Start-up e-cigarette brand aims to “improve smokers’ lives”BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2930 (Published 06 July 2018) Cite this as: BMJ 2018;362:k2930
All rapid responses
The opinion piece by Professor Kamerow (1) is timely, as recently published data (2) demonstrates how popular JUULING is in U.S. youth, utilising evidence from social media. In a sample of more than 80,000 Twitter posts, approximately 1 in 25 mentioned using JUUL at school, with some tweets linking to videos of children using JUUL devices. As the principle author of the study elucidates:
"We found young people talking about using JUUL on school grounds, in classrooms, in bathrooms, in the library, at recess and during gym," and that "Despite JUUL's branding as a smoking alternative, very few Twitter users mentioned smoking cessation with JUUL" (3)
It is further concerning that a “Big Tobacco” company, Imperial Tobacco, due to the “success” of JUUL, are beginning to produce a direct competitor to the JUUL range of electronic nicotine delivery devices (4).
“The type of experience JUUL delivered was definitely a step forward,” Alison Cooper, CEO of Imperial Brands was reported as informing Bloomberg. “Smokers weren’t switching completely in to vaping before because the experience wasn’t satisfying enough” (4) - likely why, to date, e-cigarettes have been identified as not being the “disruptive technology” that some observers have claimed they are (5).
First and “new- generation” e-cigarettes have substantially less ability to delivery nicotine to the user (6), delivering approximately one third to one fourth of the nicotine after five minutes of use compared to smoking a conventional cigarette. Thus, the development of e-cigarettes, like JUUL and the Imperial Tobacco MyBlu device, that can much more closely mimic the rapid nicotine hit of conventional cigarettes, mean that children using the devices are much more likely to get hooked.
As has been demonstrated, it takes only minimal exposure to nicotine, when delivered via a cigarette, for adolescents to very rapidly develop the first symptoms of dependence (7). Further, it has clearly been demonstrated that very limited exposure to nicotine leads, in the vast majority of adolescents, to a lifetime of addiction. As has been articulated:
“Over 90% of teenagers who smoke 3-4 cigarettes are trapped into a career of regular smoking which typically lasts for some 30-40 years” (8).
The development of electronic nicotine delivery devices, such as JUUL and MyBlu, make the predicted “Gateway to Addiction” in youth (9) very much wider. As Kamerow articulates: “Watch out, world.”
All views are those of the author, and do not necessarily represent those of his employer.
Competing interests: No competing interests