Delaware Public Health issues advisory about ‘JUULing’


A selection of the popular Juul brand vaping supplies on display in the window of a vaping store in New York. (Richard B. Levine/Sipa USA/TNS)

DOVER — According to the acronym “JUUL” indicates JUice USB Lighting in an e-cigarette.

To Delaware health officials, this translates into concern for school-age children across the country.

On Thursday, the state’s Division of Public health issued a news release announcing that parents and teachers should be aware of the trending youthful use known as “JUULing” nationwide. DPH was focused on reaching out to schools, school nurses, wellness centers and pediatricians in what it described as a “health alert.”

DPH described JUUL as “a brand of e-cigarette that looks similar to a flash drive and can be charged in the USB port of a computer. JUULs can be appealing to youth for a variety of reasons. Pods come in a variety of fruit and candy flavors, the devices can be difficult to distinguish from a real flash drive, and the vapor dissipates quickly instead of hanging in the air like a smoke trail.

“This has caused concern among school administrators across the country as youth have taken to “JUULing” on school property, even in class.”

In response to media questioning Thursday, a JUUL Labs’ spokesperson said its “mission is to eliminate cigarette smoking by offering existing adult smokers a true alternative to cigarettes. JUUL is not intended for anyone else. We strongly condemn the use of our product by minors, and it is in fact illegal to sell our product to minors. No minor should be in possession of a JUUL product.”

Several emailed inquiries to school superintendents throughout Kent and Sussex counties about the potential trend in Delaware response were not immediately returned.

Polytech School District Superintendent Mark Dufendach said, “I’m not aware of any issues related to this.”

According to Capital School District spokeswoman Candace McCarthy, “This is the first that our superintendent has heard of this.”

According to Milford School District Superintendent Kevin Dickerson, “The health, safety and well-being of our students is always a major priority.

“While we have not had any issues, we have begun educating our school-community regarding this trend and will continue to monitor going forward.”

State taking action

Delaware banned e-cigarette sales to minors in 2014, and expanded the Delaware Clean Indoor Air Act when prohibiting e-cigarette and other electronic vapor devices in workplaces and indoor public areas.

More information about Delaware’s quest to address youth tobacco and e-cigarette use is online at or

“While research is under way to determine the health effects of e-cigarette usage, the aerosol from e-cigarettes contains harmful substances such as nicotine, lead products and cancer-causing agents, according to the Centers for Disease Control and Prevention,” the DPH news release said.

The DPH pointed to a Truth Initiative study indicating that 37 percent of 15- to 24-year-old JUUL users are uncertain whether the product contains nicotine. Since users don’t consider JUUL to be vaping or an e-cigarette, they consider the activity safer, according to the study.

“There is no safe form of tobacco,” said DPH Director Dr. Karyl Rattay in the news release.

“Students are under the impression that ‘JUULing’ is safe and that these products don’t have nicotine, however, that is not the case. We believe it is important to educate parents and teachers about this trend, and e-cigarettes in general, and that it is critical that students understand the dangers posed by JUULs and nicotine as well.”

The DPH maintained that, “According to the product label, just one pod used in a JUUL allows for 200 puffs and contains the same amount of nicotine as one pack of cigarettes.

“Nicotine is highly addictive and can affect the developing brains of youth. In less than five years, e-cigarettes and vape products have become the fastest-growing sector of the American tobacco industry.

“Nationally and in Delaware, e-cigarettes are the most commonly used tobacco product among youth.”

DPH spokeswoman Jen Brestel said a health advisory notice was sent Wednesday to schools, school-based wellness centers, DOE, nurses, pediatricians, family physicians, and Federally Qualified Health Centers “to provide them with information about JUULing and to provide recommendations.

“The purpose of both the advisory and the press release are to increase awareness among parents, school staff, and physicians about this issue.”

The recommendations included:

• Encouraging school administration staff to share information on this trend with parents

• Asking schools to share the information with staff, particularly school nurses, teachers, school resource officers and wellness center staff.

• Encouraging school staff to engage students in open dialogue about this trend, their awareness, and knowledge of any activities occurring on school property

• Encouraging healthcare providers who serve children and families to make discussions about “JUULing” a part of their dialogue during well and sick visits.

Aware of issues

In late 2017, Ms. Brestel said, DPH Tobacco Program staff “started to become aware of the issue of JUULing and had already begun working on methods for gathering data around it by including a question about JUULs in our Youth Tobacco Survey questionnaire, as well as begun working to create additional messaging, more DPH staff began hearing discussion about JUULing from their own children over the last week.

“An overwhelming concern for the Division was learning that youth didn’t believe these devices contained nicotine and weren’t harmful, and the national discussion over the last week about JUULing generated additional awareness about its widespread nature.

“DPH felt it was important to increase awareness among parents and schools about the trend and potential health risks to students.”

When DPH was designing a new e-cigarette commercial in December, it heard from students in focus groups that many of their friends were using JUULs.

Other health issues have spurred DPH to provide public notices impacting teens such as immunizations, tobacco use, and certain diseases, the department said. The most recent example was sending a letter to schools during the particularly challenging flu season, with recommendations for reducing the spread of the disease, Ms. Brestel said.

In addition, DPH said its programs, including the Tobacco program, “create awareness campaigns that are specifically aimed at teens such as the recent “Don’t be an e-cig Guinea Pig” campaign.”

The DPH said for those under age 18, NOT on Tobacco is a cessation service available at most school wellness centers. Contact 1-800 LUNGUSA for more details on the NOT program,

Also, JUUL said, “Our goal is to further reduce the number of minors who possess or use tobacco products, including vapor products, and to find ways to keep young people from ever trying these products. We approach this with a combination of education, enforcement, technology and partnership with others who are focused on this issue, including lawmakers, educators, community leaders and our business partners. We welcome the opportunity to collaborate and engage with parents and educators and encourage them to email us at”

JUUL listed some initiatives, including:

• Limiting the sale of JUUL on its website to ages 21+. JUUL’s ecommerce platform incorporates industry-leading controls to help ensure minors are not able to purchase our products on its Web site.

• Working to engage school districts across the country to deploy educational programs.

• Actively working with law enforcement and community leaders across the country.

• Deploying a secret shopper program to monitor age verification of retailers.


About JUUL issued a fact sheet about JUUL inhalation, including:

What is a JUUL?

The term “electronic cigarettes” covers a wide variety of products now on the market, from those that look like cigarettes or pens to somewhat larger products like “personal vaporizers” and “tank systems.” Instead of burning tobacco, e-cigarettes most often use a battery-powered coil to turn a liquid solution into an aerosol that is inhaled by the user.

One e-cigarette device, called a JUUL, has become increasingly popular since its launch in 2015. JUUL Labs produces the JUUL device and JUUL pods, which are inserted in to the JUUL device. In appearance, the JUUL device looks quite similar to a USB flash drive, and can in fact be charged in the USB port of a computer.

According to JUUL Labs, all JUUL pods contain flavorings and 0.7mL e-liquid with 5 percent nicotine by weight, which they claim to be the equivalent amount of nicotine as a pack of cigarettes, or 200 puffs.

JUUL pods come in five flavors: Cool Mint, Crème Brulee, Fruit Medley, Virginia Tobacco, Mango, as well as three additional limited edition flavors: Cool Cucumber, Classic Tobacco, and Classic Menthol.

Other companies manufacture “JUUL-compatible” pods in additional flavors.

There are also companies that produce JUUL “wraps” or “skins,” decals that wrap around the JUUL device and allow JUUL users to customize their device with unique colors and patterns (and may be an appealing way for younger users to disguise their device).

Increased popularity

According to data from Wells Fargo, JUUL’s popularity has grown dramatically in the last year, with unit sales increasing more than 600 percent in 2017.

JUUL use among youth and young adults

According to the National Youth Tobacco Survey, 11.3 percent of high school students and 4.3 percent of middle school students — over 2 million youth — were current e-cigarette users in 2016.

However, a study from Truth Initiative found that a quarter of youth and young adult JUUL users don’t refer to JUUL use as “e-cigarette use” or “vaping,” but rather as “JUULing.”

Therefore, it is possible that existing surveys may not be capturing the full spectrum of youth e-cigarette use.

News articles, letters from school officials, and anecdotal evidence indicate that JUUL has gained popularity among youth and young adults across the country, from middle schools to college campuses. These stories attribute JUUL’s sleek and discreet design to its appeal among this population.

Health concerns and JUUL

The number of youth using e-cigarettes, including JUUL, is alarming and raises serious concerns that e-cigarettes could be an entryway to nicotine addiction and use of regular cigarettes for some kids.

According to some sources, though, there is insufficient research on the long-term effects of using e-cigarettes in general, and certainly not specific to JUUL, the use of such products still raises concerns because they contain nicotine. The company claims that the nicotine in JUUL is from “nicotine salts found in leaf tobacco, rather than free-base nicotine, ”which they claim “accommodate cigarette-like strength nicotine levels.”

The health impact of that specific form of nicotine is yet unknown.


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