to advertise to young people. As we talked about before, that wasn't really who was smoking. That wasn't the population that could benefit from this product. So right from the moment they launched in the year 2015 people were wary of this company. Then as it did end up taking off among teenagers, I think a lot of those fears came to pass.

Andy:
You have some quotes in the book from people who even just thought that they were inhaling flavored water or something. There was just not even an awareness of really what the product even is.

Jamie:
There was a famous study done somewhere around the time that Juul launched, maybe a couple of years after, and just a shocking percentage of the teenagers surveyed for this study had no idea that e-cigarettes contained nicotine. They thought that they were just inhaling flavored water vapor. I've heard that from so many families of how their child ended up getting addicted was they did not know. They didn't have any clue what they were using.

Andy:
Don't they have to mark that now on the box or on the product somehow that says "Contains nicotine" warning?

Jamie:
Yeah, they do. If you buy a pack of Juul pods now, there's a huge sticker that takes up about a third of the box that says, "Warning. Nicotine is a dangerous chemical," all of that stuff. But when they first launched that did not have to be on the packaging, and a lot of people were caught unaware.

Andy:
Is that changing the way the way that it's spread or the spread of it now that it's marked so clearly?

Jamie:
You mean among teenagers?

Andy:
Yeah.

Jamie:
I think for a few reasons it does seem that fewer teenagers are vaping and specifically using Juul now than they used to. Like I said, in 2019 it was something like 27% of high school students had vaped in the last month, which was far, far higher than cigarettes or cigars or any other tobacco product. Now that number is down closer to 10%, which is a pretty huge drop in the course of only a few years. I think part of that is there's more awareness of how addictive these products can be, and a lot of young people, for obvious reasons, don't want to get addicted. The pandemic, I think, has played a part just since kids haven't been at school. They maybe haven't been going to parties in the same way, and so the access wasn't quite there. Then I think also the FDA has really cracked down on this industry banning flavors and taking some products off the market. So I think the combination of those factors has led to a decrease.

Andy:
It sounds like when it first came out it was really, really easy to get for teenagers.

Jamie:
Yeah, for sure. When Juul first launched they did have an age verification platform that they used on their website, but I spoke to a bunch of teenagers who basically said it was not hard to find a way around it. It's not all Juul's fault. To their credit, people would buy in bulk and then resell on eBay and Facebook Marketplace and all these places where Juul would try to take those posts down, but there's only so much they can do.

Jamie:
One scam that I heard that was very popular is a teenager would somehow get their hands on a Juul. They would send a replacement request to the company. All they had to do was send them the serial number of the product they already had and say, "This broke or whatever. I need a replacement." Juul would, kind of with no questions asked, just send them a new one. Now they have two, and they would sell the extra, and this scam would just keep piling up. Now I do think the company has gotten some of this under control, but in those first few years... Teenagers are smart. If they want something, they're going to find a way to get it, and there are all kinds of ways that they found.

Andy:
There's information here about it was things people were posting on Twitter at the time and how much it was infiltrating teenagers and becoming part of teenage culture, like such a thing for kids to do in a bathroom at school or a fun thing to hide from adults.

Jamie:
The Juul looks just like a flash drive. If you've ever seen one, it's this little metallic stick that fits in your pocket. It's super sleek and discreet. It actually looked so much like a flash drive that, especially in the beginning, teachers didn't know what it was. They thought kids just had USB sticks in class. By the time it started to get really, really popular, at least one school that I found in my research was having such a difficult time differentiating between a legitimate flash drive and a Juul that they just banned flash drives at school. They said, "You can't use them because we don't know if it's a Juul or not." So that was crazy. Another one I heard is one school had such a problem with vaping in the bathroom that they actually took the stall doors off so that they would know who was in there vaping. It truly got wild. Schools were just overrun with kids Juuling.

Andy:
Thankfully, then they started a campaign to go into schools and educate kids about e-cigarettes.

Jamie:
This, I think, is the craziest chapter in the book. When people read it this is the one that really gets them and surprises them that it ever happened. The way it went down is around 2018 Juul was starting to become aware that teen vaping was a big problem. They were hearing that schools were having trouble with it. They decided that it would be a good idea to hire two former educators to make an anti-vaping curriculum that they would then pay schools to teach to students, and somebody selected by Juul would come in and teach the program in some cases. So essentially you have the company that not single-handedly but to a large degree is fueling the vaping issue trying to position themselves as the one who would solve the problem and actually going into schools to do that. That's kind of insane on its own. But it's even more so if you know anything about tobacco industry history because tobacco companies were famous for doing exactly this. There are numerous studies that show it doesn't work. It's often counterproductive. Students see the branding associated with these programs.

Andy:
They become more exposed to the brand and familiar with it.

Jamie:
Exactly.

Andy:
They're pretty good. They're coming in and helping the school.

Jamie:
Exactly. So it just present a whole slew of conflict of interest issues. It got shut down pretty quickly at Juul, but the fact that they even did this program as recently as a few years ago was somewhat baffling to me.

Andy:
It's almost like they're giving away a $10,000 no-strings-attached grant to school districts to develop programs.

Jamie:
So many people who I interviewed, or at least one very prominent tobacco control expert had actually spoken to Juul and told them not to do this, that it was a bad idea. Sent them studies about tobacco companies that had done this. They just went ahead and did it anyway.

Andy:
"We're going to go for it."

Jamie:
Yeah. "We're going to try."