Is your teen ‘juuling’? Here’s what you should know.

Two young girls with e-cigarette

It’s easy to hide. It’s addictive. It’s the new, viral trend to hit schools and part of what the FDA has declared a teen vaping epidemic across the country. What is juuling?

Juul e-cigarette

Source: Juul Lab

Juul is a type of electronic cigarette – one of the more popular brands – and inhaling it is known as “juuling.”  The maker of Juul has claimed that is intended for adult use only. However, due to its design, small size (easily concealable from teachers and parents) and flavors such as mint, crème brulee and mango, it has become appealing to adolescents, says Joseph Rosen, MD, pediatric pulmonary and sleep medicine specialist at The Woman’s Hospital of Texas in Houston.

“E-cigarettes are now the most commonly used tobacco products among youth,” Dr. Rosen said, “and Juul, specifically, is the number one selling e-cigarette as of January 2018.”

So, what do parents need to know? Dr. Rosen, who has co-authored two chapters on smoking and adolescents, explains.

What makes the Juul unique?

Most e-cigarettes are cylindrical, whereas the Juul looks like a USB flash drive. It can be charged by plugging it into a USB port on a laptop in the same way that a phone can be charged. Also, it does not have the distinctive smell of cigarettes, so it is more difficult for adults to detect when teens are juuling.

Where can it be purchased?

Juul is an electronic nicotine delivery system. It can be purchased from any place that sells e-cigarettes or tobacco products. Also, it can be purchased online. The Juul online website requires at least some age verification, but third-party sellers may get around it. More expensive than traditional cigarettes or other e-cigarettes, a kit can run between 20 to 55 dollars. This may discourage some adolescents from using it.

What is the purpose of e-cigarettes?

For the Juul, specifically, the creators claim that it is intended as an alternative to smoking cigarettes, not a method to stop smoking.

Do e-cigarettes help people quit smoking?

There are mixed results on the research showing e-cigarettes ability to help adults quit smoking. There is no good evidence to show that e-cigarettes help adolescents quit smoking.

What are the health risks of juuling?

Juuling contains nicotine and that is extremely addictive. According to Juul, one pod contains about as much nicotine as one pack of cigarettes. A recent study revealed that the use of e-cigarettes by high school students doubled the risk for chronic bronchitis symptoms. Also, “popcorn lung”, a medical condition formally known as bronchiolitis obliterans, may develop in e-cigarette users due to a chemical called diacetyl(1). That causative agent is used in more than 75 percent of e-cigarettes to produce flavors such as maple, coconut, vanilla or others. According to Juul, they do not add diacetyl and acetylproprionyl (or 2,3-pentanedione) as flavoring ingredients. That said, the ingredient list of the e-liquid formula used in Juul is not available to the public.

Is juuling safer than smoking traditional cigarettes?

It took many decades to firmly demonstrate the dangers of cigarette smoking. There has not been adequate time to do these studies for e-cigarettes, which are relatively new. I am not aware of any studies comparing Juuling to smoking cigarettes. However, two new studies on e-cigarettes showed they contain cancer-causing chemicals and are associated with future cigarette smoking in teens.

What do parents need to know about juuling?

In 2015, 37.7 percent of high school students had tried e-cigarettes and the use of e-cigarettes has been going up since then. Many youth who use e-cigarettes are unlikely to have initiated tobacco smoking with cigarettes. So, e-cigarettes are expanding overall use of tobacco products among youth, rather than replacing other sources. Most importantly, e-cigarettes (including Juul) are not a safe alternative to smoking. E-cigarettes should not be used for treatment of tobacco dependence in teens, as they have not been shown to be safe or effective.

What advice would you give parents about juuling?

Because children whose parents do not smoke or who successfully quit smoking are much less likely to take up smoking, I strongly encourage parents to quit. It makes sense that the same would go for e-cigarettes. I encourage parents to:

  • maintain a smoke-free and e-cigarette-free (including Juuling) home,
  • give clear and consistent messages to their children that they expect them to remain non-smokers and “non-vapers/non-Juulers,”
  • work on fostering resistance to social influences from peers by rehearsing refusal skills (Teaching of the mnemonic REAL (Refuse, Explain, Avoid, Leave) has been successful as part of a school-based substance prevention curriculum.),
  • talk to their children about the negative effects of smoking and e-cigarettes as young as 5 years old.

Dr. Joseph Rosen is a pediatric pulmonary and sleep medicine specialist at The Woman’s Hospital of Texas, an affiliate of HCA Healthcare, and serves as Director of Sleep Medicine for Houston Pediatric Pulmonary and Sleep Associates.

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HCA Healthcare 50th Anniversary
In 1968, HCA Healthcare was conceived by two physicians and an accomplished business leader — Dr. Thomas Frist Sr., Dr. Thomas Frist Jr., and Jack Massey. This year, HCA Healthcare celebrates its golden anniversary and the culture of caring established by our three founders 50 years ago. To help us celebrate our 50th year, we’ll share stories here that reflect HCA Healthcare’s mission – above all else, the care and improvement of human life – and our pledge to improve life and make history for the next 50 years and beyond.


  1. Flavoring Chemicals in E-Cigarettes: Diacetyl, 2,3-Pentanedione, and Acetoin in a Sample of 51 1 Products, Including Fruit-, Candy-, and Cocktail-Flavored E-Cigarettes,” Joseph G. Allen, Skye S. Flanigan, Mallory LeBlanc, Jose Vallarino, Piers MacNaughton, James H. Stewart, David C. Christiani, Environmental Health Perspectives, December 8, 2015, doi: 10.1289/ehp.1510185

About HCA Healthcare

HCA Healthcare, one of the nation's leading providers of healthcare services, is comprised of 183 hospitals and more than 2,300 sites of care, in 20 states and the United Kingdom. Our more than 283,000 colleagues are connected by a single purpose — to give patients healthier tomorrows.

As an enterprise, we recognize the significant responsibility we have as a leading healthcare provider within each of the communities we serve, as well as the opportunity we have to improve the lives of the patients for whom we are entrusted to care. Through the compassion, knowledge and skill of our caregivers, and our ability to leverage our scale and innovative capabilities, HCA Healthcare is in a unique position to play a leading role in the transformation of care.

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