Teens Are ‘Juuling’ At School. Here’s What That Means

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Updated: | Originally published: ;

The most popular product in the booming e-cigarette market doesn’t look like a cigarette at all.

The Juul, a trendy vape that resembles a flash drive and can be charged in a laptop’s USB port, accounted for 33% of the e-cigarette market as of late 2017, according to Wells Fargo data. The product is made for and legally available only to adults 18 and older, and its “growth appears to be due to growth with the 18 to 24 year old age group,” according to a Wells Fargo report.

But in many cases, media reports suggest, these devices are being used by kids and teenagers even younger than that — which has some parents, educators and medical professionals concerned. Each Juul cartridge—which lasts about 200 puffs—has as much nicotine as an entire pack of cigarettes. Here’s what to know about “Juuling,” the trend sweeping schools nationwide.

What do parents need to know about Juuling?

Although Juul products, like most e-cigarettes, are made and marketed as smoking alternatives, the device is increasingly popping up on high school and college campuses. The term “Juuling” usually refers to this recreational use.

Because of their sleek design and resemblance to USB drives, Juul products are easy for students to conceal and use in school — sometimes even in the middle of class. (Juuls also produce less smoke than many similar devices, making them even more discreet.) The problem has grown widespread enough that school districts in states including Kentucky, Wisconsin, California and Massachusetts have voiced their concerns and, in some cases, begun amending school policy to address the issue. Some college publications, including those at New York University and the University of Illinois, have also reported on the trend.

Ashley Gould, chief administrative officer at Juul Labs, says that the product was created by two former smokers specifically and solely to help adult smokers quit, and that the company has numerous anti-youth-use initiatives in place because “we really don’t want kids using our product.” Gould also notes that Juul uses age authentication systems to sell only to adults 21 and older online, though most of its sales take place in retail stores, where state laws may allow anyone 18 and older to purchase the devices.

The design, she adds, was not meant to make the device easier to hide.

“It was absolutely not made to look like a USB port. It was absolutely not made to look discreet, for kids to hide them in school,” Gould says. “It was made to not look like a cigarette, because when smokers stop they don’t want to be reminded of cigarettes.”

Are e-cigs safe?

While e-cigarettes contain fewer toxic substances than traditional cigarettes, the CDC warns that vaping may still expose people to cancer-causing chemicals. (Different brands use different formulations, and the CDC’s warning did not mention Juul specifically.)

It’s not clear exactly how e-cigarettes affect health because there’s little long-term data on the topic, says Dr. Michael Ong, an associate professor of general internal medicine and health services at the David Geffen School of Medicine at the University of California Los Angeles. “We just don’t have a lot of information as to what the harms potentially are going to be,” he says. “There likely would be health risks associated with it, though they’re not going to be the same as a traditional cigarette.”

Doctors do know, however, that each Juul pod contains nicotine equivalent to a pack of cigarettes. That’s troubling, because nicotine is “one of the most addicting substances that we know of,” Ong says. “Having access to that is certainly problematic,” Ong adds, because it may get kids hooked, which could potentially lead them to later take up cigarettes.

Juul’s products come in flavors including mango, fruit medley and creme brûlée — and the chemicals used to flavor vaping liquid may also be dangerous, Ong adds. “Even if the manufacturer doesn’t intend it to be something that’s kid-friendly, it’s kid-friendly,” he says. A 2016 study suggested that these flavoring agents may also cause popcorn lung, a respiratory condition first seen in people working in factories that make microwave popcorn.

Does Juuling help you quit smoking?

It’s not yet clear. Gould acknowledges that Juul doesn’t have great end-user data since its products are mostly sold in retail stores, but she says the company is actively researching the effectiveness of its devices.

Research about the efficacy of nicotine replacement therapy using tools such as e-cigarettes and nicotine gum is relatively inconclusive. A new study published in the Annals of Internal Medicine even found that smokers trying to quit may actually have less success if they use e-cigarettes.

“The literature has suggested that when you have nicotine replacement therapies, they work best if [people are] being advised by a professional,” Ong says. “When we provide things over the counter, we don’t see the benefits of cessation that we would have expected by making it widely available, and that’s probably the reason why: because people aren’t actually getting professional help.”

Correction: The original version of this story misstated the legal purchasing age for Juul. It is 18 in some states, not 21. The original version of this story also misstated Juul’s marketing strategy. The product is marketed as a smoking alternative, not a smoking cessation tool.

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Write to Jamie Ducharme at jamie.ducharme@time.com