Exploring the Interface Between JUUL Addiction and
Digital Media Addiction

An Addiction Within an Addiction?

Sabrina Jung, Randall Research Scholars Program, The University of Alabama
Alan Blum, MD, Center for the Study of Tobacco and Society (csts.ua.edu)


In 2000, Charlton and Bates hypothesized in the British Medial Journal that the decline in cigarette smoking among teenagers in the United Kingdom was a result of spending their disposable income on cell phones instead of cigarettes.1 Little did they realize, however, that teenagers might be trading one addiction for another. In 2007, Apple released the iPhone which rapidly became a ubiquitous consumer product. E-cigarettes were also introduced to the United States (U.S.) in 2007, and their use soared in 2015 after the introduction of JUUL, an ecigarette that resembles a USB flash drive. The brand has captured 75% of the e-cigarette market, and the rapid rise in the use of e-cigarettes by high school and college students has caused grave concern among health professionals, educators, and parents alike.2

Overview of Digital Media

The term digital media encompasses electronic devices, including television, computers, and cell phones. For this review, we focused primarily on cell phone use and the use of social media which refers to websites and applications (apps) that allow users to produce and share information. Facebook, Instagram, and Twitter are the most popular social networking sites in the U.S. based on active monthly users. Instagram and Snapchat are the most popular among college-age users.3

Overview of Vaping

E-cigarettes are battery-operated devices used to inhale a vaporized liquid containing nicotine. Most resemble traditional cigarettes but can also be used to deliver vapor of marijuana (ecannabis). 4 The use of these devices is called vaping.

Different Types of E-Cigarettes 9

Year Company E-Cigarette
2009  Imperial Tobacco  blu eCigs
2013  R.J. Reynolds  Vuse
2014  Altria  MarkTen
2015  JUUL Labs  JUUL

Health Concerns

Cigarettes are the leading preventable cause of disease in the U.S., with the death toll of nearly 500,000 per year. E-cigarettes were invented as a way to reduce the exposure to the toxic chemicals of combustion and to aid in stopping smoking.10 One unintended consequence is that ecigarettes have been taken up en masse by adolescents who have never smoked, nor are e-cigarettes free of harmful chemicals. In 2019, vaping was found to cause severe lung injury.11 On December 4th, 2019, the Centers for Disease Control and Prevention reported that there have been 2,291 cases of vaping-associated lung injury, resulting in 48 deaths. But most of these illnesses appear to have been related to the use of THC containing e-liquids purchased online.12 There is no federal regulation of these products.

JUUL: Addiction By Design

JUUL’s resemblance to a USB drive has made it attractive to a wired generation. The design was deliberate. JUUL was created by two graduate students at Stanford University with a twofold purpose: to look cool and to deliver nicotine more rapidly than other e-cigarettes. Although JUUL Labs, Inc.’s website claims that it is an alternative to cigarettes for adult smokers, the product has become controversial because of its extreme popularity among teenagers.

Adolescent Dependence on Digital Devices

78% of teens check digital media devices at least every hour, and teens spend an average of nine hours per day on digital devices.14 E-cigarette use has escalated in the past ten years among teenagers, raising concerns about nicotine addiction and other adverse health consequences.15 16 11.7% of 12th graders report vaping daily and 40.5% of 12th graders report having vaped at least once.17 Of youth who have never used traditional cigarettes or e-cigarettes, those with the highest use of electronic devices are more likely to begin using cigarettes. 3 Digital media addiction and e-cigarette addiction appear to reinforce each other.

Peer Posts

Social media platforms are an indirect way to promote e-cigarette use.18 43% of social media users report viewing a peer post about e-cigarettes through at least one social media platform in the last 6 months. Of these, 31% viewed posts on Facebook, 16% on Twitter, and 28% on Instagram.18 Commentary on these platforms is often accompanied by hashtags such as “#ecigs”, “#vape”, or “#juul”, creating a collection of posts that can develop into a community of users.19 Even posts that make fun of JUUL are a way to maintain its visibility and popularity. This can be especially problematic for teens who are trying to find a group of people they can connect with. The sharing of experiences on social media has the potential to reinforce social acceptability of JUUL use.18

Social Media as a Source of Information

Many e-cigarette users engage with social media to obtain information on vaping products that is often inaccurate.18 18-24 year olds rely on online sources including social media as their main source of news. 75% of 18-24 year olds report that their main sources of information about e-cigarettes are internet searches and user generated social media posts.20 This can result in inaccurate and misleading information about the products and their health effects.18 Users tend to view input from peers via social media as more trustworthy than e-cigarette websites because they are exposed to both the positive and the negative aspects of a product.

JUUL Marketing as a Source of Deception

Digital media have substantially replaced print media.21 Digital marketing involves new media such as social networking sites and brand websites. Marketing on digital media now far surpasses traditional marketing, especially for adolescents who have on-demand access to content and are active consumers of digital media.22 They are highly susceptible to media influence and are more likely to identify with and to model what they view, and e-cigarette companies are taking advantage of this.22 Since its inception, JUUL Labs, Inc. has heavily utilized social media, spending nearly half of its advertising expenditure on online marketing with a focus on Instagram advertisements.2 JUUL’s first advertising campaign was “Vaporized”, featuring young models and bright colors.3 JUUL also extensively promoted its variety of flavors such as mango and crème brulee, but in 2019 halted sales of pods with flavors other than tobacco and menthol due to public criticism. JUUL also ended its youth-oriented advertisements on social media. JUUL’s official Instagram page @juulvapor discontinued use on November 13, 2018. In 2017, almost half of social media users in 6th, 8th, and 10th grades recalled viewing an e-cigarette advertisement in the previous 6 months. Of these, 40% viewed advertisements on Facebook, 13% on Twitter, and 13% on Instagram.18 23 Exposure to e-cigarette advertising increases the likelihood of future initiation of e-cigarette use.24

Social Media as a Possible Remedy

An anti-JUULing movement has begun on social media using hashtags such as ”#ditchjuul”. The Truth website, established with funds from the Master Settlement Agreement, specifically targets young people. It was originally centered on ending cigarette and other tobacco product use but now focuses on JUULing due to its widespread use among teens. They utilize social media platforms to appeal to young people. 15 A new antivaping program, ThislsQuitting, is tailored by age group to give teens and young adults appropriate recommendations about quitting via text. The daily texts are specific to age and product that they are trying to quit, and 54,000 young people have signed up since its launch in January 2019.17


Just as fighting smoking means going after Marlboro, JUUL is by far the leading brand of e-cigarettes among college students and teens, and future efforts to counteract electronic cigarette introduction and habituation should be directed at counteracting the promotion of JUUL. Meanwhile, efforts must be made to reduce the number of hours per day that high school and college students spend on digital media. Overall, e-cigarette addiction appears to be more closely related to dependence on digital media than cigarette smoking.


  1. Charlton, A. (2000). Decline in teenage smoking with rise in mobile phone ownership: hypothesis. Bmj, 321(7269), 1155–1155. doi: 10.1136/bmj.321.7269.1155
  2. Huang, Jidong; Duan, Zongshuan; Kwok, Julian; Binns, Steven; Vera, Lisa E.; Kim, Yoonsang; Szczypka, Glen; Emery, Sherry L. (May 2018). “Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market”. Tobacco Control. 28 (2): 146–151. doi:10.1136/tobaccocontrol-2018-054382. PMC 6274629. PMID 29853561. Retrieved 2018-09-26.
  3. Lee S, Han D-H, Chow A, Seo D-C. A prospective longitudinal relation between elevated use of electronic devices and use of electronic nicotine delivery systems. Addict Behav. 2019;98:106063. doi:10.1016/j.addbeh.2019.106063
  4. National Institute on Drug Abuse. (2019, September). Electronic Cigarettes (E-cigarettes). Retrieved from https://www.drugabuse.gov/publications/drugfacts/electronic-cigarettes-e-cigarettes
  5. Historical Timeline of Electronic Cigarettes. (2018, October 18). Retrieved from http://www.casaa.org/historical-timeline-of-electronic-cigarettes/
  6. Gilbert, H. A. (1963). United States Patent No. US3200819A. Retrieved from https://patents.google.com/patent/US3200819
  7. Ron, C. (2019, June 18). The Many Fathers of Vaping. Retrieved from https://www.techwalls.com/the-many-fathers-of-vaping/.
  8. Heat Not Burn and Other Products. (n.d.). Retrieved from http://www.evolvingcigarette.com/cigarette-automation-2/heat-not-burn-and-other-products-2/.
  9. Electronic Cigarettes, What is the bottom line? (2019). Electronic Cigarettes, What is the bottom line? Retrieved from https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/Electronic-Cigarettes-Infographic-508.pdf 
  10. Cahn, Z. & Siegel, M. J Public Health Pol (2011) 32: 16. https://doi.org/10.1057/jphp.2010.41
  11. JUUL: Electronic Cigarettes & Your Health. (2017, January 27). Retrieved from https://www.aafp.org/patient-care/public-health/tobacco-nicotine/tools/e-cigs.html.
  12. Speedy, Andrea. “E-Cigarettes – A College Health Crisis in the Making? The Latest Facts About This Troubling Trend and What Campuses Can Do in Response.” College Health and Wellness in Action, ACHA, 26 Nov. 2019, acha.readz.com/e-cigarettes–a-college-health-crisis-in-the-makin.
  13. The Smoking Alternative, unlike any E-Cigarette or Vape. (n.d.). Retrieved from https://www.juul.com/
  14. Dealing with Devices: The Parent-Teen Dynamic: Common Sense Media. (2016, May 3). Retrieved from https://www.commonsensemedia.org/technology-addiction-concern-controversy-and-finding-balance-infographic.
  15. Jamal, A., Gentzke, A., Hu, S., Cullen, K. A., Apelberg, B. J., Homa, D. M., & King, B. A. (2017). Tobacco Use Among Middle and High School Students — United States, 2011–2016. Morbidity and Mortality Weekly Report, 66, 597–603. Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6623a1.htm#suggestedcitation 
  16. Grana, R. A. (2013). Electronic Cigarettes: A New Nicotine Gateway? Journal of Adolescent Health, 52(2), 135–136. doi: 10.1016/j.jadohealth.2012.11.007
  17. Layden, J. E., Hu, Marder, S. R., Cannon, T. D., Plaçais, L., & Denier, C. (2019, September 6). Trends in Adolescent Vaping, 2017–2019: NEJM. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMc1910739
  18. Sawdey, M. D., Hancock, L., Messner, M., & Prom-Wormley, E. C. (2017). Assessing the Association Between E-Cigarette Use and Exposure to Social Media in College Students: A Cross-Sectional Study. Substance Use & Misuse, 52(14), 1910–1917. doi: 10.1080/10826084.2017.1319390
  19. Laestadius, L. I., Wahl, M. M., & Cho, Y. I. (2016). #Vapelife: An Exploratory Study of Electronic Cigarette Use and Promotion on Instagram. Substance Use & Misuse, 51(12), 1669–1673. doi: 10.1080/10826084.2016.1188958
  20. Dobbs, P. D., Clawson, A. H., Gowin, M., & Cheney, M. K. (2019). Where college students look for vaping information and what information they believe. Journal of American College Health, 1–10. doi: 10.1080/07448481.2018.1549557
  21. Charney, Noah; (7 December 2014). “America’s vaping revolution: How suspicious should we really be of the e-cigarette craze?”. Salon (website).
  22. Jackson, K. M., Janssen, T., & Gabrielli, J. (2018). Media/Marketing Influences on Adolescent and Young Adult Substance Abuse. Current Addiction Reports, 5(2), 146–157. doi: 10.1007/s40429-018-0199-6
  23. Hébert, E. T., Case, K. R., Kelder, S. H., Delk, J., Perry, C. L., & Harrell, M. B. (2017). Exposure and Engagement With Tobacco- and E-Cigarette–Related Social Media. Journal of Adolescent Health, 61(3), 371–377. doi: 10.1016/j.jadohealth.2017.04.003
  24. Camenga, D., Gutierrez, K. M., Kong, G., Cavallo, D., Simon, P., & Krishnan-Sarin, S. (2018). E-cigarette advertising exposure in e-cigarette naïve adolescents and subsequent e-cigarette use: A longitudinal cohort study. Addictive Behaviors, 81, 78–83. doi: 10.1016/j.addbeh.2018.02.008
  25. #FinishIT. (n.d.). Retrieved from https://www.thetruth.com/.
  26. Quitting E-cigarettes. (2019, January 19). Retrieved from https://truthinitiative.org/research-resources/quitting-smoking-vaping/quitting-e-cigarettes
  27. Case, K., Crook, B., Lazard, A., & Mackert, M. (2016). Formative research to identify perceptions of e-cigarettes in college students: Implications for future health communication campaigns. Journal of American College Health, 64(5), 380–389. doi: 10.1080/07448481.2016.1158180
  28. Pokhrel, P., Fagan, P., Herzog, T. A., Laestadius, L., Buente, W., Kawamoto, C. T., … Unger, J. B. (2018). Social media e-cigarette exposure and e-cigarette expectancies and use among young adults. Addictive Behaviors, 78, 51–58. doi: 10.1016/j.addbeh.2017.10.017 
  29. Sampasa-Kanyinga, H., & Hamilton, H. (2018). Use of social networking sites, electronic cigarettes, and waterpipes among adolescents. Public Health, 164, 99–106. doi: 10.1016/j.puhe.2018.08.001
  30. Link, A. R., Cawkwell, P. B., Shelley, D. R., & Sherman, S. E. (2015). An exploration of online behaviors and social media use among hookah and electronic-cigarette users. Addictive Behaviors Reports, 2, 37–40. doi: 10.1016/j.abrep.2015.05.006
  31. Emery, S. L., Vera, L., Huang, J., & Szczypka, G. (2014). Wanna know about vaping? Patterns of message exposure, seeking and sharing information about e-cigarettes across media platforms. Tobacco Control, 23(suppl 3), iii17–iii25. doi: 10.1136/tobaccocontrol-2014-051648
  32. Depue, J. B., Southwell, B. G., Betzner, A. E., & Walsh, B. M. (2015). Encoded Exposure to Tobacco Use in Social Media Predicts Subsequent Smoking Behavior. American Journal of Health Promotion, 29(4), 259–261. doi: 10.4278/ajhp.130214-arb-69
  33. Perrin, A., & Anderson, M. (2019, April 10). Share of U.S. adults using social media, including Facebook, is mostly unchanged since 2018. Retrieved from https://www.pewresearch.org/fact-tank/2019/04/10/share-of-u-s-adults-using-social-media-including-facebook-is-mostly-unchanged-since-2018/.
  34. Mock, J., & Hendlin, Y. H. (2019, October 10). Notes from the Field: Environmental Contamination from E-cigarette, Cigarette, Cigar, and Cannabis Products at 12 High Schools – San Francisco Bay Area, 2018–2019. Retrieved from https://www.cdc.gov/mmwr/volumes/68/wr/mm6840a4.htm?s_cid=mm6840a4_w.
  35. (2019, October 14). Retrieved October 22, 2019, from https://finance.yahoo.com/video/probe-social-media-methods-juul-183351443.html
  36. Emery, S. L., Vera, L., Huang, J., & Szczypka, G. (2014). Wanna know about vaping? Patterns of message exposure, seeking and sharing information about e-cigarettes across media platforms. Tobacco Control, 23(suppl 3), iii17–iii25. doi: 10.1136/tobaccocontrol-2014-051648
  37. Mishra, M., & Joseph, S. S. (2019, October 24). U.S. vaping-related deaths rise to 34, cases of illness to 1,604. Retrieved from https://www.reuters.com/article/us-usa-vaping-cdc/u-s-vaping-related-deaths-rise-to-34-cases-of-illness-to-1604-idUSKBN1X32CA.
  38. Dutra, Lauren M; Grana, Rachel; Glantz, Stanton A (2016).“Philip Morris research on precursors to the modern e-cigarette since 1990”. Tobacco Control. 26 (e2): tobaccocontrol–2016–053406. doi: 10.1136/tobaccocontrol-2016-053406. ISSN 0964-4563. PMC 5432409. PMID 27852893.
  39. Hoffman, J. (2019, January 30). E-Cigarettes Are Effective at Helping Smokers Quit, a Study Says. Retrieved from https://www.nytimes.com/2019/01/30/health/ecigarettes-nicotine-smoking-quit.html.
  40. 5 Vaping Facts You Need to Know. (n.d.). Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/5-truths-you-need-to-know-about-vaping.
  41. Verto Analytics. (September 9, 2019). Most popular mobile social networking apps in the United States as of June 2019, by monthly users (in millions) [Graph]. In Statista. Retrieved November 18, 2019, from https://www.statista.com/statistics/248074/most-popular-us-social-networking-apps-ranked-by-audience/
  42. Cambridge University Press. (n.d.). SOCIAL MEDIA: definition in the Cambridge English Dictionary. Retrieved from https://dictionary.cambridge.org/us/dictionary/english/social-media.
  43. Fox, M., & Edwards, E. (n.d.). Teens Spend ‘Astounding’ Nine Hours a Day in Front of Screens: Researchers. Retrieved from https://www.wvea.org/content/teens-spend-astounding-nine-hours-day-front-screens-researchers.