E-cigarette Brands Research Articles

Characterizing Social Media Messages Related to Underage JUUL E-Cigarette Buying and Selling: Cross-Sectional Analysis of Reddit Subreddits.

BackgroundStopping the epidemic of e-cigarette use among youth has become the common goal of both regulatory authorities and health departments. JUUL is currently the most popular e-cigarette brand on the market. Young people usually obtain and exchange information about JUUL with the help of social media platforms. Along with the rising prevalence of JUUL, posts about underage JUUL buying and selling have appeared on social media platforms such as Reddit, which sharply increase the risk of minors being exposed to JUUL.ObjectiveThis study aims to analyze Reddit messages about JUUL buying and selling among the users of the UnderageJuul subreddit, and to further summarize the characteristics of those messages. The findings and insights can contribute to a better understanding of the patterns of underage JUUL use, and help public health officials provide timely education and guidance to minors who have intentions of accessing JUUL.MethodsWe used a novel cross-subreddit method to analyze the Reddit messages on 2 subreddits. From July 9, 2017, to January 7, 2018, we collected data from the UnderageJuul subreddit, which was created for underage JUUL use discussion. The data set included 716 threads, 2935 comments, and 844 Reddit users (ie, Redditors). We collected our second data set, comprising 23,840 threads and 162,106 comments posted between July 9, 2017, and January 8, 2019, from the JUUL subreddit. We conducted analyses including the following: (1) annotation of users with buying/selling intention, (2) posting patterns discovery and topic comparison, and (3) posting activeness observation of discovered Redditors. Term frequency–inverse document frequency and regular expression-enhanced keyword search methods were applied during the content analysis to extract the posting patterns. The public posting records of the discovered users on the JUUL subreddit during the year after the UnderageJuul subreddit was shut down were analyzed to determine whether they were still active and interested in obtaining JUUL.ResultsOur study revealed the following: (1) Among the 716 threads on the UnderageJuul subreddit, there were 214 threads related to JUUL sale and 168 threads related to JUUL purchase, which accounted for 53.5% (382/714) of threads. (2) Among the 844 Redditors of the UnderageJuul subreddit, 23.82% (201/844) of users were annotated with buying intention, and 21.10% (178/844) of users were annotated with selling intention. There were 34 users with buying/selling intention that self-reported as being <21 years old. (3) The most common key phrases used in selling threads were “WTS,” “want to sell,” “for sale,” and “selling” (154/214, 72.0%). The most common key phrases used in buying threads were “look for/get JUUL/pods” (58/168, 34.5%) and “WTB” (53/168, 31.5%). (4) The most important concern that UnderageJuul Redditors had in obtaining JUULs was the price (311/1306, 23.81%), followed by the delivery service (68/1306, 5.21%). (5) The most popular flavors among the users with buying/selling intention were mango, cucumber, and mint. The flavor preferences remained consistent on both subreddits. Adverse symptoms related to the mango flavor were reported by 3 users on the JUUL subreddit. (6) In total, 24.4% (49/201) of users wanted to buy JUULs and 46.6% (83/178) of users wanted to sell JUULs, including 11 self-reported underage users, who also participated in the discussions on the JUUL subreddit. (7) Within one year of the UnderageJuul subreddit shutting down, there were 40 users who continued to post 186 threads on the JUUL subreddit, including 10 threads indicating buying/selling willingness that were posted shortly after the UnderageJuul subreddit was closed.ConclusionsThere were overlapping users active in the JUUL and UnderageJuul subreddits. The buying/selling-related content appeared in multiple venues with certain posting patterns from July 9, 2017, to January 7, 2018. Such content might lead to a high risk of health problems for minors, such as nicotine addiction. Based on these findings, this study provided some insights and suggestions that might contribute to the decision-making processes of regulators and public health officials.

Pharmacokinetic Comparison of a Novel Non-tobacco-Based Nicotine Pouch (ZYN) With Conventional, Tobacco-Based Swedish Snus and American Moist Snuff.

The single-dose pharmacokinetics (PK) of a novel, non-tobacco-based nicotine pouch, ZYN, 3 and 6 mg, were compared with 8 mg General snus (part 1) and ZYN 8 mg was compared with 18 mg Longhorn moist snuff (part 2). The present study demonstrates the characteristics of three strengths of a novel tobacco-free oral snus, ZYN, viz. the extraction of nicotine from the oral cavity and its uptake into the systemic blood circulation. Comparison is made to Swedish General snus and American Longhorn moist snuff and from literature 4 mg Nicorette gum and mean of 13 brands of e-cigarettes. A single-dose randomized crossover design was used. In vivo extraction and PK parameters were determined. Part 1. The AUCinf of ZYN 3 mg was 27% smaller than that of 8 mg General and the AUCinf of ZYN 6 mg was 34% larger than that of 8 mg General. Less nicotine was extracted from ZYN 3 mg (1.5 mg) and more from ZYN 6 mg (3.5 mg) than from 8 mg General (2.4 mg). The extracted fractions of nicotine for both ZYN products (56% and 59%) were significantly larger than for 8 mg General (32%). Part 2. Close to identical plasma nicotine curves, AUCinf and Cmax were found for ZYN 8 mg and Longhorn Natural 18 mg moist snuff. The extracted amount of nicotine from ZYN 8 mg (3.8 mg) was larger than the amount extracted from Longhorn Natural 18 mg (3.0 mg), but smaller than the extracted amount of nicotine from General 2 × 8 mg snus pouches (5.0 mg). The extracted fraction of nicotine for ZYN 8 mg (50%) was larger than for Longhorn Natural (19%) and General 2 × 8 mg snus pouches (33%). The two higher doses of ZYN (6 and 8 mg) deliver nicotine as quickly and to a similar extent as existing smokeless products, with no significant adverse effects.

Social media use by leading US e-cigarette, cigarette, smokeless tobacco, cigar and hookah brands

BackgroundYouth and young adults frequently use social media and are susceptible to tobacco use. This study is the first to provide a systematic overview of how leading tobacco product brands...

Awareness of the presence of nicotine in the JUUL Brand of e-cigarette among adolescents, young adults, and older adults in the United States

Nicotine warning labels on e-cigarette products can inform potential consumers that using e-cigarettes can cause addiction. This study examined awareness of the omnipresence of nicotine in the JUUL e-cigarette through a cross-sectional online survey of 4860 adolescents (13–17 years), 3746 young adults (18–24 years) and 5000 older adults (25–99 years) in the United States. Analyses also examined variation in nicotine awareness as a function of age, ownership, and past 30-day frequency of JUUL use. Results indicated fewer than half of JUUL ever-users and fewer than half of past 30-day JUUL users were aware that JUUL e-cigarettes always contain nicotine. Among JUUL ever-users, awareness of the omnipresence of nicotine in JUUL e-cigarettes was significantly lower among adolescents and those who did not personally own a JUUL. Among past 30-day JUUL users, awareness of the omnipresence of nicotine was significantly lower among adolescents and infrequent users (i.e. used on 1–19 of the past 30 days). Results suggest many users of a JUUL, especially youth, non-owners and infrequent users, may be underestimating their risk of becoming addicted to JUUL products, or overestimating their ability to stop using JUUL products whenever they choose. Reasons for low awareness and methods for increasing public awareness of the omnipresence of nicotine in JUUL products are proposed.

Cancer and Non-Cancer Risk Concerns from Metals in Electronic Cigarette Liquids and Aerosols

We evaluated metal concentrations in e-liquids and e-aerosols from eight studies and estimated the range of corresponding cancer and non-cancer risks. Chromium and nickel were the leading contributors to cancer risk, with minor contributions from cadmium, lead, and arsenic. The increased cancer risks, assuming exposure to 2 mL/day, ranged from 5.7 to 30,000 additional cancers in a million e-cigarette users. The average cancer risk was 3 in 1000. Cancer risks in the mid to upper end of these ranges exceed acceptable levels. The hazard quotient (HQ) approach was used to evaluate non-cancer risks. Hazard quotients exceeding 1.0 indicate the possibility for non-cancer adverse health effects. Estimated exposures at the maximum reported concentrations of nickel, chromium, and manganese resulted in HQ values of 161, 1.1, and 1.0, respectively, with additional contributions from lead. The average concentration of nickel resulted in an HQ value of 14. We conclude from these studies that exposure to metals in e-cigarette liquids and aerosols may pose a significant cancer and non-cancer health risk at the mid and upper end of the reported ranges. The device design and heating elements appear to be the main source of metals in e-aerosols. The large range of metals within and across e-cigarette brands indicate the need for improvements in product design, enforced product safety regulations and manufacturing quality control. Implementation of such measures could reduce metal exposure in e-cigarette users.

From the Deeming Rule to JUUL-US News Coverage of Electronic Cigarettes, 2015-2018.

News media may influence public perceptions and attitudes about electronic cigarettes (e-cigarettes), which may influence product use and attitudes about their regulation. The purpose of this study is to describe trends in US news coverage of e-cigarettes during a period of evolving regulation, science, and trends in the use of e-cigarettes. We conducted a content analysis of e-cigarette topics and themes covered in US news articles from 2015 to 2018. Online news databases (Access World News, Factiva) were used to obtain US news articles from the top 34 circulating newspapers, four national wire services, and five leading online news sources. The number of articles increased by 75.4% between 2015 and 2018 (n = 1609). Most articles focused on policy/regulation (43.5%) as a main topic, followed by health effects (22.3%) and prevalence/trends (17.9%). Discussion about flavor bans quadrupled (6.1% to 24.6%) and discussion of youth e-cigarette use was most prevalent (58.4%) in 2018, coinciding with an increase in coverage about JUUL. JUUL was mentioned in 50.8% of 2018 articles. Across years, articles more frequently mentioned e-cigarette risks (70%) than potential benefits (37.3%). E-cigarettes continue to be a newsworthy topic, with coverage both reflecting numerous changes and events over time, and providing repeated opportunities for informing the public and policymakers about these novel products. Future research should continue to track how discourse changes over time and assess its potential influence on e-cigarette perceptions and policy changes. E-cigarette news coverage in the United States increased between 2015 and 2018 and predominantly focused on policy and regulation. Notable spikes in volume were associated with some but not all major e-cigarette events, including the FDA's deeming rule, Surgeon General's report, and release of the National Youth Tobacco Survey data in 2018. Coverage of the 2018 National Academy of Medicine, Engineering, and Sciences report on the Public Health Consequences of E-cigarettes received minimal news coverage. The high volume in 2018 was driven in large part by coverage of the e-cigarette brand JUUL; over half of news articles in 2018 referenced JUUL specifically.

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

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. To examine e-cigarette and JUUL use among adolescents in New Jersey. 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. 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. Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL. 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; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use. This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.

Determination of Thermal Decomposition Products Generated from E-Cigarettes.

An electronic cigarette (e-cigarette) is a product used to smoke aerosol by heating a solution of "e-liquid" that consists of propylene glycol (PG) and glycerol (GLY) containing nicotine and flavors. In this study, thermal decomposition products generated from three brands of e-cigarettes were determined at various electric power levels. When using neat PG or GLY instead of e-liquid, propylene oxide was detected only in the gas phase from PG and not detected from GLY. In contrast, glycidol was detected only from GLY and not from PG. Almost all of the glyoxal and acrolein was detected from GLY, but formaldehyde and methyl glyoxal were detected from both PG and GLY. Using commercially available e-liquids, the same results were obtained. Nearly all chemical compounds generated from e-cigarettes have a carbon number of 3 or less except for nicotine and flavors. We measured chemical compounds generated from e-cigarettes at various electric power levels (1-85 W). At an electric power of 10 W, the generation of chemical compounds was very low; however, when the electric power exceeded 40 W, it increased exponentially. As thermal decomposition products of e-liquid, acetaldehyde, acrolein, and propylene oxide mainly occur as gaseous matter, while glyoxal, methylglyoxal, and glycidol mainly occur as particulate matter. Formaldehyde exits in both gaseous and particulate matter forms. Thermal decomposition products can be divided into three groups: thermal decomposition products originating from PG and GLY, those originating from other sources, and those directly generated. Concentrations of these thermal decomposition products were mostly higher than those in traditional cigarettes. In particular, thermal decomposition products generated from one of the studied e-cigarettes were very high; e.g., formaldehyde reached 4400 μg/15 puffs at 50 W. E-cigarette users must know that hazardous substances are generated even within the recommended electric power limits.

60. Youth Use of Different Brands of Pod-Type E-Cigarettes Popularized by Juul: How and Why they are Using

60. Youth Use of Different Brands of Pod-Type E-Cigarettes Popularized by Juul: How and Why they are Using

Differences in nicotine intake and effects from electronic and combustible cigarettes among dual users.

To describe systemic nicotine exposure and subjective effects of electronic cigarettes (e-cigarettes) in people who use both e-cigarettes and cigarettes (dual users), including within-subject comparisons of e-cigarette and cigarette use. Two-arm, counterbalanced cross-over study. Participants used their usual brand of e-cigarette or cigarette during a standardized session in a 2-week study. Hospital research ward, San Francisco, CA, USA. Thirty-six healthy (eight women, 28 men) participants. Plasma nicotine was analyzed by gas chromatography-tandem mass spectrometry; nicotine withdrawal, urge to smoke and vape, affective states, craving, satisfaction and psychological reward were measured by standardized questionnaires. Compared with cigarettes, average maximum plasma nicotine concentration (Cmax ) was lower with e-cigarettes [6.1±5.5ng/ml, mean ±standard deviation (SD) versus 20.2±11.1ng/ml, P<0.001] and time of maximal concentration (Tmax ) was longer (6.5±5.4versus 2.7±2.4minutes, P<0.001). Use of both products resulted in a reduction in the severity of withdrawal symptoms, negative affect and urge to use either product. E-cigarettes were less rewarding and satisfying and reduced craving to a lesser degree than cigarettes. We were not able to detect any differences in withdrawal symptoms, affective states and urge to smoke cigarettes between e-cigarette and cigarette use. Systemic nicotine exposure was, on average, lower with single use of e-cigarettes compared with cigarettes, and e-cigarettes were judged to be less satisfying and rewarding and reduced craving less than cigarettes.

E-Cigarette Use Among Youth in the United States, 2019

The prevalence of e-cigarette use among US youth increased from 2011 to 2018. Continued monitoring of the prevalence of e-cigarette and other tobacco product use among youth is important to inform public health policy, planning, and regulatory efforts. To estimate the prevalence of e-cigarette use among US high school and middle school students in 2019 including frequency of use, brands used, and use of flavored products. Cross-sectional analyses of a school-based nationally representative sample of 19 018 US students in grades 6 to 12 participating in the 2019 National Youth Tobacco Survey. The survey was conducted from February 15, 2019, to May 24, 2019. Self-reported current (past 30-day) e-cigarette use estimates among high school and middle school students; frequent use (≥20 days in the past 30 days) and usual e-cigarette brand among current e-cigarette users; and use of flavored e-cigarettes and flavor types among current exclusive e-cigarette users (no use of other tobacco products) by school level and usual brand. Prevalence estimates were weighted to account for the complex sampling design. The survey included 10 097 high school students (mean [SD] age, 16.1 [3.0] years; 47.5% female) and 8837 middle school students (mean [SD] age, 12.7 [2.8] years; 48.7% female). The response rate was 66.3%. An estimated 27.5% (95% CI, 25.3%-29.7%) of high school students and 10.5% (95% CI, 9.4%-11.8%) of middle school students reported current e-cigarette use. Among current e-cigarette users, an estimated 34.2% (95% CI, 31.2%-37.3%) of high school students and 18.0% (95% CI, 15.2%-21.2%) of middle school students reported frequent use, and an estimated 63.6% (95% CI, 59.3%-67.8%) of high school students and 65.4% (95% CI, 60.6%-69.9%) of middle school students reported exclusive use of e-cigarettes. Among current e-cigarette users, an estimated 59.1% (95% CI, 54.8%-63.2%) of high school students and 54.1% (95% CI, 49.1%-59.0%) of middle school students reported JUUL as their usual e-cigarette brand in the past 30 days; among current e-cigarette users, 13.8% (95% CI, 12.0%-15.9%) of high school students and 16.8% (95% CI, 13.6%-20.7%) of middle school students reported not having a usual e-cigarette brand. Among current exclusive e-cigarette users, an estimated 72.2% (95% CI, 69.1%-75.1%) of high school students and 59.2% (95% CI, 54.8%-63.4%) of middle school students used flavored e-cigarettes, with fruit, menthol or mint, and candy, desserts, or other sweets being the most commonly reported flavors. In 2019, the prevalence of self-reported e-cigarette use was high among high school and middle school students, with many current e-cigarette users reporting frequent use and most of the exclusive e-cigarette users reporting use of flavored e-cigarettes.

A content analysis of the promotional strategies employed by e-cigarette brands on Twitter

Cigarette smoking in the U.S. is declining, but e-cigarette (e-cig) use is rapidly expanding. E-cig brands utilize social media for promotion and have the autonomy to disseminate messages that encourage the use of their products. The current study categorized the most frequent strategies among popular e-cig brands on Twitter. A content analysis of over 1800 tweets was performed based on Philip Morris brand personality characteristics. Most tweets emphasized e-cigs’ economic value (24.2%) and normalized their use by portraying e-cigs as “cool” (23.1%). E-cig brands are employing similar strategies as tobacco companies and easily connecting to young adults through social media.

Underage JUUL Use Patterns: Content Analysis of Reddit Messages.

BackgroundThe popularity of JUUL (an e-cigarette brand) among youth has recently been reported in news media and academic papers, which has raised great public health concerns. Little research has been conducted on the age distribution, geographic distribution, approaches to buying JUUL, and flavor preferences pertaining to underage JUUL users.ObjectiveThe aim of this study was to analyze social media data related to demographics, methods of access, product characteristics, and use patterns of underage JUUL use.MethodsWe collected publicly available JUUL-related data from Reddit. We extracted and summarized the age, location, and flavor preference of subreddit UnderageJuul users. We also compared common and unique users between subreddit UnderageJuul and subreddit JUUL. The methods of purchasing JUULs were analyzed by manually examining the content of the Reddit threads.ResultsA total of 716 threads and 2935 comments were collected from the subreddit UnderageJuul before it was shut down. Most threads did not mention a specific age, but ages ranged from 13 years to greater than 21 years in those that did. Mango, mint, and cucumber were the most popular among the 7 flavors listed on JUUL’s official website, and 336 subreddit UnderageJuul threads mentioned 7 discreet approaches to circumvent relevant legal regulations to get JUUL products, the most common of which was purchasing JUUL from other Reddit users (n=181). Almost half of the UnderageJuul users (389/844, 46.1%) also participated in discussions on the main JUUL subreddit and sought information across multiple Reddit forums. Most (64/74, 86%) posters were from large metropolitan areas.ConclusionsThe subreddit UnderageJuul functioned as a forum to explore methods of obtaining JUUL and to discuss and recommend specific flavors before it was shut down. About half of those using UnderageJuul also used the more general JUUL subreddit, so a forum still exists where youths can attempt to share information on how to obtain JUUL and other products. Exploration of such social media data in real time for rapid public health surveillance could provide early warning for significant health risks before they become major public health threats.

Altria-Juul Labs deal: why did it occur and what does it mean for the US nicotine delivery product market

On 19 December 2018, Altria announced an offer of US$12.8 billion for a 35% share of Juul Labs.1 2 The deal combines Altria (formerly Philip Morris),3 the company with the...

E-cigarette Awareness among Young Adults: A Pilot Survey Study.

ObjectivesThis study sought to assess: 1) pervasiveness of vaping or electronic cigarette (e-cigarette) use, 2) General understanding of information on vaping or e-cigarette use, 3) Prevalence and respondent awareness of smoking/vaping prevention programs, and 4) Awareness of the harmful effects of e-cigarettes.MethodsThis was a cross-sectional survey of 101 young adults (ages 18-24) in the United States designed to assess the prevalence and knowledge of vaping. Ten questions tested this knowledge and prevalence, some directly (for example, "Which of the following have you used? Select all that apply") and some indirectly (Which of the following pictures corresponds with that of an e-cigarette?). After the results were obtained, the crosstabs showed the percentage of respondents who identified a particular answer for each question.ResultsMost of the surveyants had heard about e-cigarettes (about 88.6% of all respondents). About 55% of the study’s sample attended schools with tobacco prevention programs. Sixty-four percent of the cohort thought that vaping is actually safer than traditional cigarettes. Most (87.4%) of the people were able to identify an e-cigarette when shown a picture of e-cigarettes versus two computer flash-drives and a cigarette. However, 78.2% of respondents were aware of at least one of the effects of nicotine in humans, which corresponds with the number of respondents who were familiar with any of the provided e-cigarette brands (as 71.7% of respondents to question six knew of the six provided brands of e-cigarettes) and the respondents with parents who smoke (as about 75% of respondents said that neither parent smokes). Thirty-eight percent of respondents had used either traditional tobacco products (such as cigarettes, cigars, or chewing tobacco) or e-cigarettes before, with 13% of respondents having used both tobacco and e-cigarettes.

JUUL from the USA to Indonesia: implications for expansion to LMICs

Indonesia has one of the largest tobacco markets in the world, well known for their clove cigarettes, kreteks . However, electronic cigarettes (e-cigarettes) are growing in popularity among Indonesians. While...

Characterising JUUL-related posts on Instagram

BackgroundJUUL, a high-tech, popular vaping device, was the first major electronic cigarette (e-cigarette) brand to incorporate social media into its marketing strategy. There is growing concern around the increasing use...

British American Tobacco (BAT) and retail merchandising: Vype e-cigarette promotion in Ontario, Canada

Electronic cigarettes (e-cigarettes) were initially offered by many independent producers, but multinational tobacco companies, which have notable marketing budgets, have increasingly acquired e-cigarette brands and developed their own ‘next generation...

Characteristics of Daily E-Cigarette Use and Acquisition Means Among a National Sample of Adolescents.

To examine the relationship between several e-cigarette-related characteristics and daily e-cigarette use among adolescent current users. Secondary analysis of 2016 National Youth Tobacco Survey data. United States middle schools and high schools. One thousand five hundred seventy-nine current e-cigarette users. Daily e-cigarette use and e-cigarette flavors, brands, device type, and acquisition were measured. Logistic regression and Poisson regression models were built. A total of 13.6% of current users reported daily use. Results indicated that daily users were at increased odds of using all flavor types (all P < .001), with the exception of menthol/mint, and using a higher number of flavors than nondaily users (P < .001). Daily users were more likely to use Blu, eGo, Logic, Halo, NJOY, and another unlisted brand but less likely to report they did not know the brand used (all P ≤ .01). Daily users also reported using a higher number of brands than nondaily users (P < .001). Daily users were at increased odds of using marijuana/tetrahydrocannabinol (THC) oil wax as device ingredients (P < .001) and less likely to use only nicotine (P < .001) or unknown ingredients (P = .004). Daily users were more likely to acquire e-cigarettes from a vape shop, gas station/convenience store, Internet, mall/shopping center kiosk, drug store, grocery store, or other place (all P ≤ .01). Comprehensive efforts are needed to reduce e-cigarette use and nicotine addiction among adolescents.

A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL

Electronic cigarettes (e-cigarettes) and vape devices have rapidly become the most common tobacco products used by youth, driven in large part by marketing and advertising by e-cigarette companies. There is substantial evidence that adolescent e-cigarette use leads to use of combustible tobacco products. E-cigarette companies commonly advertise that e-cigarettes contain nicotine, flavoring chemicals, and humectants (propylene glycol and/or vegetable glycerin), but toxicants, ultrafine particles, and carcinogens have also been found in e-cigarette solutions and emissions, many of which are known to cause adverse health effects. Most major e-cigarette brands are owned by big tobacco companies that use similar marketing and advertising strategies to attract youth users as they did with traditional tobacco products. In this review, we provide an overview of e-cigarettes and vape devices with an emphasis on the impact for the pediatric population. We describe the vast array of e-cigarette devices and solutions, concern for nicotine addiction, and the scientific background on the known health harms. There are accompanying visual depictions to assist in identifying these products, including newer e-cigarette products and JUUL. Because current federal regulations are insufficient to protect youth from e-cigarette use, exposure, and nicotine addiction, there are recommendations for pediatricians and pediatric health care providers to counsel and advocate for a tobacco-free lifestyle for patients and families.