E-cigarette company Juul has sparked a “nicotine arms race,” tobacco marketing expert Robert Jackler argues.

When Juul first put its e-cigarettes on the market, it brought a new level of nicotine to the industry. At the time, most brands contained e-liquids that were 1 to 2 percent nicotine by volume. Juul pods contain 5 percent (by weight)—equivalent to 5.9 percent by volume—three times more concentrated than what was on the market before.

The disparity caused other e-cigarette companies to increase the amount of nicotine in their devices and pods, which Jackler, professor and chair of otolaryngology at Stanford University and senior author of a new paper in Tobacco Control, argues led to nicotine one-upmanship in the e-cigarette industry.

In the paper, Jackler and his coauthor discuss drive to add more nicotine to e-cigarettes and provide evidence to suggest that it plays into earlier addiction trends, especially among the youth demographic.

Here, Jackler, who is the founder of a group called the Stanford Research Into the Impact of Tobacco Advertising, discusses how this competition plays into earlier addiction trends, especially among young people, how elevated nicotine levels affect health, and what changes policy makers need to make.

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