Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users

Chen-Sankey, Julia; Kong, Grace; Choi, Kelvin

doi:10.1371/journal.pone.0212353

Cited by 29 publications

(27 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The combination of widespread use and unknown health effects of new alternative, non-combustion tobaccorelated products, delivered by JUUL and related devices, points to a pressing need to investigate respiratory system responses to inhaled JUUL and JUUL-related aerosols. The availability of more than 7700 unique flavors for ENDS, including sweet and fruity flavors [69] is considered the main driver of the recent explosive use of e-cigs among pre-teens, teens and young adults [4][5][6]39]. In response, at least in part, to an unexpected public outcry in October 2019, JUUL Labs suspended the sale in the US of their popular flavored pods: crème brûlée, mango, cool mint, and fruit medley [70].…”

Section: Discussionmentioning

confidence: 99%

“…E-cig devices were formally targeted to adult smokers attempting to quit smoking; however, e-cigs have quickly gained immense popularity among adolescents and young adults, making these devices the most popular form of tobacco product usage within this demographic [1]. Moreover, ENDS products are more attractive to youth (< 18 years of age) compared to cigarettes at least in part due to targeted marketing and availability of a substantial assortment of flavored e-liquids [3][4][5][6]. According to the Centers for Disease Control and Prevention (CDC), e-cig usage among youth has increased to more than 5 million individuals in the US as of 2019 [7,8], in addition to about 8 million adult users [9].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface

et al. 2020

View full text Add to dashboard Cite

Backgroud JUUL, an electronic nicotine delivery system (ENDS), which first appeared on the US market in 2015, controled more than 75% of the US ENDS sales in 2018. JUUL-type devices are currently the most commonly used form of ENDS among youth in the US. In contrast to free-base nicotine contained in cigarettes and other ENDS, JUUL contains high levels of nicotine salt (35 or 59 mg/mL), whose cellular and molecular effects on lung cells are largely unknown. In the present study, we evaluated the in vitro toxicity of JUUL crème brûlée-flavored aerosols on 2 types of human bronchial epithelial cell lines (BEAS-2B, H292) and a murine macrophage cell line (RAW 264.7). Methods Human lung epithelial cells and murine macrophages were exposed to JUUL crème brûlée-flavored aerosols at the air–liquid interface (ALI) for 1-h followed by a 24-h recovery period. Membrane integrity, cytotoxicity, extracellular release of nitrogen species and reactive oxygen species, cellular morphology and gene expression were assessed. Results Crème brûlée-flavored aerosol contained elevated concentrations of benzoic acid (86.9 μg/puff), a well-established respiratory irritant. In BEAS-2B cells, crème brûlée-flavored aerosol decreased cell viability (≥ 50%) and increased nitric oxide (NO) production (≥ 30%), as well as iNOS gene expression. Crème brûlée-flavored aerosol did not affect the viability of either H292 cells or RAW macrophages, but increased the production of reactive oxygen species (ROS) by ≥ 20% in both cell types. While crème brûlée-flavored aerosol did not alter NO levels in H292 cells, RAW macrophages exposed to crème brûlée-flavored aerosol displayed decreased NO (≥ 50%) and down-regulation of the iNOS gene, possibly due to increased ROS. Additionally, crème brûlée-flavored aerosol dysregulated the expression of several genes related to biotransformation, inflammation and airway remodeling, including CYP1A1, IL-6, and MMP12 in all 3 cell lines. Conclusion Our results indicate that crème brûlée-flavored aerosol causes cell-specific toxicity to lung cells. This study contributes to providing scientific evidence towards regulation of nicotine salt-based products.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Due to flavour availability, youths may begin to vape thinking that they will be less likely to be addicted to nicotine and less likely to harm their health and that of others. This would be especially important if using non-tobacco flavoured e-cigarettes is a gateway to smoking combustible cigarettes, although evidence to support the gateway hypothesis is mixed 33–35…”

Section: Discussionmentioning

confidence: 99%

Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey

Strombotne

Buckell

Sindelar³

2020

Tob Control

View full text Add to dashboard Cite

IntroductionUse of JUULs and e-cigarettes is growing rapidly, particularly among adolescents. Research suggests that flavours may increase the appeal of these products, but little is known about how flavours influence perception. We examined whether youth perceptions about the health risks of JUULs and e-cigarettes vary with flavours.MethodsWe conducted a national survey in 2018 of 1610 high-school students aged 14–18 who had ever heard of either JUULs or e-cigarettes. Respondents were asked to rate the lung cancer risk, the harm of second-hand vapour, potential for addiction and healthiness of differently flavoured JUUL and e-cigarette products. We investigated the relationship among flavour, risk perception and socio-demographic information.ResultsWe found that risk perceptions for both JUULs and e-cigarettes differ significantly by flavour type. Youths perceive fruit flavours to be less likely to lead to lung cancer (−0.909 (0.065)), have harmful second-hand vapour (−0.933 (0.060)) and be more addictive (1.104 (0.094)) relative to tobacco flavours. Candy, menthol/mint and alcohol flavours show similar patterns of risk association, although the magnitude is slightly smaller than for fruit flavours.ConclusionsYouths believe that flavours are related to the health risks of both JUULs and e-cigarettes despite the fact that these differences in risk by flavour have not been scientifically or systematically established. A policy concern is that misperceptions based on flavour may result in increased vaping by youths. The findings from this study support the assertion that banning fruit, menthol or mint and sweet flavours could reduce the appeal of JUULs and e-cigarettes to youth, with concomitant health protections.

show abstract

“…Tobacco product curiosity correlates with product susceptibility and use among youth 14,28 . Youth who perceived flavored smokeless tobacco and flavored e-cigarettes as easier to use than unflavored options were more likely to be susceptible to smokeless tobacco use 17 and to initiate future e-cigarette use 16 , respectively. The present discrete choice findings demonstrate that multiple independent product-related factors are associated with constructs shown to predict future tobacco use.…”

Section: Discussionmentioning

confidence: 99%

“…In each experiment, for each pair of product composites, participants were asked which product 'are you more curious about', which 'is more dangerous to health', which 'would be easier to use', and which 'would give a bigger 'buzz' or 'head rush''. These outcomes were chosen because of previous work showing associations between tobacco use and/or susceptibility with youth-reported curiosity 14 , perceived danger 15 , and perceived ease-of-use 16,17 . The outcome 'buzz' was introduced to measure perceived physiological effects or potency.…”

Section: Discrete Choice Experimentsmentioning

confidence: 99%

Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions

Chaffee¹,

Couch²,

Urata³

et al. 2020

Tob. Induc. Dis.

View full text Add to dashboard Cite

Use of non-cigarette tobacco is increasing among youth. Past 30-day use of electronic cigarettes (e-cigarettes) among US high school students recently rose substantially, more than doubling in two years, from 11.7% in 2017 to 27.5% in 2019 1,2. Similarly, the use of conventional smokeless (spit) tobacco in 2018 nearly equaled the prevalence of cigarette smoking among male US high school students (smokeless: 8.4%; cigarettes: 8.8%) 1. Use of ABSTRACT INTRODUCTION Tobacco product characteristics convey product attributes to potential users. This study aimed to assess independent contributions of specific e-cigarette and smokeless tobacco product characteristics to adolescents' perceptions about these products. METHODS In 2019-2020, students (N=1003) attending a convenience sample of 7 high schools in California (USA) were individually randomized to one of two discrete choice experiments, featuring either electronic cigarettes (e-cigarettes) or moist snuff. Participants were presented like-product pairs of randomlygenerated hypothetical tobacco products differing in device type, flavor, vapor cloud, and nicotine amount (for e-cigarettes) or differing in brand, flavor, cut, and price (for moist snuff). Within pairs, participants were asked about which product they were more curious, was more dangerous, would give a greater 'buzz,' and would be easier to use. Conditional logistic regression was used to quantify independent associations of product characteristics to participants' choices. RESULTS Each e-cigarette and moist snuff characteristic was independently associated with multiple product perceptions. All non-tobacco flavors were associated with more curiosity and perceived ease-of-use but lower perceived danger. Tank and pod-type e-cigarettes were viewed as easier to use and garnered more curiosity than 'cigalike' or 'drip-mod' devices. Smaller vapor cloud e-cigarettes and lower-price moist snuff were viewed as less dangerous, less buzz-inducing, and easier to use. Product ever users held stronger perceptions than never users about device type (e-cigarettes) and brands (moist snuff), while product naïve participants more strongly associated flavor with danger and buzz. CONCLUSIONS Tobacco product characteristics convey product attributes to adolescents that may increase appeal. Restricting specific characteristics, including flavors, could reduce positive perceptions of these products among youth.

show abstract

Perceived ease of flavored e-cigarette use and e-cigarette use progression among youth never tobacco users

Cited by 29 publications

References 41 publications

Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface

Cell-specific toxicity of short-term JUUL aerosol exposure to human bronchial epithelial cells and murine macrophages exposed at the air–liquid interface

Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey

Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions

Contact Info

Product

Resources

About