How E-Cigarette Use is Exposing Youth — and the Environment — to Toxic Chemicals

Jeremiah Mock
UCSF associate professor Jeremiah Mock holding a JUUL e-cigarette cartridge and a cigarette butt he found on a local high school campus. (Photo by Elisabeth Fall)


By Milenko Martinovich

The use of electronic cigarettes, or e-cigarettes, by American youth has surged so dramatically in recent years that the U.S. Surgeon General has declared it an “epidemic.” According to the Centers for Disease Control and Prevention, e-cigarette use among middle school students increased by 48 percent (3.3 percent to 4.9 percent) and among high school students by 78 percent (11.7 percent to 20.8 percent) from 2017 to 2018. In 2018, about 3.6 million middle and high school students nationwide reported using e-cigarettes, according to the CDC. 

Communities in the San Francisco Bay Area have not been immune to this epidemic. For example, in Marin County between 2016 and 2018, e-cigarette use among seventh-graders rose from 2 percent to 5 percent, and among 11th-graders from 11 percent to 28 percent, according to the California Healthy Kids Survey.

JUUL is the leader in the e-cigarette industry with a market share around 70 percent. 

“A year ago, there were very few high school administrators and parents in Marin County who knew what JUUL was or how to pronounce it,” said Jeremiah Mock, a health anthropologist and associate professor in the UC San Francisco School of Nursing’s Institute for Health & Aging and member of UCSF’s Center for Tobacco Control Research and Education. “JUULing caught a large majority of parents and teachers flat-footed.”

In addition, the waste from e-cigarettes may pose negative environmental effects. Mock and other researchers at UCSF are investigating this potential risk, which has taken them from the parking lots of San Francisco Bay Area high schools to the beaches and national parks of the Pacific Rim.

12 High Schools, 893 Pieces of Tobacco Waste

First introduced in the U.S. in 2007, e-cigarettes were hailed by some as a healthier alternative to combustible cigarettes because users avoided inhaling some of the estimated 7,000 chemicals that are produced from burning tobacco. 

But e-cigarettes, notably JUUL, have become increasingly popular with adolescents and teens — and with considerable dangers. Emerging evidence shows that the use of e-cigarettes can cause heart attackslung disease, and may cause seizures. E-cigarette aerosol can also contain cancer-causing chemicals, according to the American Cancer Society. Additionally, e-cigarettes contain nicotine, which is more damaging for younger users because brain development continues into one’s mid-20s. Studies have shown nicotine affects cell activity in the brain and negatively impacts the capacities for attention, learning and memory. 

JUUL’s meteoric rise and Mock’s involvement with the Smoke-free Marin Coalition and Marin Healthy Youth Partnerships, motivated him to investigate the extent of e-cigarette and other tobacco product waste at 12 Bay Area high schools. Mock and Yogi Hendlin, a research associate at UCSF’s Environmental Health Initiative, joined by Gia Asher, a former environmental leadership student at San Rafael’s Terra Linda High School, scoured the campuses over 10 months from 2018 to 2019 to see how much and what types of tobacco waste they would find.

They collected 893 waste items, of which 19 percent was e-cigarette waste. Mock said the amount of flavored e-cigarette products found was “alarming.” Seventy-three of the 74 JUUL/JUUL compatible pod caps collected were from flavored pods, some with appealing names such as Fruit Medley, Crème Brulee and Cool Mint. 

“The flavors are really important,” Mock said. “When you look at the food, candy or soft drink industries, they know kids are attracted to flavors. So, it’s no surprise that kids would find it more appealing to use flavored products when it comes to e-cigarette use.”

Read the full story in our Science of Caring publication.