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April 17, 2018

Miller: JUUL offers opportunity to reduce smoking rates

Stop and think about JUUL

There have been examples around the country of many teachers and parents extremely concerned about JUUL.  There are many places around the country that this is not the case.  Iowa is one of those places.  Minority communities appear to be similar.  It may be that we are seeing heavy use of JUUL in high socio-economic schools, in large part because JUUL is so expensive.  We have enough information to be concerned, but not to make policy decisions.  Anecdotal information/stories are never enough to make good policy.

            What should we do about JUUL?  Three things:

1. We need more information.

  • How many kids are using JUUL and how much?  Are they like other young e-cigarette users-largely experimental?  At the peak of use by kids, approximately 80 percent were experimental.
  • Who are the kids using JUUL?  Has JUUL increased the total number of kids using e-cigarettes?  Are they kids who otherwise wouldn’t be using e-cigarettes?  Are they kids who would otherwise be smoking?
  • Most important, what happens later to the kids that use JUUL?  Are they like other e-cigarette kid users—80 percent experimental?  Or are they somehow different and gravitate to regular combustible use in much greater numbers? 

Then we need to act based on this information.

2. We can work with JUUL to produce a model of how combustible and e-cigarette companies can keep their product from kids. JUUL executives have stated from the start that they do not want kids using the product.  They sell directly only to people age 21 and older. JUUL has been outstandingly successful in the adult market.  They don’t need sales to adolescents to succeed.  Indeed, current youth use is far more harmful to JUUL than the cash generated.  JUUL has pledged to do anything within reason to keep their products from kids and to work with me and others to accomplish this.  This is an opportunity we have never had before.

3. We should set a goal to reduce adult use of combustibles to below 10 percent by the year 2022. Today 38 million adult Americans smoke combustibles, and 19 million will die from smoking-related disease.  If all 38 million switched to e-cigarettes, we could save 10 to 12 million lives.  (This is based on the position taken by Public Health England that e-cigarettes are at least 95 percent less harmful than combustibles.  This is a consensus position taken by the public health and tobacco-control community in England and has not been successfully challenged.)  JUUL was developed to provide smokers with a compelling substitute for smoking, but without combustion.  The company has achieved remarkable growth among e-cigarette users.  The current estimate for adult smoking prevalence for 2017 is 14.1 percent.  This is the lowest ever recorded and is dropping at an accelerated rate.  The most plausible explanation for at least part of this dramatic decline is smokers switching from cigarettes to e-cigarettes, including JUUL.  Dropping  the adult smoking rate below 10 percent would be one of the most important public health achievements in decades.  We must do everything we can to seize this opportunity.    

— Iowa Attorney General Tom Miller



            Truth Initiative has issued a report today (April 18, 2018) that is relevant to and supportive of two positions taken above:

  1. Only 7 percent of those aged 15-17 have ever used JUUL.


  1. Of those using JUUL, there is a significantly higher proportion of those living comfortably in financial terms.

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