Potential Benefits and Risks of High-Nicotine e-Cigarettes

Abstract

The substantial reduction in smoking in the United States represents one of the most important public health advances of the last 50 years. Among children and adolescents this progress has been particularly encouraging, with smoking rates declining among 8th-, 10th-, and 12th-grade students from 28.3% in 1997 to 5.4% in 2017. 1 These positive trends suggest that the powerful appeal of tobacco and nicotine has been reduced in younger generations. However, emerging products such as JUUL, Suorin Air, Envii FITT, and MYLE, high-tech e-cigarettes capable of delivering nicotine at levels comparable to cigarettes, have the potential to undo years of progress if a new generation of young people becomes addicted to nicotine. An expert committee of the National Academy of Sciences, Engineering, and Medicine presented e-cigarettes as a safer alternative to cigarettes in a 2018 report, concluding, "There is conclusive evidence that completely substituting e-cigarettes for combustible tobacco cigarettes reduces users' exposure to numerous toxicants and carcinogens present in combustible tobacco cigarettes." 2These high-tech e-cigarettes may represent a positive innovation, but also are associated with significant challenges. On one hand, these products may enable adults to switch completely from more harmful VIEWPOINT

Electronic Cigarette and JUUL Use Among Adolescents and Young Adults

“…33 In an encouraging first step to stem use among youths, the FDA reported that it would invoke the regulatory mechanism needed to remove flavored e-cigarettes from the market. 4 We believe the FDA, however, can and should do much more. The 2017 delay by the FDA to enforce its authority to regulate e-cigarettes and require premarket review created the opportunity for JUUL to enter and dominate the marketplace.…”

“…Given that nearly all e-cigarettes contain nicotine, 1 public health officials worry that rates of addiction to tobacco and other drugs will increase in young people, as early nicotine exposure can harm the brain and increase addiction susceptibility. [2][3][4] A substantial body of evidence shows an association between e-cigarette use and future combustible tobacco use, with some research suggesting that young adult e-cigarette users are 4 times more likely to smoke cigarettes within 18 months compared with their nicotine-naive peers. 5,6 In addition, recent vaping-related illnesses reported by more than 2000 individuals have led to 39 deaths.…”

Intention to Quit Vaping Among United States Adolescents

“…Parents of participating youth and youth provided written permission and assent, respectively. We focus on the most recent wave of data collection (December 2016 to January 2018), given the recent proliferation of high-nicotine delivery devices . The sample included adolescents aged 12 to 17 years who had vaped more than once in their lifetime and at least once in the past 30 days (ie, current vapers), weighted to be representative of all US adolescents who vape.…”

Electronic Cigarettes and Youth in the United States: A Call to Action (at the Local, National and Global Levels)

“…USB-like e-cigarettes, and one product in particular, Juul, has captured over 75% of the market share of the e-cigarette category since its introduction in 2014–2015. This product transformed both the category and use patterns given its efficient delivery of highly concentrated nicotine, flavors, and covert design [14,15,16]. The increasing use of e-cigarettes among youth threatens five decades of public health gains in successfully deglamorizing, restricting, and decreasing the use of tobacco products [17].…”