Attribution of Use Characteristics to Electronic Cigarette Brands in the National Youth Tobacco Survey

Abstract

_Background _This manuscript responds to a study published in the journal Drug and Alcohol Dependence (DAD). This re-analysis was submitted to DAD and received peer-review comments that were critical because the paper referred to the original authors by name and reviewers were concerned about conflict due to the sponsorship by JUUL Labs; no fundamental concerns were raised about the paper’s methods or findings. Following an appeal letter to DAD (see Supplemental Materials), which did not reverse the refusal to publish, the manuscript was transferred to the companion journal DAD Reports, where it was rejected, again without methodological concerns being raised. _Introduction_ A previous publication, using NYTS data, reported higher electronic nicotine delivery system (ENDS) use frequency and tobacco cravings among adolescents using JUUL-brand ENDS vs other ENDS brands. Re-analysis explores the effect of methodological decisions the original study employed that confound brand attributions: (1) imputing non-JUUL use to those reporting they “don’t know” what brand they used (“DKs”); and (2) counting as JUUL users those with _any_ JUUL use, even if they _usually_ used another ENDS brand. _Methods_ Analyses of the same data examined the effects of assigning DKs to the ‘other brands’ group vs. coding DKs as missing, and re-examined the effects reported for JUUL when brand assignment was based on _usual_ and _exclusive_ brand use, respectively. _Results_ DKs used ENDS significantly less frequently and were significantly less likely to report craving than other ENDS users; assigning DKs to the “other-brand” group, as in the original analysis, resulted in every ENDS brand, when considered in turn, appearing to be used more frequently and eliciting greater craving, than all comparison brands. When DKs were coded as missing, there was no association between JUUL use and these outcomes. When assignment was based on _usual_ or _exclusive_ use, JUUL users were significantly _less_ likely to be frequent users, compared to non-JUUL users (Usual: Relative Risk Ratio (RRR): 0.45 (0.28–0.75); Exclusive: RRR: 0.31 (0.18–0.55)), and non-significantly less likely to report cravings. _Conclusions_ Previous findings are attributable to methodological confounds in brand usage definitions. Re-analysis illustrates the impact of such methodological decisions.