Why Teens Are Getting Addicted to their Juuls

By Sanjiv Bhattacharya

First published by The Times, 2018

https://www.thetimes.co.uk/article/why-teenagers-are-addicted-to-their-juuls-the-iphone-of-e-cigarettes-dtswdsswg

When Juul launched in the UK this July, it met with anticipation and trepidation in equal measure. Anticipation because Juul has captured 71% of the American e-cigarette market in three short years and been duly dubbed the “iPhone of e-cigarettes”. But trepidation because it has also amassed a vast teenage fanbase, who think it’s cool to Juul (the verb) and are busy vaping like mad all over social media. Under #juul and #juulnation you’ll see teenagers smoking multiple Juuls at once, Juuling while eating or making out, or tucking their Juuls into their cleavage. It’s become part of a culture of daft memes and dumb jokes.

So I’ve come to ask the founders about it, James Monsees, 38, and Adam Bowen, 42, at their grand new building in San Francisco, a former naval hospital by the waterfront in the industrial Dogpatch district. And right away, there’s a tension in the air. On the face of it, Juul looks like just another tech company on the upswing. The offices are buzzing and open plan, with a free canteen and young staff working on laptops on sofas. But you can’t just walk up to reception, you need to be buzzed in. And the visitor sign-in constitutes an automatic Non-Disclosure Agreement. Photography is verboten.

For the interview, we head to a bright lofted boardroom where Monsees and Bowen sit across from me, watching quietly while two publicists take up positions on one side, taking notes. Everyone but the company lawyers, essentially. And one can see why – since April, Juul has faced a number of lawsuits alleging that it has exacerbated nicotine addiction in some cases, and deceptively marketed its product as safe.

So Monsees and Bowen are in a sensitive spot. When they both graduated in design from Stanford, they were determined, in that Silicon Valley spirit, to improve the world, specifically to take on Big Tobacco and “solve” the public health nightmare of cigarettes by making them obsolete, an epochal shift. But that mission, and their image, has been tarnished by all these underage addicts. Rather than being hailed as crusading tech disruptors, they instead find themselves under the same uncomfortable glare as the very industry they disrupted.

As we get underway, for instance, I ask whether they tried to make Juul cool, to compete with the iconic allure of cigarettes. And instantly, anxious glances pass between them and their publicists.  

 “Oh no, we don’t want that,” says Bowen, carefully. “The idea is to develop something that’s attractive enough for smokers, but without glamorizing it or making it cool.”

It is cool, though, the Juul. Just as a gadget, a minimalist marriage of form and function. It’s techy and small enough to hide in a fist. And its youth appeal has prompted a whole secondary industry of Juul wraps and accessories, akin to iPhone cases and skins. The flavor pods click neatly into place – a different color for each flavor, be it Crème Brulee, Mango or Mint (there are eight in total). It leaves a minimal vapor trail, with no lingering odor. At its launch in June 2015, it looked like nothing else on the market, and the nicotine hit was new too. Most e-cigarettes use a fluid called freebase nicotine that absorbs into the bloodstream at a slower rate than regular cigarettes, but Juul uses nicotine salts, which replicate the hit almost exactly.

Ever since then, Juul’s graphs have been headed skyward. Having eclipsed its e-cigarette competition, it continues to expand at a stunning rate, tripling its headcount in 2018 alone to just over 800 employees. In July, it secured $1.2 billion in funding, setting the company’s value at $16 billion, which is currently more than Snapchat. But its success has a flipside. Because the very features that made Juul a hit among smokers have also appealed to underage users. “I’ve got desk drawers full of confiscated Juuls,” says Lori Krumm, a vice principal at Southridge High School in Beaverton, Oregon. “Probably every teacher in the country has right now. It’s definitely the latest cool gadget. And they’re so small, students can hide them easily. They don’t realize they’re getting addicted – they’re kids!”

Juul has made numerous public statements against underage use of their product, and several measures have been taken. To buy Juul products at their online store, one requires a government ID to prove age, for instance. But still, it’s been reported that teenagers are buying Juuls and Juul pods in bulk on Ebay and Alibaba, and selling them as contraband at school.

According to Bowen, the more conciliatory and gently spoken of the two, teen use is “similar to, and actually less than other adult products, like cigarettes and alcohol.” It just doesn’t seem that way because, according to Monsees, the more evangelical character, “there’s just a very loud microphone. This is a social media problem, more than anything else.” Monsees looks indignant. “Look,” he says. “We understand that underage consumption is a problem. We don’t want it! But our fear is that that is detracting from what we’re trying to do. We’ve converted 1 million smokers away from cigarettes, that aren’t going back. And that means half a million people have done something extraordinary.” (Roughly half of all smokers die of causes related to smoking.)

This is the big sell of vaping – that it saves lives. And the UK, more than almost any other country, is on board. Public Health England estimates that e-cigarettes are 95% less harmful than smoking, that they cause 20,000 people to quit smoking each year, and that it is very rare that e-cigarettes attracts young non-smokers into regular use – less than 1% of never-smokers vape, and e-cigarette trial does not usually result in regular use. These findings are supported by Cancer Research UK, the British Lung Foundation and others. And it sounds exhilarating at first—as though vaping is one of the greatest boons to public health in our lifetimes. Not every market is as enthusiastic – Juul has only launched in the US, UK and Israel, and already Israel has banned Juul, citing a public health risk. But the UK is a much bigger market, the third biggest vaping market in the world after America and Japan.

“We’ve only just begun,” Monsees says. “Our mission is to eliminate cigarettes from the face of the earth.”

 It all started in 2004, when Monsees and Bowen were at Stanford University taking cigarette breaks outside the Design Loft, a small studio for the 25 or so design graduate students. They’d met a year earlier and become fast friends. They were already collaborating on a thesis together—Monsees has the edge at mechanisms, apparently, and Bowen at electronics.

“We just said, this is stupid, there has to be a better way than a burning stick,” Bowen says. They’d both tried quitting several times. James was smoking despite his grandfather dying of lung cancer when his mother was 18 years old. They thought of the British researcher Michael Russell, who said, in 1976, “people smoke for the nicotine, but they die from the tar.” And they resolved to disrupt the tobacco industry.

At the time, e-cigarettes were barely getting started. The first ever vape pen – a battery powered device that vaporizes rather than burns the plant – was invented by a Chinese man, Hon Lik, in 2003, though it took several years before it was launched in the US. And the early designs typically mimicked the shape, size and color of cigarettes, often with fake tips that lit up. Later designs were more clunkier, with bigger batteries, bigger plumes of vapor.

“We decided early on that whatever would replace cigarettes, would not look or taste like a cigarette,” says Monsees. “Because you’ll never get that perfect replication, so any difference becomes a negative.”

Also, smoking was being increasingly stigmatized as a dirty habit that makes your clothes smell and causes litter. Why mimic that? “Out of 1.3 billion smokers in the world, 70% of them want to quit, and not just for health reasons,” says Monsees. “Very few people like exhaling something that lingers, that’s harmful. It can distance you from your families and children.”

So, they created a new experience that nevertheless retained some of smoking’s more appealing sensorial aspects. “Like the hand to mouth ritual and seeing the vapor as you exhale,” says Bowen. The device was flat and rectangular device because electronics boards were flat and the lithium polymer batteries were rectangular – the function guided the form. Plus, it resembled a pen drive, which feels modern and technological.

“We like that you can’t really gesture with it or use it as a cultural stylus like a cigarette,” Monsees says. “It’s not meant for that. It has a serious purpose: to get smokers to switch.”

Getting the “hit” right required thousands of prototypes. The critical breakthrough came when they realized that, in the tobacco plant itself, nicotine took the form of salts. And by 2013, just over eight years after they’d started, they had their first “Juul”, a name that evoked both a precious stone and a unit of energy (the Swedish singer songwriter was apparently not part of their consideration).

 “We knew it would be big,” Bowen says. “I’d tried other e-cigarettes, and I still smoked. But with Juul I switched completely. And other test consumers and retailers were telling us the same thing.”

Were they not nervous about taking on Big Tobacco?

“Somewhat,” Monsees says. “It really is an astonishingly huge industry. Enough cigarettes are produced every day for every person on earth to have two. But we knew that they had little incentive to create an e-cigarette because it would obsolete their money-making product. The solution had to come from outside. What we weren’t scared of was Big Tobacco’s ability to innovate. We were confident we could outpace them there.”

Next to the immensity of BAT and Philip Morris, Juul will always be the scrappy upstart, which is how they like to see themselves, despite their market valuation. “We might be 71% of the US e-cig market,” Monsees says, “but we’re only 0.5% of the global tobacco market. So everything’s upside for us.”

The downside, however, is the skepticism that Juul has provoked. There are many doubters, particularly in the US. In January of this year, the National Academies of Sciences, Engineering, and Medicine analyzed the findings of 800 peer-reviewed studies and their conclusions were damning—that many e-cigarette users also smoke, a phenomenon known as “dual use”, which weakens the argument that it helps smokers switch, and that young people who use e-cigarettes are four times as likely to use combustible tobacco (though a Yale Study from December 2017, estimates that they’re seven times as likely).

Robin Clover, from Truth Initiative, America’s largest anti-tobacco non-profit, says, “we’re getting a whole new generation of young people addicted to nicotine, while combustible tobacco is still widely available—that’s a dangerous scenario, given the evidence for dual use.”

Juul’s response is that dual use applies more to other e-cigarettes, which don’t replicate the cigarette hit as accurately as Juul does. “This is the first truly satisfying alternative for most smokers,” Bowen says. “We funded a study, conducted by an independent research group in Scotland which surveyed 19,000 Juul users in the US, and it found that of the smokers who tried Juul, 64% switched completely, and another 20% reduced cig consumption by half or more. Those are huge numbers. Also, 45% of those switched smokers did so within the first 30 days.”

Clover remains unconvinced. “That study was company-sponsored and not peer-reviewed,” she says. “And it was done by the Center for Substance Use Research, which is well known for working for Big Tobacco, so most people in the scientific community would say it’s suspect. If Juul has compelling evidence then it should be published by independent researchers, in peer reviewed journals.” (On the CSUR website, its list of funders includes Philip Morris and BAT, but also the United Nations and the UK Department of Health.)

Then there’s the question of whether vaping itself may be harmful. Certainly, it’s less harmful than smoking, but still its long-term health effects remain unknown. The National Academy of Sciences concluded that it wasn’t yet clear how vaping may affect pregnant women, or adolescent asthma, or risks of cancer. After all, vapes also contain carcinogens and toxins, like formaldehyde and acrolein.

“All I can say is we’re doing a ton of research into the safety of our product, in vitro and in vivo studies,” Monsees says. “But as a regulated product, we can’t talk about it publicly.”

The most persistent charge, however – which runs contrary to Public Health England’s research – is that teenagers are being introduced to nicotine through Juul, making it a gateway to addiction. Just a few miles from Juul’s HQ, at the Center for Tobacco Control, Research and Education in the University of California, the director Stanton Glantz accuses the company of “expanding the tobacco epidemic by bringing lower-risk youth into the market, many of whom then transition to smoking cigarettes.” He cites a 2015 US National Youth Tobacco Survey (117) that suggests that this process may be starting, and a 2017 study by Tobacco Control, that shows that most teenagers don’t even know that Juuls contain nicotine. Earlier this year, Jonathan Winickoff, a professor at Harvard Medical School, told The New Yorker that the Juul was “absolutely unconscionable. The earlier these companies introduce the product to the developing brain, the better the chance they have a lifelong user.” (Two thirds of smokers start before the age of 18.)

In April, the FDA responded to the growing alarm by ramping up enforcement on underage sales and citing retailers who were in violation, among other measures. A Congressional hearing was held, after which Juul was required to submit its marketing materials to the FDA for review, to better understand its youth appeal. All of which sounds like a painful process for the company – to be so suddenly and extensively regulated.

But Juul doesn’t see it that way. Through it all, James and Bowen have defended their mantle as the ethical antidote to Big Tobacco. They welcome the process, they tell me. They want to work with regulators. The FDA, they say, is their “partner”.

“Our goals are completely in line,” Bowen says. “They want to get people off cigarettes to safer forms of nicotine, while minimizing unintended consequences, like youth use and so on. Well, so do we! We all want to get to the same place.”

I tell Robin Clover this, and she chuckles. “It’s hard not to see this as a massive Crisis PR effort,” she says. “They’re just saying things that the public health community likes.” If I want to gauge Juul’s true intentions, she says, I should examine Juul’s advertising campaign from 2015, in which the Juul is portrayed as sexy, glamorous and desirable, just as cigarettes were presented in the 50s. Monsees now calls that early campaign, “failed and quickly abandoned”, but it adds to the growing sense that tobacco’s disruptors may not be so different to the disruptees. Meet the new boss, just like the old boss, a common trope especially in Silicon Valley, where our tech saviors never quite shape up to their first billing.

“Let’s see,” says Clover. “They use the same research agency, they’ve mounted a similar lobbying effort, their marketing has, until recently, made it look glamorous, using young people, sponsoring parties and that kind of thing. And then you have the flavors.”

Flavor has long been a lightning rod for e-cigarettes. Like alcopops, vape flavors like Strawberry and Fruit Medley are said to directly appeal to a younger palate. In the US, 11 Democratic senators wrote to Juul, chastising it for endangering the lives of America’s youth, and urging the FDA to clamp down on “kid-friendly flavors.”

Monsees smiles. He’s fought this battle before. “Flavor’s one of the most powerful tools we have to make sure consumers don’t go back to cigarettes,” he says. “The further people move from the taste of tobacco, the ritual of lighting a stick on fire, and the flavor component - from all those reference points – then when they go back and try a cigarette again, it’s disgusting.” Monsees himself like Crème Brulee, while Bowen prefers Mango. They both assure me, that Juul flavor names won’t directly appeal to children, like Gummi Bear and Cotton Candy (actual vape flavors for other e-cigarettes).

What’s important, they say, is that Juul takes teen use extremely seriously. In fact, several meaningful efforts are already underway. For instance, in June, they changed their social media strategy to stop using models. Instead, they only use real people giving testimonials about how they switched from smoking to Juul. They’re campaigning to raise the vaping age to 21 from 18 in the US. They say they’re working with social media platforms to remove posts or pages that target underage vapers, in addition to performing secret shopper tests of random retailers to ensure they’re testing IDs before selling Juuls.

No doubt, other vape brands are not nearly as exacting. One direct competitor, Kandypens – the name is clue enough – brazenly targets teen users, by filling its Instagram with scantily clad models, and even hiring DJ Khaled in their advertising. “It’s sad to see opportunists come in and throw DJs at a public health problem,” James says.

What’s more, fresh innovations are afoot at Juul that they hope will retire once and for all the charge that Juul has been courting teen users. Monsees looks over at the PRs – is he allowed to talk about this? Is there time?

“What you’re seeing is Phase One,” he explains. “In Phase Two, which kicks in next year, we’re going to step well beyond what a burning stick can achieve.” They’ll be introducing smart Juuls with microchips and Bluetooth connectivity and a companion app. This way, consumers will be able to monitor and manage their usage through the app – “you could ask your device, I’d like to reduce my consumption by 20% over the next week and algorithms will kick in to smoothly transition you.” All the usage data can be collated across millions of users to provide regulators with real time information about vape use – “it would create an immense public health resource.” And devices can be better traced through to sale.   

Critically, youth prevention would take a leap. “Basically, your device and your phone will need to pair with each other,” Monsees says. “So if you leave your Juul at home, and go out, your kids or babysitter won’t be able to use it because it won’t recognize the phone nearby.”

Yes, but now the babysitter’s been incentivized to steal your phone, I tell him. You’re going to be responsible for a wave of phone theft.

He laughs. “That’s the trouble! There’s always going to be workarounds.”