Editor's note: This story has been updated to include comments from Juul.
Popular e-cigarette company Juul's November 2018 commitment to stop marketing its products to youth on social media may have done little to curb the brand's reach among young people.
Following intense scrutiny from public health professionals and the government, Juul announced it would try to reach fewer young people with its advertising in the U.S. The company terminated its Instagram and Facebook accounts in November 2018, and says it does not use paid social media influencers.
However, according to a study published this week in the BMJ journal Tobacco Control, and interviews with several researchers, Juul's recent efforts are unlikely to stop the spread of its products and other e-cigarette brands on youth-oriented social media. That's because, researchers say, the Juul brand has become so ingrained in youth culture that young people advertise it organically — and third-party companies use the Juul name for exposure.
The study analyzed nearly 15,000 Juul-relevant posts from 5,201 unique Instagram users between March and May of 2018. Juul itself was the author of only a tiny fraction of these posts.
The researchers found that the majority of Juul-related posts were targeted toward young people; about 55% involved content related to youth culture. Over one-third of the posts were promotional in nature, and 11% contained nicotine and addiction-related content.
These findings, the study authors say, show that Juul no longer drives the spread of its own products. Instead, young people and other vendors have taken to using the brand as a shorthand for youth culture, further popularizing the product — and the habit of vaping.
"We're at a point where young people are doing Juul's job for them," says Elizabeth Hair, a study co-author and senior vice president at the Truth Initiative Schroeder Institute, a nonprofit dedicated to ending tobacco use among youth. She says that in addition to the spread of Juul through organic posts like Spongebob memes, many third party vendors of vaping products have continued to push explicitly youth-targeted advertisements for Juul and similar e-cigarette products under Juul-related hashtags.
Though Juul shut down its Instagram account after the study period, multiple researchers say this analysis remains relevant today. The study period only saw a handful of posts that came directly from the Juul company. Instead, the mix of posts was dominated by posts from consumers or from third party vendors using the Juul brand. Both consumers and third party vendors continue to post about Juul on Instagram today.
In fact, since Juul closed its Instagram, the volume of Juul-related content on the platform has only increased: According to separate research conducted by Stanford University's Stanford Research Into The Impact of Tobacco Advertising, there were 260,866 Instagram posts containing the #juul hashtag in late October just before Juul shut down its account. They've now more than doubled to over 522,000 as of July 3.
"[Juul is a] hugely trendy topic amongst teens," says Robert Jackler, a Stanford professor and the principal investigator of the research group that studied the explosion of #juul posts. Jackler was not involved in the BMJ study. He says JUUL's early marketing efforts towards teens in 2015 were so successful that they took on a life of their own.
"Once they lit the match, it took off like a wildfire," he says. "The fact that Juul shut down its own social media postings had little effect."
The Stanford analysis shows how Juul's advertising in its first six months on the market in 2015 was "patently youth oriented." Juul pulled back from targeting youth after the initial period, but young people, affiliates and influencers quickly amplified the brand on social media channels.
Use of e-cigarettes took off from 2017 to 2018: According to the 2018 National Youth Tobacco Survey, vaping among teens increased by 78 percent during that period, from 11.7 to 20.8 percent of high schoolers. The sharp rise in teen vaping led then-FDA commissioner Scott Gottlieb to crack down on sales of vapes to kids, issuing more than 1,300 warning letters and fines to stores selling e-cigarettes to minors, as NPR reported.
Today, Juul says it's fighting third party accounts. In an emailed statement to NPR, Juul spokesman Ted Kwong said that Juul "strongly support[s] restrictions on social media marketing of vapor products."
Kwong said the company has a team monitoring third-party social media and it submits takedown requests against companies that improperly post third-party social media content related to Juul products; to date, it has succeeded in getting 25,405 Instagram posts removed, he said. The company has also recently sued one third party company, Eonsmoke, for infringement of its intellectual property.
"We don't want youth using our product," Kwong said.
The FDA has also taken enforcement actions against e-cigarette companies that market to youth online. But according to Jidong Huang, an associate professor in the School of Public Health at Georgia State University, a number of third party vendors still advertise Juul and similar e-cigarette products on Instagram.
E-cigarette marketing on social media falls into a regulatory grey area, says Huang, who was not involved in the BMJ study (though he reviewed it prior to publication).
"Marketing of e-cigarettes on social media is really this Wild West," says Huang. "There is no clear guidance in terms of what companies can and cannot do." For instance, does an Instagram ad featuring a gummy-bear flavored tobacco product only appeal to youth? Could companies make a case it could be targeted toward adults?
Unlike products like cigarettes and smokeless tobacco that have had foundational federal regulations, there are currently few federal rules that govern the specific content of e-cigarette advertising, explains Desmond Jenson, staff attorney and tobacco policy expert at the Public Health Law Center at the Mitchell Hamline School of Law in St. Paul, Minn.
There are exceptions: E-cigarette products must add labels of specific sizes and locations stating the products are addictive, and companies are not allowed to make misleading statements about health benefits or claim their products help people "quit."
However, because the FDA has broad authority to regulate tobacco products under the Tobacco Control Act, it can police youth-focused marketing — and it has done so increasingly. This June, for example, it cited four firms that sell e-liquids for inappropriate marketing to teens on social media. Starting in 2022, the agency will also subject all e-cigarette companies to premarket review, meaning it will conduct a more thorough audit of all companies marketing these products in the country.
Hair, the BMJ study coauthor, says the FDA could be doing more to restrict these companies now. Her study recommends that the federal government "focus on restricting promotional efforts for e-cigarette products, particularly on social media platforms where young people are a primary audience."
Stronger regulations likely won't stop teens from using #juul to share angsty memes and TikTok videos on Instagram. I've seen first-hand how pervasive "juuling" and Juul culture is. Many of my younger relatives are frequent users, and some of my friends have made Juul-related memes and shared them with hundreds or thousands of followers.
But as far as social media goes, Jackler has a suggestion.
"When Juul shut down its [Instagram] handle, they didn't do anything to prohibit hashtags," Jackler says. He suggests Facebook (Instagram's parent company) and other social media companies explore the idea of monitoring or shutting down popular Juul-related hashtags to quell the spread of what he calls "community harm."
Michael Felberbaum, an FDA spokesperson, says the organization does not comment on specific studies but says "the FDA is committed to continuing to tackle the troubling epidemic of e-cigarette use among kids. This includes limiting youth access to, and appeal of, flavored tobacco products like e-cigarettes and cigars, taking action against manufacturers and retailers who illegally market or sell these products to minors, and educating youth about the dangers of e-cigarettes and other tobacco products."
Susie Neilson is an intern on NPR's Science Desk. Find her on Twitter here: @susieneilson.