Everything you need to know about the wildly popular USB-looking vapes, including its health effects.

Vaping has become one of the biggest public health issues of our time, and at the center of it is San Francisco-based e-cigarette company Juul. While there are many nicotine vapes on the market, Juul has gained popularity (especially among teenagers) for its sleek design and easy-to-use pods. Even after the company was forced to shutter its social media presence while the FDA investigated concerns that Juul was promoting underage use of tobacco products, Juul continues to prove popular with rising sales and affectionate nicknames, such as the "iPhone of vaporizers."

But what is a Juul, and is it safe to use one? Here's everything you need to know about Juul, including what's in the e-juice, the long-term health effects and how Juul compares to regular cigarettes.

Juul is like many other e-cigarettes, but with a couple of caveats that set it apart. First, this vape is sleek and hardly noticeable: Its USB-drive design can be enclosed in the palm of a hand, and it doesn't produce a massive plume of vapor like some other e-cigarettes. Second, the nicotine content in its cartridges, or "pods," set a new precedent for the e-cigarette market.

E-cigarettes work by converting liquid nicotine into a vapor that the user inhales. They're battery-operated and intend to provide a similar stimulus to that of smoking regular cigarettes.

Developed by two former smokers, Juul's mission is to "improve the lives of 1 billion adult smokers by eliminating cigarettes." One way the company encourages the switch from cigarettes to Juul is with its Juul calculator, where people can estimate how much money they'd save if they used a Juul instead.

Juul's high nicotine content used to be an anomaly in the e-cigarette market, but now researchers note it seems to be the rule. After Juul's surge in popularity, other e-cigarette manufacturers began bumping up the nicotine content in their products.

Juul uses a closed system, which means users can't refill the pods themselves, a helpful factor for quality control.  Some e-cigarettes, such as the Suorin Drop, use open systems that allow users to refill the vape themselves with bottles of e-liquid or e-juice.

Juul's small size, compact design and minimal plume make it more discreet than many other brands. With no buttons or switches -- just disposable, snap-on cartridges -- Juul is simple, and its built-in temperature regulation prevents you from experiencing a "dry hit." Dry hits occur when vape cartridges get too low on liquid or when they overheat, producing a burnt taste and throat irritation.

The Juul comprises two parts. There's the e-cigarette itself, which contains the battery, temperature regulator and sensors that read the charge level. Then there's the pod, which contains Juul's patented e-liquid formula. A mixture of nicotine salts, glycerol, propylene glycol, benzoic acid and flavorings.

The nicotine salts in Juul vape juice are a type of nicotine that supposedly feels more like a cigarette when inhaled, as opposed to other vapes that use freebase nicotine. Freebase nicotine, which can cause coughing and leave a film in people's throats, is harsher and commonly found in cigars.

Juul pods currently come in eight flavors; cucumber, creme, mint, mango, menthol, fruit, Virginia tobacco and classic tobacco. It's worth noting that the FDA's Family Smoking Prevention and Tobacco Control Act banned flavored cigarettes in 2009, so it's possible that this might come into play for vapes one day, too.

Juul measures nicotine content by weight, which is different from most brands, which usually measure by volume. Juul originally only sold pods with 5% nicotine by weight, but started offering 3% pods in August 2018.

According to an older version of Juul's FAQ page, one 5% pod contains roughly the same amount of nicotine as one pack of cigarettes, or about 200 puffs. However, this information is no longer available on Juul's website, and there's no precise information about 3% pods, either. However, an article in the New England Journal of Medicine says that the 5% pods contain a concentration of 59 milligrams of nicotine per milliliter of liquid.

In contrast, prior to the Juul frenzy most vapes contained roughly 1 to 3% nicotine by volume. A study in the journal Tobacco Control notes that the new average seems to be rising to that 5% mark. Juul's creators increased the nicotine because they felt other vapes on the market couldn't compare to the sensations delivered by regular cigarettes.

An older version of Juul's FAQ page disclosed precise information about the nicotine content in Juul pods. However, this information is no longer on the site.

Nicotine is a known addictive substance, and Juul is no exception. There are currently no studies that prove whether or not Juul is more addictive than regular cigarettes, simply because e-cigarettes are a relatively new phenomenon. However, I certainly know people who seem as addicted to their Juul as they are to their iPhones, and I've watched friends throw fits when their pod runs dry.

Nicotine is a harmful drug, regardless of delivery method. It's linked to various changes in the body and brain, and public health officials worry that most people, especially youths, aren't aware of the potential consequences.

Many people consider vaping a safer alternative to smoking because it eliminates tobacco, which is a known carcinogen. But cigarettes contain many chemicals beyond tobacco, and e-cigarettes contain some of the same.

Studies have detected acetamide (a compound used in industrial solvents), formaldehyde and benzene (another known carcinogen) in various e-cigarettes brands.

Not all e-cigarette liquids contain all of these toxic compounds, and even in those that do contain them, the concentration isn't always high enough to cause concern. One study looked at the benzene formation of Juul and two other vaping systems versus traditional cigarettes, finding that traditional cigarettes present a higher risk of benzene exposure. However, the study authors note that the benzene exposure created by e-cigarettes is not negligible -- that is, there's still a health risk. 

Another study looked at adolescents who use e-cigarettes and found that their urine contained significantly higher amounts of five different chemicals, compared to adolescents who never use e-cigarettes.

Another issue arises when companies don't disclose what's in their products. Juul openly states its e-liquid ingredients, but research has found that e-cigarette products aren't always labeled accurately, which can cause people to inhale more nicotine and chemicals than they think they're breathing in.

Nicotine is a highly addictive substance that causes cravings and bona fide withdrawal symptoms when those cravings are ignored. Whether or not vaping is a "gateway" to cigarette smoking is irrelevant because vaping itself is an addictive habit.

Nicotine isn't just addictive, but it's also toxic. It stimulates your adrenal glands, spiking adrenaline production and leading to a series of bodily reactions: People who use nicotine experience a release of glucose and an increase in heart rate, breathing rate and blood pressure.

The drug seems to act as both a stimulant and a depressant at the same time, as it's linked to increased alertness but also increased relaxation.

Use of nicotine is also associated with a number of side effects on organs and organ systems, including:

"The prefrontal cortex, the area of the brain responsible for decision-making, logic, personality expression and many other traits integral to one's personality, is not fully mature until around the age of 25," Dr. Lawrence Weinstein, chief medical officer of American Addiction Centers, told CNET. "Introducing nicotine to the brain 10 years prior to that, without speaking of the massive amount of nicotine contained in each cartridge, will undoubtedly alter that developing brain."

Looking beyond nicotine, using e-cigarettes -- Juul or otherwise -- comes with many health risks, including the possibility for seizures, heart attacks, lung damage and birth defects.

Dentists have also been noticing that their patients who vape are experiencing more cavities, tooth damage and dental issues. Especially when it comes to the enamel on your teeth, once damage is done it cannot be reversed.

Lastly, e-cigarettes work by heating a liquid into an aerosol that the user inhales. While the amount of aerosol in a single puff isn't likely to harm anyone, it's worth noting that inhaling aerosols is associated with impaired judgment and functioning.

As for the long-term health effects of Juul and other vapes, doctors and scientists aren't sure yet. E-cigarettes are too new for health professionals to make any correlative claims like they can with traditional cigarettes. But with so much research in progress, new claims will certainly surface. 

Although Juul demands age verification upon navigating to its website and holds a firm stance against minors' use of Juuls, these vapes are still wildly popular with teens.

Depending on the state, no one under 18 or 21 is supposed to be able to purchase e-cigarettes or any tobacco products. But according to a report from the CDC, e-cigarette use is rising among middle school and high school students, and more than 3.5 million of them used e-cigarettes in 2018.

Advertising is part of the problem. According to the CDC, more than 18 million high school and middle school students combined were exposed to e-cigarette ads in 2014. And Stanford researchers point out that Juul's marketing hasn't been congruent with its adults-only stance. 

The explosive popularity of Juul and others like it among kids is particularly troubling because they often do not see it as harmful. A report showed that 63% of people aged 14 to 25 aren't even aware that vaporizers like Juul contain nicotine at all.

In April 2018, the FDA demanded that Juul submit marketing and research documents, and explain what Juul knows about the use of its products among teens. A month later, as part of the FDA's Youth Tobacco Prevention Plan, the agency also requested information from several other e-cigarette manufacturers. And in October 2018, the FDA visited Juul's San Francisco headquarters to gather information on the company's sales and marketing tactics.

Despite the fact that selling tobacco products to minors is illegal, the FDA has so far uncovered 40 violations for illegal sales of Juul products to young people. Warning letters were issued for those violations. The company also shut down its Facebook and Instagram accounts in November 2018 to avoid promoting its product to teens and nonsmokers -- two groups that Juul specifically says it does not want to become customers.

In a statement, FDA Commissioner Scott Gottlieb said, "...the nicotine in these products can rewire an adolescent's brain, leading to years of addiction."

But, he continues: "Make no mistake. We see the possibility for electronic nicotine delivery systems (ENDS) products like e-cigarettes and other novel forms of nicotine-delivery to provide a potentially less-harmful alternative for currently addicted individual adult smokers ... But we've got to step in to protect our kids."

The FDA continues to monitor Juul and vaping in general, recently calling Juul out for marketing the device as safer than it really is, as well as investigating the 120-plus vape-related seizure cases.

The Centers for Disease Control and Prevention (CDC) isn't a fan of Juul or other e-cigarettes, either. The CDC says outright that e-cigarettes aren't safe, especially for children and teens, and is currently investigating cases of lung disease associated with vaping.

While federal government bodies have been warning people about the health risks of vaping for years, e-cigarette use has become such an epidemic that state and local government bodies are finally taking note. San Francisco -- the headquartering city of Juul -- became the first city to ban e-cigarette sales completely.

Juul Labs spun off from Pax Labs in 2015. Founders Adam Bowen and James Monsees co-founded the company when, as former smokers, they decided they wanted a better alternative to cigarettes than anything that was already on the market.

Their idea of "better" manifested as Juul's high nicotine content and slim design that gives off very little vapor compared to other vapes. Since its debut, Juul has grown to dominate more than 50 percent of the market share.

In December 2018, Altria -- one of the world's largest tobacco products companies -- bought a 35% stake of Juul for $12.8 billion dollars. Altria owns Phillip Morris, which owns the brands Marlboro, Virginia Slims, Parliament and other cigarette brands.

Candy- and dessert-flavored e-juice is enticing to kids who might be otherwise turned off by vaping or smoking.

Juul's staggering success prompted many e-cigarette brands to follow suit with high nicotine content and new designs. The FDA isn't happy with these copycat brands, and neither is Juul, which filed a complaint with the US International Trade Commission for patent infringement.

Everyone should be concerned about copycat Juuls, especially those that openly market to children using enticing flavors like Blue Slushie Lemonade and strawberry whipped cream. 

The attributes of these vapes -- attractive, compact and free of odor -- make them popular with young people because they can easily hide them from authority figures, like teachers and parents.

Juul's popularity and the influx of similar products raises concern that this new "pod mod" class of e-cigarette products is not just a trend and will influence the decisions and habits of adolescents for their entire lives.

Staying true to its stance on nicotine use among minors, Juul announced that it is going after companies that do market to children and teens, but the FDA warns that this is an ongoing battle. 

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