The use of e-cigarettes among teens and young adults continues to climb in the United States. Using e-cigarettes, or vaping, is often referred to as “juuling” a reference to the preferred brand of e-cigarette among this age group.

State and local governments and the U.S. Food and Drug Administration have tried to limit youth access to Juul and other brands of e-cigarettes, but for these policies to be effective, researchers and policymakers need to understand young people’s knowledge and beliefs about e-cigarettes, and their motivation for vaping.

Teens reported they have little or no trouble getting e-cigarettes, despite the laws prohibiting their sale to minors.

A team from the University of Michigan recently asked teens about their attitudes about juuling, and why they do it. “The findings shed light on what kind of messaging and interventions are needed to reduce e-cigarette use among youth,” Tammy Chang, senior author on the paper, told TheDoctor. The team took a direct approach to discovering why kids used e-cigarettes and their attitudes towards taking risks — they asked them. “Their responses showed us that unless you ask youth directly, it’s difficult to know what they’re actually going through,” explained Chang.

The researchers analyzed over 1100 responses to the national MyVoice survey of teens and young adults, ages 14 to 24 years old. During a one-week period, participants were sent four questions via text message: Have you ever heard of Juul?; Why do you think people your age juul?; Do you think juuling is dangerous? Why or why not?; and Do you think juuling leads to using alcohol, cigarettes or other drugs? Why or why not?

Eighty-eight percent of the teenagers surveyed said they had heard of Juul, and 62 percent said kids vape for social reasons (“It’s trendy and cool!”). Many reported they used e-cigarettes to fit in. They also thought of e-cigarettes as alternatives to other substances, such as regular cigarettes, Chang said.

As the same time, though, most kids — 79 percent — thought using e-cigs was dangerous. And 72 percent said they thought it could lead to the use of other drugs, including traditional cigarettes. So, even though most respondents said they felt vaping was dangerous, they also thought it was not as dangerous as using other substances.

But even if youths are aware of the dangers of juuling, they still use e-cigarettes. “People, including teens and young adults, don’t necessarily act rationally,” remarked Chang, because they feel a lot of social pressure.

Only five percent of respondents said flavors were the reason they juuled. “We thought flavors might be the reason young people are using Juul, so that in itself was surprising,” said Chang. But, as she pointed out, too many other options like snacks and candies are available if teens want to taste a particular flavor.

Taking risks and experimenting during adolescence is normal and even essential, but not if it means doing dangerous things, like using e-cigarettes, that are likely to have lasting health consequences. As healthcare providers, Chang added, “We try to get youths to take healthy risks and avoid unhealthy risks.”

Laws are in place that should limit youth access to e-cigarettes, but teens reported they have little or no trouble getting them. Parents, healthcare providers and policymakers should advocate for stricter enforcement of tobacco laws, the same laws that govern access to e-cigarettes. “Adults can step in to create and enforce these laws so that’s it’s not easy for teens to get e-cigarettes,” Chang noted.

The research letter was published in JAMA Pediatrics.