Researchers say the popularity of Juul and other vaping products could get teens hooked on smoking.

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Only about 5 percent of teenagers were smoking cigarettes in 2017. Experts are concerned e-cigarettes will cause that rate to rise again. Getty Images

There are certain milestones that humanity should be proud of, including increasing lifespans of people across the globe and protections against numerous preventable diseases.

But new research backed by e-cigarette industry data suggests we may be backtracking from one of those milestones.

“The substantial reduction in smoking in the United States represents one of the most important public health advances of the last 50 years,” a new paper published in the Journal of the American Medical Association (JAMA) begins.

The paper’s authors pointed to the most recent National Survey Results on Drug Use report that shows that smoking rates among junior and high school students dropped from 28 percent in 1997 to 5 percent in 2017.

“These positive trends suggest that the powerful appeal of tobacco and nicotine has been reduced in younger generations,” the paper stated.

But with e-cigarettes capable of delivering nicotine at levels comparable to cigarettes, the paper’s authors fear these products “have the potential to undo years of progress if a new generation of young people becomes addicted to nicotine.”

While presented as a safer alternative to cigarettes because they contain fewer toxins and carcinogens, e-cigarettes aren’t being used merely by current smokers trying to quit traditional cigarettes.

And that, researchers say, is a major concern.

“Extensive research has shown the adverse effects of nicotine on developing brains, and nicotine exposure during adolescence is likely to adversely affect cognitive function and development,” the paper stated.

Earlier this month, Dr. Scott Gottlieb, the commissioner of the U.S. Food and Drug Administration, made a statement regarding the “epidemic” of youth cigarette use.

We need a regulatory process that requires product applications to show that the marketing of the product is appropriate for the protection of the health of the overall population,” his statement said. “And we need a regulatory process that keeps these same electronic cigarette products out of the hands of youth.”

Of particular concern is the San Francisco–based brand Juul, which operates under the “goal of improving the lives of the one billion adult smokers,” according to the product’s website.

While it’s only been on the market for a few years, researchers note the product now accounts for more than 65 percent of all e-cigarette sales, the paper stated.

It’s become so popular that teens use the term “juuling” instead of vaping or smoking.

Juul devices and their nicotine-filled pods contain nicotine salts derived from tobacco leaves, which experts say enables delivery of nicotine at levels comparable to cigarettes.

This, coupled with flavors that make the aerosol less harsh than other e-cigarettes “could lead to addiction to nicotine in children and adolescents.”

The lead author of the paper was Robin Koval, the chief executive officer of the Truth Initiative, the United States’ largest nonprofit public health organization “dedicated to making tobacco use a thing of the past.”

They’re the organization that runs many of the anti-vaping campaigns across the nation.

A spokeswoman for the Truth Initiative said youth are attracted to vaping products for many reasons, including the variety of available flavors, including mango or cool mint.

The spokeswoman says this is particularly concerning because the amount of nicotine in one standard Juul pod roughly equals the nicotine in a pack of cigarettes.

“Despite a claim by JUUL that they’re ‘only for adults,’ it has created a cultlike following among youth, most of whom don’t realize that they’re inhaling nicotine when they vape,” the spokeswoman told Healthline.

To combat these trends, Koval and the other authors of the JAMA paper urge stronger regulatory actions to keep the youth smoking rates low.

This includes requiring age verification for internet sales, prohibiting branded merchandise, and carefully reviewing how flavors are used in products, as well as where and how e-cigarettes are marketed, the Truth Initiative spokeswoman said.

Juul has been accused of using advertising and marketing tactics similar to the “banned tricks of Big Tobacco.”

In response to these claims, Juul has run ads across several types of media reminding would-be customers that its products are meant for smokers who want to quit tobacco, not children.

In its “marketing code,” the company says it is a “switching product” for age-appropriate users.

They say they don’t target or feature kids with their advertising and their product “is not appropriate or intended for youth.”

Karina DiLuzio, a smoking cessation specialist with Allina Health in Minneapolis, says the JAMA paper missed a few things, namely that there’s limited evidence that e-cigarettes are helpful as a tobacco cessation tool.

“They are not designed to help people quit and very few people actually quit using these products,” she told Healthline.

This, she says, puts quite a wrench into the argument for flavors that would keep these products “appealing” for adults, so what’s the problem with removing flavors?

“The only thing this will deter will be making our children nicotine addicts,” DiLuzio said. “Those who are standing on the threshold of using such a product would be less inclined if it no longer seems as appealing, playful, and candylike. Fun, fruity flavors imply a harmless innocence.”

But putting that kind of regulation on tobacco products, DiLuzio says, “is an arduous task.”

“Big Tobacco has enough money, influence, and resources to significantly slow the process of limiting anything to do with tobacco,” she said.

While marketed as aids to help adults quit smoking, there’s not enough evidence to conclude that e-cigarettes are effective at doing so.

Experts warn that the prevalence in vaping — namely Juuling — among children could get another generation hooked on nicotine.

They fear that this could drive up the teen smoking rate, which has been decreasing for decades.