Despite COVID Risks, Teens Are Struggling to Quit JUUL

“It’s easy to give into peer pressure and do what everyone else is doing without first thinking about the long-term effects,” Ashley Bartels, a 22-year-old recent graduate of Ball State University in Indiana, tells Verywell. “Everyone I know uses some sort of vaping product still—even during COVID; I definitely think they are more addictive than smoking actual cigarettes.”

Bartels is right. A new study out of the University of South California Institute for Addiction Sciences analyzed Twitter posts about JUUL cessation during the pandemic and found, not surprisingly, that JUUL is tough to quit.

In analyzing these posts, researchers found that the three most common themes were methods to quit (25.4%), having quit (17.8%), and wanting to quit (16.1%). Posters wrote about the extreme difficulties they face when trying to quit JUUL, including failed attempts and intense withdrawal symptoms.

“As a pediatrician, I’ve had teens saying they used a whole JUUL pod today which is equal to a pack of cigarettes,” Susan Walley, MD, FAAP, a professor in the division of pediatric hospital medicine at the University of Alabama at Birmingham, tells Verywell. “This is a massive amount of nicotine exposure for a developing teen brain and can be so easy to get addicted quickly—it’s really frightening.”

JUUL Products Not Regulated by the FDA

Walley, who chairs the American Academy of Pediatrics Section on Tobacco Control, says JUUL’s business model is explicitly about getting children, including very young children, as addicted as possible to nicotine. “It’s just way too easy for youth to go to the grocery store or go to the local gas station or go online and get e-cigarettes—especially these disposable e-cigarettes,” she says.

In September 2019, the U.S. Food and Drug Administration (FDA) issued a warning letter to JUUL Labs, Inc. “for marketing unauthorized modified risk tobacco products by engaging in labeling, advertising, and/or other activities directed to consumers, including a presentation given to youth at a school.” A year later, in the midst of the pandemic, the FDA released a comprehensive youth tobacco prevention plan aiming to:

• Prevent youth access to tobacco products
• Curb marketing of tobacco products aimed at youth
• Educate teens about the dangers of using any tobacco product, including e-cigarettes, as well as educate retailers about their key role in protecting youth 

Based on statistics, it’s not going to be an easy task. According to the 2020 National Youth Tobacco Survey, 19.6% of high school students (3 million) and 4.7% of middle school students (555,000) reported e-cigarette use.

Pandemic Alerts Parents to Vaping

For some teens, smoking and vaping are no longer an available outlet. “With teens home, some parents are likely to realize that it is their teens who are vaping and may be addicted to nicotine,” Danielle Ramo, PhD, a clinical psychologist and senior director of research at Hopelab, tells Verywell. “This is likely forcing conversations in homes that parents may not have had in the absence of the pandemic.”

The good news is many teens are saying they are ready to quit. A recent study actually found young people have quit or reduced their vaping habits during the pandemic by as much as 45%. “This percentage is a higher number than we typically see with most substances,” Ramo says.

Rise in Smoking Cessation During COVID-19

Smoking cessation, the process of discontinuing using harmful tobacco products, like cigarettes, chewing tobacco, and e-cigarettes like JUUL, is at the center of many public health experts’ minds. Smokers are considered high-risk for severe COVID-19 symptoms and are also included in Phase 1c of the federal vaccine rollout guidelines.

“We know smoking increases the likelihood a person will have lung disease, many different types of cancer, and heart disease,” Ramo says. “We should not be judging individual behaviors and discriminating against people for having them. What is far more important than worrying about who is in line ahead of whom is making sure we get the vaccine when it’s our turn.”

Walley agrees, noting that the overall mission of the vaccine distribution plan is trying to protect people known to be at a much higher risk for serious COVID-19 side effects. “Try to focus on the fact that most smokers today started smoking before the age of 19 and were basically kids when they became addicted,” she says. “These consequences are all ones we are trying to prevent for this new generation.”  

In May 2020, Stanford University’s School of Medicine did a survey on 4,351 teens who vape and found they were seven times more likely to get COVID-19 than non-cigarette users and are at an “immediate risk” of contracting COVID-19.  

Help Quitting JUUL During COVID-19

Bartels, who did a summer internship at the American Academy of Pediatrics in 2019, said she has tried many times to get her friends to quit with the knowledge she gained through the experience. “I always say there are a lot of things I would rather spend or save money on than using vape or e-cigarettes— especially now with so many of us still looking for jobs,” she says.

Behavioral health experts agree that quitting vaping in our current state of flux amidst a pandemic makes it all the more challenging. When people are under pressure from multiple forms of stress—like financial strain, discrimination, or housing insecurity—they become much more likely to smoke.

Ramo is currently researching how social media can be used to deliver evidence-based treatment for smoking cessation to young people. “In three clinical trials, my team has shown that our model of social media intervention can lead to trying to quit smoking and has been promising when delivered to smokers generally, when adapted for smoking and heavy drinking, and when adapted for LGBTQ+ young adults who smoke at higher rates than their peers,” she says.  

Ways to Quit Vaping

For many different forms of addiction, the 12-step model can be a supportive, effective treatment. For nicotine addiction, the most effective treatment is a combination of counseling and medication.  

“If a teen has symptoms of moderate to severe nicotine addiction then the American Academy of Pediatrics recommends considering using things like nicotine replacement therapy,” Walley says.

According to a Smoking Cessation Market Analysis Report released February 3 from DelveInsight, there are 89 distinct products and services available for management of smoking cessation, along with 12 smoking alternatives that are not specifically indicated for cessation.

FDA-approved NRT options include:

• Transdermal patch
• Gum
• Nasal spray
• Oral inhaler
• Lozenges
• Bupropion
• Warenicline (Chantix/Champix) 

Presently, the FDA has not approved nicotine replacement therapy (NRT) for youth under 18. But, Walley said pediatricians are familiar with these medications and know how to use them. “We will sometimes prescribe NRT off-label; studies have shown NRT is very, very safe,” she says. In her experience, however, she said teens tend not to be as reliable as adults about using the patch or the gum over time; relapse is common.

Not all health insurance companies cover cessation therapies for those under 18. As an alternative option, Ramo suggests checking out the many free digital treatments available for teens today. One example she mentions is This Is Quitting, a text message program by Truth Initiative, a nonprofit tobacco control organization targeted at young adults.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.