Students JUUL Despite Risk Of Addiction
Names have been changed to protect anonymity.
Upper Mia* began using a JUUL at Exeter after seeing her peers doing it. “I had tried it maybe once before coming here,” Mia said. “At first, I JUULed to look cool, and now just to feel good.” She uses her friends’ vaping devices “a few times” per week, and while she doesn’t see herself as an addict, Mia says she frequently gets headaches and nicotine cravings.
“Everyone else did it,” she said. “You get peer pressured.”
E-cigarettes and vaporizers have recently become popular among high school students as a substitute to traditional cigarettes that can be used discreetly and carry seemingly fewer health risks. The JUUL is about half an inch wide, three inches long and does not produce smoke or a distinctive scent. The device uses nicotine salts and a heat delivery system—made up of a heating coil and wick—to produce vapor meant to be inhaled and held in the lungs for several seconds. Claiming to produce fewer carcinogens because of its “novel heating system,” the JUUL advertises itself as an “alternative to smoking,” despite delivering to users concentrations of nicotine that are much stronger than traditional cigarettes.
According to statistics from the 2015 Youth Health Risk Behavior Survey, a survey administered to all Exeter students every two years, tobacco usage in any form declined slightly at Exeter between 2005 and 2015. At the time the survey was administered, 7% of Exeter students reported using tobacco within the past 30 days. This percentage places tobacco usage at Exeter at about 38% of the national average.
The survey did not ask students about e-cigarette usage specifically until 2015, when 9% of Exeter students reported using e-vapor products within the 30 days before filling out the survey, approximately 37% of the national average of e-cigarette usage.
Out of 9% of Exonians using e-cigarettes, according to Dean of Residential Life Arthur Cosgrove, over the past two years, only one student has been charged with possession of a vaporizer. The Academy added a rule to the E-Book forbidding possession of nicotine on campus “a few years ago,” according to Cosgrove, in alignment with New Hampshire state law.
Anyone under the age of 18 is prohibited from purchasing nicotine or tobacco products under New Hampshire state law. However, underage students on campus obtain vaporizers in many different ways. Upper Allen* and lower Oliver* share a JUUL that their friend, upper Steven*, brought from home, where stores that sell vaporizers “don’t card underage kids.” Upper Allegra*, who uses her own JUUL regularly, said that an upperclassman over the age of 18 bought it for her.
While Allen and Steven attributed their use of vaporizers or e-cigarettes to “the culture back home,” some students have felt pressured by their classmates to start using a JUUL since coming to Exeter. Senior Mindy* got involved in using nicotine on campus. “Everyone else did it,” she said. “You get peer pressured.” Upper Lawrence* was similarly encouraged to try using an e-cigarette by a friend during his lower year, and now inhales from a JUUL. He asserted that he is not addicted to nicotine and could stop using the device should he choose to do so, but he has not taken a day off of JUULing in about a month.
The widespread use of JUULs speaks to students’ ignorance, and sometimes disregard, of the health risks that come with e-cigarettes and vaporizers. Senior Jason*, who occasionally uses his friends’ JUULs, thinks that the health risks of these devices are overblown. “I don’t think e-cigarettes are that bad,” he said. “People make them out to be much worse than they really are when they should consider that they’re a much better alternative, given how toxic actual cigarettes are.”
Senior Jeffrey* said of students who use JUULs, “They definitely just think it’s something that can have absolutely no negative effect.” He added that students who do acknowledge the risks often see them as “negligible.” Psychologist at the Lamont Health Center Szu-Hui Lee agreed. “Many people think JUULs or e-cigarettes are less dangerous than actual tobacco,” she said. “That is simply not true.” Dr. Lee specified that e-cigarettes contain the carcinogens cadmium and nickel in the heating coils, acrolein—which can destroy lung tissue in large doses—and propylene glycol, the chemical antifreeze in cars. “Don’t be fooled; it is not a healthy alternative to smoking,” Lee warned. JUUL Labs Inc, the company that makes the vaporizers, has a warning at the bottom of every page on their website that reads: “This product contains chemicals known to the state of California to cause cancer and birth defects or other reproductive harm.”
Chair of the Health Department Michelle Soucy said that many students are unaware of the risks and think electronic cigarettes are not dangerous, an outlook perpetuated by the industry itself. “The e-cigarette industry wants you to believe that it’s safe, and they actually write that it’s safe on their products,” Soucy said. She added that even though it is untrue, this information helps people justify their use of the product. “When someone tells you something that you want to believe, you believe it,” Soucy said.
E-cigarette companies are able to make these claims because of limited knowledge of the emerging market. According to Soucy, the products have only become popular within the past ten years, and therefore researchers do not know what long-term effects e-cigarettes may have on users. Originally, the products were considered to be safer than traditional cigarettes, but new risks have been associated with long-term use. “It’s the same with cigarettes, you don’t see the negative effects right away, they’re cumulative over time, and so with e-cigarettes people aren’t going to notice what’s happening to them,” she said.
Jeffrey noted that even people who experience adverse effects when using a JUUL will often continue using it anyway. “I have multiple friends who, if they hit it, they will say their heart hurts.” According to Jeffrey, using an e-cigarette is especially dangerous “if you have a weak heart.”
Upper Selena* has also had bad experiences vaping. “The first time I used a JUUL, I didn't know how to inhale so it didn't feel that good,” she said. “Once I learned how to ‘zero’ it (inhaling vapor and holding it in the lungs for around 10-20 seconds), I felt the headrush and liked the feeling; however, I felt sick after and got a headache.” Despite this unpleasant experience, Selena said she continued to use e-cigarettes and vaporizers, doing so around once a week.
According to Soucy, research is surfacing that shows e-cigarettes can cause lung infections and bring mold spores into the lungs. “You’re bringing water into a space of your body that isn’t supposed to have moisture in it. So the smog analogy, I think, is a good one; if you’re in smog for a long time, you’re going to start to have health impacts,” she said. Soucy added that these effects are present even if students are inhaling flavored vapor without nicotine. Without nicotine, someone cannot become addicted to a vaporizer or e-cigarette. However, according to Soucy, students can still form a habit of using the device.
With nicotine added to the vapor, the desire to use the drug can transition from a habit to an addiction. Nicotine is a central nervous system stimulant that increases heart rate and blood pressure and constricts blood vessels. Soucy explained that the drug’s detrimental effects are similar to other stimulants and mainly confined to the heart and other organs. “Long-term use of it can put extra strain on your heart, and because it’s habit-forming, it can be incredibly difficult to stop and the withdrawal symptoms are pretty severe,” Soucy said. Students become addicted to the drug because it “has a very short-acting rise in dopamine in the brain; that’s why people need to continually use throughout the day, it doesn’t last very long,” she said. “It gives a short, intense feeling and then the body wants more right away. That’s why nicotine ends up being so addictive.”
She differentiated between experimentation and addiction by classifying a student as addicted to the drug if they continue using it despite a likely negative outcome to their use. “Addiction is defined as a compulsion to use when negative consequences are within reach,” she said. Lee added that she considers a student addicted to nicotine if the drug is affecting a student’s ability to function, either in their academics, social life or self-care.
Soucy explained that if a student were to go through Exeter’s ASAP program, receive education on the risks of using an e-cigarette and still continue to use the drug, she would suspect the student to be addicted to nicotine. “Using again when you know that the risks for disciplinary action are going to be there should [one] get caught indicates to me that the drug, this being nicotine, is more important than their placement here at the school, and that’s when I get concerned,” Soucy said.
Along with possible disciplinary or legal consequences associated with using nicotine, withdrawal from the drug can manifest itself in the form of physical symptoms. Soucy noted that someone withdrawing from nicotine use can be jittery, irritable, have an upset stomach or a headache and will have a strong desire to use the drug despite being aware of the negative consequences.
Lee added that students should seek help from counselors as soon as they begin using maladaptive strategies because of curiosity or as a way to cope with stress and before they develop an addiction to the drug. “With addiction, the behavior can become out of control and hard to stop even when the person knows the negative consequences,” Lee said. She added that e-cigarette usage can lead to increased drug use in the future. Lee said about nicotine, “It is often the gateway drug to opioids and marijuana.”
The health center works both to help students already dependent on the drug combat their addiction and to prevent Exonians from ever using an illegal substance. Students addicted to nicotine work with the physician’s assistant Rebecca Fisher on smoking cessation, and all new students learn about chemical dependency in health class. Soucy noted an increase in the number of students asking questions about e-cigarettes in her health classes recently, and attributed the greater number of questions to “a curiosity and a false idea that these are safe, non-addictive things to use.”
However, Soucy urged students to consider the dangers of e-cigarette use, both with and without nicotine, before using the device. “It’s so new that you could be taking a risk that we don’t even know about yet,” she said. “If you think about when cigarettes came out and they were new and nobody knew how dangerous they were, now everyone’s like ‘Why would anyone smoke a cigarette?’ This could be the same thing and we just don’t know it yet in terms of the really significant problems.”