In the Journals

Juul, pod-based e-cigarettes increasingly popular among teens

Adolescents and young adults are using pod-based e-cigarettes — such as Juul — more frequently than other types of e-cigarettes and conventional cigarettes, according to research published in JAMA Network Open. Researchers said this is of particular concern as many youths do not understand the addictive potential of these products.

“I was surprised and concerned that so many youths were using Juul more frequently than other products,” Bonnie Halpern-Felsher, PhD, professor of pediatrics at Stanford University, said in a press release. “We need to help them understand the risks of addiction. This is not a combustible cigarette, but it still contains an enormous amount of nicotine — at least as much as a pack of cigarettes.”

Halpern-Felsher and colleagues examined data on adolescent and young adult use of various forms of cigarettes between April 6 and June 20, 2018.

Of the 437 individuals from California included in the study who provided information on their use of cigarettes and e-cigarettes, 15.6% had previously used pod-based cigarettes. Nearly one-quarter of respondents (24.3%) reported cigarette use, and 30.4% used e-cigarettes.

Pod-based cigarettes were more likely to be used within the past 7 days (mean number of days [SD] = 1.5) and within the past 30 days (SD = 6.7) compared to other e-cigarettes (SD = 0.8 [7 days]; SD = 3.2 [30 days]) and conventional cigarettes (SD = 0.7 [7 days]; SD = 3 [30 days]).

Only 34 youths reported data on loss of autonomy from nicotine. The researchers observed no significant difference in the average Hooked On Nicotine Checklist scores between those who used pod-based e-cigarettes (2.59) and other types of e-cigarettes (2.32).

“The absence of clear messaging is interpreted as safety among adolescents,” Halpern-Felsher said. “The earlier you are exposed to nicotine, the higher the likelihood that you will be addicted throughout your life.”

Flavored e-liquid use was commonly reported as the first exposure to pod-based e-cigarette users, with 26.5% smoking menthol or mint liquid, and 27.9% reported fruit flavored e-liquid. Youths who used other types of e-cigarettes also used flavored e-liquid, but menthol and mint use was significantly lower, and fruit flavors were more commonly used (9.8% menthol or mint; 37.6% fruit).

When individuals were asked about the perceived social risks associated with e-cigarette use, as well as the perceived short- and long-term health outcomes, the average reported chance was 40%. Halpern-Felsher and colleagues wrote that this perceived chance was not statistically different between e-cigarette types.

“We need to get in front of identifying and explaining new and different nicotine-containing products so that we can regulate them and protect youth from using them,” she said. “It took a while for teachers to start realizing that [Juul] existed and that what they were seeing in classrooms were not USBs.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Adolescents and young adults are using pod-based e-cigarettes — such as Juul — more frequently than other types of e-cigarettes and conventional cigarettes, according to research published in JAMA Network Open. Researchers said this is of particular concern as many youths do not understand the addictive potential of these products.

“I was surprised and concerned that so many youths were using Juul more frequently than other products,” Bonnie Halpern-Felsher, PhD, professor of pediatrics at Stanford University, said in a press release. “We need to help them understand the risks of addiction. This is not a combustible cigarette, but it still contains an enormous amount of nicotine — at least as much as a pack of cigarettes.”

Halpern-Felsher and colleagues examined data on adolescent and young adult use of various forms of cigarettes between April 6 and June 20, 2018.

Of the 437 individuals from California included in the study who provided information on their use of cigarettes and e-cigarettes, 15.6% had previously used pod-based cigarettes. Nearly one-quarter of respondents (24.3%) reported cigarette use, and 30.4% used e-cigarettes.

Pod-based cigarettes were more likely to be used within the past 7 days (mean number of days [SD] = 1.5) and within the past 30 days (SD = 6.7) compared to other e-cigarettes (SD = 0.8 [7 days]; SD = 3.2 [30 days]) and conventional cigarettes (SD = 0.7 [7 days]; SD = 3 [30 days]).

Only 34 youths reported data on loss of autonomy from nicotine. The researchers observed no significant difference in the average Hooked On Nicotine Checklist scores between those who used pod-based e-cigarettes (2.59) and other types of e-cigarettes (2.32).

“The absence of clear messaging is interpreted as safety among adolescents,” Halpern-Felsher said. “The earlier you are exposed to nicotine, the higher the likelihood that you will be addicted throughout your life.”

Flavored e-liquid use was commonly reported as the first exposure to pod-based e-cigarette users, with 26.5% smoking menthol or mint liquid, and 27.9% reported fruit flavored e-liquid. Youths who used other types of e-cigarettes also used flavored e-liquid, but menthol and mint use was significantly lower, and fruit flavors were more commonly used (9.8% menthol or mint; 37.6% fruit).

When individuals were asked about the perceived social risks associated with e-cigarette use, as well as the perceived short- and long-term health outcomes, the average reported chance was 40%. Halpern-Felsher and colleagues wrote that this perceived chance was not statistically different between e-cigarette types.

“We need to get in front of identifying and explaining new and different nicotine-containing products so that we can regulate them and protect youth from using them,” she said. “It took a while for teachers to start realizing that [Juul] existed and that what they were seeing in classrooms were not USBs.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.