Young adult perceptions of JUUL and other pod electronic cigarette devices in California: a qualitative study

Abstract

ObjectiveElectronic cigarettes (e-cigarettes) which utilise prefilled‘pods’(pod devices) entered the US market in 2015. One brand, JUUL, captured more than half the e-cigarette market in early 2018, and the US Food and Drug Administration recently warned its manufacturer about adolescent uptake. This is the first qualitative study to describe distinct features of pod devices that appear to contribute to their popularity among young people.DesignQualitative interview study of young adults who had used pod devices. Participants were recruited from Facebook, other social media, street recruitment and via snowball sampling.SettingParticipants were from California, with most from the San Francisco Bay Area.ParticipantsYoung adults (aged 18–29 years) using multiple tobacco products (cigarettes, e-cigarettes and/or smokeless tobacco) were recruited. Of the sample of 60 participants, 24 were included in this analysis: 10 who reported experience with pod devices and 14 who used other non-pod e-cigarette devices.ResultsTen participants had used a pod device in the past year. Of the pod device users, seven still used a pod device at the time of the interview and five did so daily. Nearly all (n=9) pod device users smoked cigarettes in the past month; none were daily smokers. The 14 participants who used non-pod devices provided a point of comparison. Participants highlighted some distinct aspects of pod devices that facilitated use, including their aesthetic similarity to personal electronics, high levels of nicotine delivery with distinct psychoactive effects, more discreet and shorter duration use sessions, and greater social acceptability than more ostentatious non-pod e-cigarettes.ConclusionsPod devices’ unique characteristics likely encourage pod device uptake among young people. Limitations on advertising in youth channels, flavours and distribution, and education about nicotine addiction may decrease initiation among young people and non-smokers.

Who is JUULing and Why? An Examination of Young Adult Electronic Nicotine Delivery Systems Users

“…To date, however, most of the JUUL studies have examined a limited number of factors, including demographic characteristics, and other ENDS/tobacco use behaviors. Furthermore, most of the literature has been descriptive in nature [10,11,13,14] and has not examined correlates of JUUL use after controlling for important covariates including demographic characteristics.…”

JUUL and Combusted Cigarettes Comparably Impair Endothelial Function

“…However, adolescent non-smokers who are not familiar with the effects of nicotine may be more likely to chase higher levels of the drug's effects, and the ease of over-consuming nicotine with JUUL makes this likely, especially in light of reports of teenagers binging on JUUL to the point of rapid addiction and behavioral consequences. 3,28,29 It is likely, however, that the difference in nicotine absorption from JUUL and conventional e-cig aerosol does not directly dictate the magnitude of the vascular response, which we have already observed to be saturating in this model even by very brief (2 seconds) mainstream exposures to cigarette smoke and IQOS aerosol. 20 While we have reported a positive correlation between the concentration of nicotine in heavily diluted tobacco sidestream smoke and the extent to which FMD is impaired in rats exposed to it, 30 the fact that FMD is still impaired in humans inhaling nicotine-free e-cig aerosol 22 and in rats inhaling marijuana sidestream smoke 19 indicates that the nicotine is not the main driver of this effect.…”

“…Since 2016, there has 8/30/19 3 been a dramatic increase in youth e-cig use, 2 with JUUL devices particularly effective at recruiting teenagers to start nicotine usage. 3 JUUL is new, and its effects on health relative to combusted cigarettes and earlier versions of e-cigs are unclear. As with earlier generation e-cigs, the e-liquid in JUUL pods is composed of vegetable glycerin (VG) and propylene glycol (PG) along with flavors and nicotine.…”

An Analytical Perspective on Determination of Free Base Nicotine in E-Liquids

“…One possible explanation for this outcome could be that the less volatile and particulate nature of protonated nicotine can have deeper penetration into the lungs where absorption is more rapid than upper respiratory tract. Additionally, since protonated nicotine does not cause impact in throat [11], user may perform deep inhalation which can result in higher amount of nicotine reaching to alveolar region.…”

“…erefore, to control the youth addiction of nicotine, it is important to address the free base or protonated nicotine content in e-liquids for their adequate regulation. (b) Unlike free base nicotine, salt based nicotine causes less harshness in throat hit and thus improves palatability and smoothness of e-cig aerosol [11]. Based on popularity surveys and flavor studies of several other e-liquids, different flavors of e-liquids of equal strength are perceived to give different nicotine impacts [16][17][18].…”