E-cigarette Use Among Middle and High School Students — United States, 2020

Wang, Teresa W.; Neff, Linda J.; Park-Lee, Eunice; Ren, Chunfeng; Cullen, Karen A.; King, Brian A.

doi:10.15585/mmwr.mm6937e1

Cited by 416 publications

(351 citation statements)

References 2 publications

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“…According to local vape shop merchants and college students, cinnamon, strawberry, blueberry and other fruity flavors are popular among young adult ECIG users and is the reason they were also chosen for this study. Furthermore, the CDC (Wang et al, 2020) confirms these fruity preferences among youths. As shown in Figure 1, flavored and unflavored E-Liquids were all spiked with 20 mg/mL (S)-(-)nicotine (Alpha Aesar, Tewksbury, MA, United States).…”

Section: Stock E-liquidmentioning

confidence: 68%

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci

et al. 2020

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IntroductionElectronic cigarette (ECIG) use or vaping has become popular globally. While the question “Is vaping safer than smoking?” continues, it is becoming clearer that one of the most dangerous components of E-liquids are the flavorings. Since the oral cavity is the first anatomical site to be assaulted by ECIG aerosol, the aim of this study is to test the hypothesis that flavored ECIG aerosols or E-liquids pose a more detrimental effect on the growth of commensal oral streptococcal bacteria compared to flavorless aerosols or E-liquids.MethodsKirby Bauer assays and 24-h planktonic growth curves were used to compare the effects of flavorless vs. flavored (tobacco, menthol, cinnamon, strawberry and blueberry) ECIG-generated aerosols and E-liquids on the growth of four common strains of oral commensal bacteria (Streptococcus gordonii, Streptococcus intermedius, Streptococcus mitis and Streptococcus oralis).ResultsKirby Bauer assays revealed inhibition of growth for all bacteria tested when exposed to 100% menthol, cinnamon or strawberry flavors. In contrast, 5% flavor in E-liquid had no effect. When exposed to 100 puffs of ECIG-generated aerosol ± flavors (≈ 0.05% flavor in brain heart infusion media) or an equivalent amount of E-liquid ± flavors, twenty-four hour planktonic growth curves indicated no effect on growth for all streptococci tested. Subsequent twenty-four hour planktonic growth curves testing the effects of E-liquid ± flavors (0.0625, 0.125, 0.25, 0.3125, 0.625, and 1.25% flavor in brain heart infusion media) revealed dose-dependent inhibition of growth, particularly for menthol, cinnamon and strawberry), for all bacteria tested.ConclusionThese results support the hypothesis that flavored E-liquids are more detrimental to the growth of oral commensal bacteria than unflavored E-liquids. The streptococci tested in this study are early colonizers and part of the foundation of oral biofilms and dental plaque. Disturbances in the composition and growth of these primary colonizers is crucial to the development of a healthy dental plaque and host-bacteria interactions. E-liquids and their aerosols containing flavoring agents alter the growth of these bacteria. Such perturbations of pioneering oral communities pose a potential risk to the health of the oral cavity and, ultimately, health in general.

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Section: Stock E-liquidmentioning

confidence: 68%

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci

et al. 2020

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“…While flavored cartridge/pod-based products were banned by the FDA, flavored disposable e-cig products were not. A recent study examining retail data showed an increase in the use of mint flavored disposable products from 2017 to 2020 [ 29 ], and the National Youth Tobacco Survey reported a 1000% increase in the use of disposable products from 2019 to 2020 [ 26 ]. In addition, a study of internet searches reported a sharp increase of searches pertaining to disposable products, like Puff Bar [ 26 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…While the use of e-cigs may help adult smokers to reduce or quit smoking, the wide availability of e-cigs poses a risk to youth. In 2020, 19.6% of high school students and 4.7% of middle school students in the United States reported using an e-cig in the past 30 days, which makes e-cigs the most widely used tobacco product in this age group [ 26 ]. Most youth e-cig users report using pod-based products [ 26 , 27 ], like JUUL, which are capable of delivering nicotine in high doses that are similar to a cigarette [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…In 2020, 19.6% of high school students and 4.7% of middle school students in the United States reported using an e-cig in the past 30 days, which makes e-cigs the most widely used tobacco product in this age group [ 26 ]. Most youth e-cig users report using pod-based products [ 26 , 27 ], like JUUL, which are capable of delivering nicotine in high doses that are similar to a cigarette [ 5 , 6 ]. In addition, the majority of youth e-cig users reported initiating e-cig use because of the appealing flavor options [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Response to Flavored Cartridge/Pod-Based Product Ban among Adult JUUL Users: “You Get Nicotine However You Can Get It”

Yingst

Bordner

Hobkirk

et al. 2020

IJERPH

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In order to curb increasing youth electronic cigarette (e-cig) use, the United States Food and Drug Administration (FDA) banned the sale of flavored cartridge/pod-based products in February 2020. This mixed-methods study aimed to evaluate the impact of the FDA ban on adult JUUL users. The samples of current adult JUUL users were surveyed via Amazon Mechanical Turk at three time-points n = 76 (Sample 1); n = 128 (Sample 2); n = 86 (Sample 3) before and after the FDA flavored/pod ban. The participants were asked to report the JUUL flavored pod used most often and answer questions on purchasing generic pods or refilling (Quantitative). JUUL users were then interviewed in order to explore their perceptions and behaviors related to the FDA ban of flavored cartridge/pod-based products (Qualitative; n = 16). Quantitative data analysis evaluated the differences in variables by time-point. Qualitative data were coded into themes while using the constant comparative method. We found a significant decrease in the use of mint pods (43.4%, 22.7%, 16.3%) (p < 0.01), while there was a significant increase in the use of menthol pods (6.6%, 26.6%, 37.2%) (p < 0.01). Themes that emerged from the qualitative data included switching from mint to menthol pods, refilling pods, and switching to other products that are available in the desired flavors, such as generic pods or disposable e-cigs. Future research is needed in order to evaluate the impact of these behaviors on public health.

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“…In December 2019, the national tobacco purchasing age was increased to 21 [10]. In early 2020, the federal authority issued a new policy [11] against flavoring in e-cigarettes, except tobacco and menthol flavors; this rule covered cartridge-based e-cigarettes and exempted disposable e-cigarettes, which is the second most used device type among high school students based on the 2020 national survey [12]. As such, criticism against the FDA remains for its lack of swift actions and tighter market-wide regulations against e-cigarette manufacturersas youth e-cigarette consumption continues to grow [13].…”

Section: Introductionmentioning

confidence: 99%

Content analysis of the use of fear in The Real Cost Youth E-cigarette Prevention Campaign

Xuan

Choi

2021

Journal of Communication in Healthcare

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E-cigarette Use Among Middle and High School Students — United States, 2020

Cited by 416 publications

References 2 publications

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci

Response to Flavored Cartridge/Pod-Based Product Ban among Adult JUUL Users: “You Get Nicotine However You Can Get It”

Content analysis of the use of fear in The Real Cost Youth E-cigarette Prevention Campaign

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