Exposure to JUUL use: cue reactivity effects in young adult current and former smokers

Abstract

BackgroundExposure to the use of first, second and third generations of electronic cigarettes (e-cigarettes) elicits the desire to vape and smoke among observers, as well as facilitates smoking behaviour. Given the rapid rise in the popularity of the pod mod JUUL, we examined whether observing the use of this device would elicit similar responses in smokers. Exploratory analyses were also conducted to determine whether JUUL can act as a smoking cue for former smokers.MethodsThe sample consisted of 82 young adult participants (62 current smokers and 20 former smokers approximately 1 year smoke free). The study examined their response to observing use of bottled water (control cue) and JUUL (active cue) in a controlled laboratory paradigm. Both cues were delivered by a trained study confederate under the guise of a social interaction task, and participants completed mood and desire and urge surveys precue and postcue exposures.ResultsIn current smokers, exposure to the JUUL cue increased smoking urge and desire for a cigarette, mod/vape pen and JUUL, and two-thirds chose to smoke in the behavioural analogue task. In former smokers, the JUUL cue evoked modest and transient increases in desire for a cigarette and JUUL.ConclusionsThe use of JUUL affects the user and elicits responses in observers; this study is the first to demonstrate that exposure to JUUL use may act as a smoking cue and exposure to JUUL use may affect tobacco control efforts.

The consequential impact of JUUL on youth vaping and the landscape of tobacco products: The state of play in the COVID-19 era

“…The addictive ‘potential’ of JUUL, whose nicotine content is claimed to be equivalent to a pack of 20 cigarettes ( Bowen and Xing, 2014 , The Truth Initiative, 2021 , JUUL Labs, Inc, 2021a ), together with the immense popularity of JUUL among teens and young adults ( Hammond et al, 2020 , Goniewicz et al, 2019 , Hrywna et al, 2020 ) has raised concern that a new generation of tobacco product users may be en route to nicotine dependence and addition ( Lee et al, 2020 , Creswell, 2019 ). There is also concern that JUUL use in youth may lead to gateway effects, such as initiation of smoking or cannabis use ( Jenssen and Wilson, 2019 , Case et al, 2020 , Vena et al, 2020 ). Furthermore, JUUL vapor inhaled by users, is shown to contain many of the same toxicants and carcinogens as those found in tobacco smoke ( Reilly et al, 2019 , Talih et al, 2019 , Talih et al, 2020 , Mallock et al, 2020 ).…”

Cue Reactivity to Electronic Cigarettes: A Systematic Review

“… 67 Of the remaining three papers that did not include smokers, one included participants who had never smoked and did not currently smoke, 68 one assessed only exclusive ENDS users, 69 and one included both current and former smokers but analysed the groups separately. 70 All papers used visual cues.…”

“…79 , 82 In regards to nicotine content, only 10 studies reported the ENDS nicotine levels used in their experiments. 64 , 69 - 72 , 74 , 77 , 79 - 81 E-liquids nicotine content ranged from 0 to 59 mg/ml (salt). Further information about ENDS types and nicotine levels used in the reviewed studies, including related outcomes, is presented in the sub-sections below and in Table 1 .…”

“…Nichols et al 69 even reported no ENDS craving after exposure to ENDS cues for non-smoking ENDS users; yet as mentioned above, the sample in this study was small. Interestingly, Vena et al 70 found that ENDS cue exposure increased smoking urge and desire in current smokers, but only enhanced smoking desire (and not urge) in former smokers. However, the size of the latter group was considerably smaller (20 former smokers as opposed to 62 current), so statistical power may have been an issue.…”

“…King et al examined the role of first 73 and second 74 , 76 generation ENDS design (similar/less-similar to conventional cigarettes), finding that both generation designs increased tobacco cigarette craving. Vena et al 70 used a fourth generation ENDS as a cue but asked participants to indicate their desire for a third and a fourth generation ENDS. They found that smokers reported an increased desire for both generations of ENDS, while former smokers only reported higher desire for fourth generation ENDS (JUUL), suggesting that generalisation may coincide with cue salience.…”