Electronic Cigarette and JUUL Use Among Adolescents and Young Adults
Authors: Donna M. Vallone, Alison F. Cuccia, Jodie Briggs, Haijun Xiao, Barbara A. Schillo, Elizabeth C. Hair
Journal: JAMA Pediatrics (2020)

<h3>Importance</h3> The increasing use rates of electronic cigarettes (e-cigarettes) among young people in the United States have been largely associated with the emergence of high-nicotine-delivery device JUUL. Relevant data are needed to monitor e-cigarette, specifically JUUL, use to help inform intervention efforts. <h3>Objective</h3> To estimate the prevalence, patterns, and factors associated over time with e-cigarette use among adolescents and younger adults in the United States. <h3>Design, Setting, and Participants</h3> Two nationally representative longitudinal samples of adolescents and younger adults aged 15 to 34 years were drawn from the Truth Longitudinal Cohort, a national, probability-based cohort. Participants in this cohort were recruited through address-based sampling, and subsamples were recruited from a probability-based online panel. The present cohort study used data from follow-up online surveys, specifically, wave 7 (N = 14 379; collected from February 15, 2018, to May 25, 2018) and wave 8 (N = 12 114; collected from February 10, 2019, to May 17, 2019). Respondents reported their use of e-cigarettes, JUUL, and combustible tobacco products as well as their harm perceptions, household smoking status, sensation-seeking, friends' e-cigarette use, and demographic information. <h3>Main Outcomes and Measures</h3> The main outcomes were ever and current (past 30 days) JUUL use. χ<sup>2</sup>Analyses assessed differences in JUUL use by psychosocial and demographic characteristics. Logistic regression models identified the significant factors associated with wave 8 ever and current JUUL use among wave 7 e-cigarette–naive participants. <h3>Results</h3> A total of 14 379 participants (mean [SD] age, 24.3 [0.09] years; 8142 female [51.0%]) were included in wave 7 and 12 114 (mean [SD] age, 24.5 [0.10] years; 6835 female [50.1%]) in wave 8. JUUL use statistically significantly increased from wave 7 to wave 8 among ever users (6.0% [n = 1105] to 13.5% [2111];<i>P</i> &lt; .001) and current users (3.3% [680] to 6.1% [993];<i>P</i> &lt; .001). JUUL use increased among every age group and was highest among those aged 18 to 20 years (23.9% [491] ever users and 12.8% [340] current users) and 21 to 24 years (18.1% [360] ever users and 8.2% [207] current users). Users reported a higher prevalence of frequent use in wave 8 compared with wave 7 (37.6% vs 26.1%;<i>P</i> &lt; .01). Significant factors associated with future JUUL use among e-cigarette–naive participants included younger age, combustible tobacco use, lower harm perceptions, sensation seeking, and friends' e-cigarette use. <h3>Conclusions and Relevance</h3> This study found that the e-cigarette device JUUL appears to be associated with the youth e-cigarette epidemic, attracting new users and facilitating frequent use with their highly addictive nicotine content and appealing flavors. Findings of this study underscore the critical need for increased e-cigarette product regulation at the federal, state, and local levels.