Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors

Abstract

IMPORTANCE Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys. OBJECTIVE To examine e-cigarette and JUUL use among adolescents in New Jersey. DESIGN, SETTING, AND PARTICIPANTS Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12. EXPOSURES Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise. MAIN OUTCOMES AND MEASURES Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL. RESULTS In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43;

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

“…The latter products deliver considerable amount of free-base nicotine ( Nardone et al, 2019 , Keamy-Minor et al, 2019 ). JUUL’s compact size and stylish design, resembling a USB flash drive, low vapor output with minimally visible aerosol plume/cloud upon exhalation, variety of flavorings, and subtle scent, which can be passed off as perfume, are device features that make it immensely appealing to youth ( Lee et al, 2020 , Vallone et al, 2020 , Hrywna et al, 2020 , Kong et al, 2019 ). The small size, light weight, and easy to conceal JUUL can be used inconspicuously in places where smoking is prohibited; the practice is often referred to as “stealth vaping/JUULing” by teenagers in classrooms, school yards, or restrooms ( Nardone et al, 2019 , Ramamurthi et al, 2018 , McKelvey and Halpern-Felsher, 2020 ).…”

“…Since its introduction to the US market in 2015, JUUL has dramatically changed the landscape of tobacco products ( Huang et al, 2019 , Jenssen and Wilson, 2019 , Lee et al, 2020 , Vallone et al, 2020 ). A combination of sleek and high-tech design, innovative nicotine delivery technology, appealing flavorings, and social media-based marketing ( Vargas-Rivera et al, 2020 , Hrywna et al, 2020 , Kong et al, 2019 , Nardone et al, 2019 ) has propelled JUUL to become the best-selling e-cig in the US ( Huang et al, 2019 , Lee et al, 2020 ). JUUL has accounted for nearly 75% of recent point-of-sale purchases of e-cigs, being the first brand to record $1.3 billion in annual sales in 2018 ( Herzog and Kanada, 2021 ).…”

“…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 ).…”

E-cigarette in Malaysia: Reasons for Initiating of Electronic Cigarettes Among Hospital and Clinic Patients and Visitors

“…Second, this study only recruited respondents who were visiting public hospitals and clinics that cannot be generalized to other populations in different settings. In addition, this study only focused on adults in Malaysia, which did not include adolescents as recent studies suggested a higher prevalence of e-cigarette use among them [32][33][34]. Hence, future studies are needed to investigate the use of e-cigarette in this population.…”

Frequency and profile of the electronic cigarettes use in students of a Public University

“…El uso de CE ha aumentado considerablemente en los últimos años (2). Estos productos son ahora los más comúnmente utilizados por la juventud en los Estados Unidos, superando a los productos de tabaco convencionales, incluyendo cigarrillos, puros, tabaco de mascar y pipas de agua.…”