How Juul Created a Teen Vaping Epidemic

Throughout the summer of 2019, as congressional staffers plowed through 55,000 documents Juul Labs had previously never made public, a picture emerged of a carefully planned effort to expose American kids to one of the world’s most addictive substances.

The documents revealed a perfect storm of stealth marketing, sleek design and high nicotine doses that Juul Labs seemingly engineered to slip under adults’ radar, buying time to addict kids to the company’s vaping products.

“I am extremely concerned about reports that Juul use is sending kids across the country into rehab, some as young as 15,” Rep. Raja Krishnamoorthi, chairman of the U.S. House Subcommittee on Economic and Consumer Policy, wrote in a letter to Juul Labs’ CEO when the representative first requested the documents.

Congressional investigators found Juul Labs “deployed a sophisticated program” paying schools as much as $10,000 each to let company representatives deliver its message directly to children. In at least one presentation, without teachers or parents present, a company representative showed kids how to use a Juul e-cigarette. Other evidence showed that Juul Labs also targeted preteen kids through summer camps and out-of-school programs.

At the same time, tobacco researchers published detailed studies on the company’s advertising campaigns targeting youth-oriented social media channels.

“If you look at the actual marketing Juul did, they clearly went after kids,” Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, told Drugwatch.

Juul’s rapid growth coincided with what the U.S. Surgeon General in 2018 called an “epidemic of youth e-cigarette use.” News stories and lawsuits around the country detailed health problems and stints in rehab for nicotine-addicted teens hooked on “Juuling.”

“The more we learn about Juul, the more dangerous it looks,” Glantz said.

Personal and government lawsuits against Juul Labs have forced the company to turn over key documents and have exposed details of the company’s marketing strategy.

“Documents coming out of Juul in lawsuits show an absolutely determined marketing plan to get to kids, and we’re talking kids as young as 8,” Chris Bostic, deputy director for policy for Action on Smoking and Health, or ASH, told Drugwatch. “It’s astounding to me Juul executives even allowed this stuff to be written down.”

As of March 2022, hundreds of Juul lawsuits claiming personal injuries had been combined in a mass litigation in a California federal court. Lawyers have estimated the litigation could someday grow to include thousands of similar cases. In addition to Juul Labs, many of the lawsuits named Marlboro cigarette maker Altria, which owns more than a one-third stake in Juul.

Most of the lawsuits claimed that users — frequently teens or young adults — became addicted to Juul’s high nicotine content. Many alleged that Juul’s marketing targeted teens. Others claimed Juul use led to injuries such as seizures, stroke, lung damage and even death.

In one such suit, Lisa Marie Vail claimed Juul-related nicotine addiction led to the death of her 18-year-old son, Daniel Wakefield. Wakefield had been using Juul products since he was 15. The complaint said he suffered severe mood swings related to his addiction, once throwing a mini-refrigerator from the top floor of his home because he couldn’t vape.

After a year of using Juul, Wakefield developed severe breathing complications and eventually died from them, according to the lawsuit.

Cities, states and school districts have filed public health lawsuits against Juul Labs. The various lawsuits have forced Juul Labs to turn over documents about the company’s business practices.

Class action lawsuits in Florida and California claimed that Juul Labs used “copycat advertising” that mimicked the colorful, youth-oriented ads large tobacco companies had used decades earlier when they targeted young customers.

“Juul used the tobacco industry’s prior practices as a playbook,” lawyers wrote in the complaint for the Florida lawsuit.

State attorneys general and the Federal Trade Commission have also opened investigations into Juul Labs’ marketing practices.

Juul purchased banner ads on child-oriented websites for Nickelodeon and Cartoon Network among other websites designed for child audiences, according to a 2020 Juul lawsuit filed by the Massachusetts attorney general.

“Juul also purchased advertisements on a range of websites designed to help middle school and high school students develop their mathematics and social studies skills,” the complaint read.

“This gets down to intent,” Dr. Robert Jackler, chair of the Department of Otolaryngology-Head and Neck Surgery at the Stanford University School of Medicine, told Drugwatch.

Jackler and his wife, Laurie, founded Stanford Research into the Impact of Tobacco Advertising, also known as SRITA. SRITA has collected more than 50,000 tobacco and vaping advertisements, currently housed at the Smithsonian Institution’s National Museum of American History. Jackler has published numerous research articles on Juul’s marketing.

“Clearly, we know that Juul has hooked millions of American teenagers on nicotine, or at least exposed them to an extremely potent nicotine delivery system that’s become viral amongst teens in America,” Jackler said.

Juul’s founders have insisted since their product first hit the market in 2015 that it was never meant for kids, but was intended as an alternative for adult smokers.

“[U]nlike traditional cigarette manufacturers, our company has no incentive to see minors use our products,” Juul Labs co-founder and Chief Product Officer James Monsees told Congress in 2019. “We know there is skepticism on this point, but it is simply the truth.”

But Jackler calls Juul’s claims “revisionist history.”

“Juul, of course, later comes out and says, ‘We had no idea, we didn’t really mean it,’ but c’mon, Juul worked with a professional advertising agency. These agencies are experts at this. They’re not free agents. They follow the direction of their clients,” Jackler said.

Glantz said Juul’s founders, Monsees and Adam Bowen, approached him at UCSF when they were still developing their products. They asked for his input on a product they saw as an alternative to smoking. Glantz said he warned them then about the risk of kids using the device.

“They said kids wouldn’t be interested. It was the same line they take now. Maybe that’s what they really believed back then. I don’t know,” Glantz said.

A 2018 study in Tobacco Control coauthored by Divya Ramamurthi, Cindy Chau and Robert Jackler concluded that the “US market for vaping devices with stealthy characteristics is anything but inconspicuous, with Juul alone accounting for 70.5% of sales.”

In the lawsuit over her teen son’s death, Lisa Marie Vail claimed the design made it difficult for parents to catch their kids vaping and help them stop before it was too late.

“Juul is easily concealable from parents and teachers and can be used practically anywhere,” the complaint in Vail v. Juul Labs read. “Unlike traditional cigarettes, the scent does not linger on the body or in the breath of the user, making it undetectable after use. Googling ‘hiding Juul in school’ or ‘how to ghost rip Juul’ returns hundreds of videos on how to Juul anywhere without detection.”

Both Juul’s design and its early marketing campaign allowed it to go unnoticed by most adults for months after it launched. Parents and teachers mistook the small, sleek Juul devices for flash drives as kids vaped in schools. Juul avoided running ads on TV, radio and print channels where adults were most likely to see them, focusing instead on kid-friendly social media.

Rates of youth vaping exploded as Juul’s sales soared. By the time the U.S. Surgeon General declared a youth vaping epidemic, Juul Labs had cornered nearly three-quarters of the e-cigarette market in the U.S.

It’s hard to determine if the stealthiness of both Juul’s design and its social media marketing were engineered for success, or if they just came together as a highly profitable coincidence for Juul Labs.

“I can’t speak to what Juul intended, but the company’s people seem to be quite meticulous about what they do, so it’s hard to believe it was an accident,” Glantz told Drugwatch.

About 14 years before congressional investigators pored over Juul’s internal documents, the company’s founders were plowing through millions of tobacco industry documents.

The Truth Tobacco Industry Documents is a digital archive of 14 million tobacco industry communications, research reports, marketing strategies and other internal documents that seven tobacco companies turned over during lawsuits leading to the landmark 1998 tobacco settlement. It’s hosted by the UCSF Library.

With a view into the inner workings of Big Tobacco, the archive is treasured by public health researchers. But published reports have documented how Monsees and Bowen turned it into market research for Juul Labs.

“It became a very intriguing space for us to investigate because we had so much information that you wouldn’t normally be able to get in most industries,” Monsees is quoted as saying in court documents. “And we were able to catch up, right, to a huge, huge industry in no time.”

They began building e-cig prototypes and incorporating the trade secrets to Big Tobacco’s success — flavor and addiction — into the core of Juul’s business strategy.

Nicotine Played a Crucial Role in Juul’s Success

Less than two months before Juul’s launch, its manufacturer, then called Pax Labs, boasted in a news release about how “new chemistry and patented technology” would create a “compelling alternative to traditional cigarettes.”

“Juul is now the only alternative smoking product that delivers a nicotine experience truly akin to a cigarette, with two times the nicotine strength and three times the vapor quality of leading competitive products,” the news release read.

The team that created Juul spent years working on the perfect nicotine formula before the company ever produced its first Juul e-cigarette. A potent nicotine delivery system would be crucial to Juul’s success.

“Nicotine absolutely plays a role in the business model of all vaping products. The levels with Juul are so high that addiction happens quickly,” Erica Sward, assistant vice president for national advocacy for the American Lung Association, told Drugwatch.

Juul’s big breakthrough came with its “nicotine salts” formula, which allowed the company to pack high doses of addictive nicotine into vape pods.

Nicotine is difficult to inhale. It’s highly alkaline and inhaling it typically causes a gag reflex or cough. Tobacco companies turned to menthol, a local anesthetic, to make tobacco cigarettes more palatable.

Juul Labs experimented with adding benzoic acid until it found just the right nicotine and flavor balance. The company patented the formula in 2014, the year before Juul e-cigs hit the market.

“By going to the nicotine salts, by adding acid to the e-liquids, Juul brought the pH down to neutral plus slightly acidic, so it’s much easier to get the nicotine down. That is hugely important,” Glantz said.

The physics of burning tobacco also limits how quickly a smoker can inhale nicotine. Juul combined the chemistry of nicotine salts with an e-cig design that allowed users to take puffs far more quickly than tobacco smokers.

“Juul debated whether to program the device to limit how close together the puffs could be and to limit the number of puffs per hour users could take as a way to limit the addictive potential of the device. And they decided against both,” Glantz said.

The combination of chemistry and engineering allowed Juul to deliver more nicotine per puff than a Marlboro cigarette while still maintaining Marlboro’s flavor profile, according to researchers at Portland State University.

Welcome Back to Flavor Country

Big Tobacco’s research into cigarette flavors and their appeal to young people would have been part of the internal tobacco industry documents Juul Labs reportedly studied.

The iconic “Marlboro Country” ad campaign began inviting smokers to “Come to where the flavor is” starting in 1955. The ads were so memorable that more than half a century later, Urban Dictionary lists the definition of “flavor country” as “a smoker’s destination.”

“The tobacco industry has known for decades that flavor appeals to kids — it helps the poison go down,” Sward told Drugwatch.

Following mounting pressure from the U.S. Food and Drug Administration and public reaction to an outbreak of vaping-related lung injuries, Juul Labs discontinued all flavored vape pods except for tobacco, mint and menthol in October 2019. The FDA banned mint-flavored pods in January 2020.

Until then, sweet and fruity flavors had been front and center in Juul’s early marketing. Regulators and public health advocates attributed much of teen vaping’s rapid rise to flavored e-liquids.

“[F]lavored products are the primary driver of the youth e-cigarette epidemic with 97% of young people who vape using flavors,” Robin Koval, CEO and president of Truth Initiative, said in a statement.

“Young people like sweet and fruity flavors and are drawn to them more than mature adults. A mature adult smoker is acclimatized to unsweetened tobacco flavor,” Jackler said.

Sweet and fruity flavors had been a standard of the vaping industry for years before Juul. A 2018 study in PLOS Biology identified more than 7,700 different e-liquid flavors on the market at the time.

“It’s hard to imagine how bubblegum and gummy bear flavors are meant for adults,” Bostic said.

Juul hit the market on June 1, 2015, with a corporate message that it was intended to help smokers transition from tobacco. Jackler said if that had really been the case, the obvious market Juul would have targeted would have been older adults.

“Juul instead had a highly youth-oriented product launch,” Jackler said. “In its first six months, its ‘Vaporize’ campaign used 20-somethings in very casual dress, looking cool, doing playful things you might expect from a teenager — even an underage teen.”

In a 2019 research paper, Jackler and his co-authors provided a highly detailed account of the first three years of Juul’s advertising. Social media played the overwhelming role in marketing Juul, even though all social media platforms ban paid tobacco product advertising.

The company found a loophole.

“Juul Labs did organic advertising; they created social media pages and did their own posts. It didn’t cost Juul Labs anything,” Jackler said. “But it was the channel they used that stuck it right in front of high school kids.”

Juul enlisted an army of social media “influencers” to spread the company’s message across Instagram, Facebook and Twitter. Influencers are people with large numbers of social media followers who review products, feature the products in photos they post and incorporate those products into their online persona.

The company invited large numbers of influencers to Juul’s 25 or so launch parties and sampling events in major U.S. cities.

“The principal focus of these activities was to get a group of youthful influencers to accept the gifts of Juul products, to try out their various flavors and then to popularize their products among their peers,” a post on SRITA’s website read.

An Aug. 4, 2015, Juul Monthly Marketing Update obtained by congressional investigators showed the scope of Juul’s efforts to recruit influencers.

“We’ve targeted 1,500 current smokers turned Juul influencers to spread the word. These Influencers have strong networks in fashion, music and entertainment — many of whom have incredibly strong presences in social media with millions of followers,” the internal Juul company email read.

Another update in the same email said a Juul sampling tour “will get Juul into the hands of over 12,500 influencers, subsequently introducing Juul to over 1.5 million people.”

“It was very contemporary. In the world of tobacco, there are social media promotion and influencers, but Juul really took it to another level. It was highly intense and very sophisticated social media marketing that was targeted to a young audience,” Jackler said.

In addition, Juul’s social media pages shared photos of young celebrities using or holding their devices. A 2020 Juul lawsuit filed by Massachusetts Attorney General Maura Healey claimed one of Juul’s advertising agencies, Grit, actively tried to recruit singer Miley Cyrus as an influencer.

Juul Labs sponsored a VIP lounge at the 2018 Sundance Film Festival for celebrities, gifting them with the company’s products. Photos from the event featured actors Elijah Wood and Nicholas Cage as well as band members of Imagine Dragons, according to SRITA research.

Researchers also found the company had posted images to its Facebook and Instagram accounts of Katy Perry and Orlando Bloom sharing a Juul at the 2016 Golden Globes. It’s not clear that any of these celebrities knew they were being featured in a marketing campaign.

“Juul’s real marketing innovation was not its youth-oriented marketing. That was very typical for the tobacco industry. It was rather the fact that it used unpaid organic social media marketing,” Jackler said.

Six months after Juul’s launch, its marketing campaign gave anti-smoking advocates and tobacco researchers a feeling of déjà vu. Juul ads spreading on social media looked surprisingly similar to some of the most successful tobacco ad campaigns from decades past.

“The methods Juul used to market to youth are straight out of the 1970s, Big Tobacco playbook. Why wouldn’t Juul use Big Tobacco’s old tactics? They work,” Bostic said.

Juul Labs continued the campaign on social media for two and a half years. The ads featured bright, eye-catching images while associating Juul with strong emotional or sensory themes such as pleasure, relaxation and romance.

“Advertising agencies, especially tobacco advertising agencies, have long known that the images and motifs they use — brightly colored, flashy, youth-oriented activities — are exactly how you target the teenage audience,” Jackler said.

Juul sold 2.2 million devices in 2016, its first full year on the market. With its marketing campaign in full swing, those numbers skyrocketed more than 600 percent in 2017 to 16.2 million, according to tobacco-free advocacy group Truth Initiative.

By the summer of 2018, as regulatory pressure to stem the tide of teen vaping mounted, there was a tectonic shift in Juul’s marketing. A new “Make the Switch” ad campaign replaced the company’s youth-oriented marketing.

Middle-aged or older models replaced the youthful ones. The tobacco industry copycat themes were replaced with testimonial videos on social media of adult smokers switching to Juul. And Juul Labs started running the switch-themed ads on television.

A Juul Labs news release — that has since been deleted from the company’s website — called it an “adult education campaign.” The ads sought to sell people on the idea that vaping Juul products was safer than smoking.

“Yeah, you may say vaping is safer than smoking, but that’s a hell of a low bar when you think about how bad smoking is,” Jackler said.

In September 2019, with an outbreak of vaping-related injuries killing dozens and sickening hundreds more, the FDA fired off a warning letter accusing Juul Labs of breaking the law by making unproven claims.

“Referring to your ENDS [electronic nicotine delivery system] products as ‘99% safer’ than cigarettes, ‘much safer’ than cigarettes, ‘totally safe,’ and ‘a safer alternative than smoking cigarettes’ is particularly concerning because these statements were made directly to children in school,” the FDA warning letter read.

Juul and other e-cigs are often promoted as smoking cessation devices. But the FDA has never approved of any e-cig for that purpose.

“I know that some adults do use vaping products to try to stop smoking, but I would encourage them to try other forms of approved smoking cessation tools,” oncologist Dr. Joshua Mansour told Drugwatch. “There are other alternative routes to smoking cessation that are safer than vaping.”

Vaping is relatively new. There hasn’t been enough time for scientists to determine what long-term effects vaping may have. Researchers are just beginning to turn up Juul and e-cigarette side effects. And research in the U.S. has not yet clearly shown that Juul or other e-cigarettes help people quit.

“But if you look at what happens in the population as a whole, among people using e-cigarettes compared to tobacco users, the net effect is they depress quitting. They actually keep people smoking,” Glantz said.

Pressure against Juul mounted in 2019 as the vaping-related lung injury outbreak worsened. Cities proposed Juul bans and the FDA floated new e-cigarette crackdowns.

After Juul Labs spent an estimated $104 million on advertising in the first half of 2019, new FDA warnings became too much for the company. Juul abruptly dropped all paid advertising and CEO Kevin Burns resigned in September 2019.

But even as the company pulled its “Make the Switch” campaign from broadcast, print and digital channels, it still had a stealth ad campaign running full time.

Juul Labs had closed its social media accounts and deleted ads in late 2018. But Juul hashtags were still humming along without any work from the company.

“Even though Juul’s own posts stopped, it didn’t really matter because their social media community became the company’s marketing arm,” Jackler said.

According to SRITA’s 2019 research on Juul marketing, “a vast community” of predominately young people continued to post company-created hashtags after Juul’s social media sites went away.

Another 2019 SITRA study found that in the first seven months after Juul Labs deleted its social media sites, the average number of daily posts with Juul-related hashtags tripled. The number of posts grew to more than 500,000.

“This campaign continues to this very day,” Jackler said. “If you go on Instagram and search #Juul, you’ll find tons of pictures of kids using their Juul, holding five Juuls in their mouth, or vaping with friends or saying which flavor is their favorite.”

Juul used vaping-related hashtags to create “a social identity among e-cigarette users,” according to SRITA researchers. Hashtags make it easier to bring different posts and conversations on social media together. They also make it easier to search for posts on a particular topic.

Hashtags increase engagement and increase the likelihood a post will be shared or retweeted, increasing the number of eyes that will see the post. And narrowly focused hashtags mean those eyes will be people looking for specific information — in this case, information on Juul products.

“A hashtag is a very potent way of marketing,” Jackler said.

The hashtags worked as a multiplier, continuing to spread the company’s advertising and creating a perpetual motion marketing machine for Juul.

In their 2019 research article on Juul’s marketing in its first three years, Jackler and his co-authors identified 31 Juul-specific hashtags the company used on its social media sites to promote its products.

The researchers found hundreds of thousands of posts with hashtags related to Juul’s own marketing. These hashtags allowed Juul Labs to spread huge volumes of social media posts that “stimulated a viral person-to-person promotion to teens,” according to Jackler.

“Juul realizes, I’m sure, that there’s enormous Juul promotion going on amongst teens that is no longer controlled by the company,” Jackler said. “They don’t need to because Juul Labs created a wildfire.”