Adolescent Use and Perceptions of JUUL and Other Pod-Style e-Cigarettes: A Qualitative Study to Inform Prevention

Abstract

JUUL, a discrete pod-style e-cigarette, popular among adolescents, delivers high levels of nicotine. Limited research has assessed social and environmental influences that contribute to use of JUUL and other pod-style devices. We examined how these factors, as well as individual characteristics, shape adolescent use. Twenty-nine middle and high school students participated in six focus groups in June 2019 (58.6% female, 65.5% White, 27.6% Hispanic). Groups were stratified by e-cigarette use status and grade to understand perceptions and experiences among groups. Transcripts were coded using thematic analysis for individual, social, and environmental factors contributing to use. Users (n = 13) described their first experience with JUUL as mostly negative, mentioning reactions such as burning in the throat, coughing, wheezing, and headaches. Despite a negative first experience, stress relief and addiction were mentioned as reasons for continued use. Users and non-users identified vaping as a source of disruption to their daily life. Social factors included peer and parental influences, lack of support for quitting, and accessibility. Environmental factors included contrasting messages about long- and short-term health effects of e-cigarettes, as well as a lack of school vaping policy enforcement, health education, medical screenings, and cessation resources. Findings highlight the complex social system that influences adolescent e-cigarette use and have important implications for school and community responses. Strategies to prevent or reduce use may include reviewing existing school tobacco policies, providing counseling and cessation resources, training staff, and increasing knowledge through public education campaigns.

Exposure, Retention, Exhalation, Symptoms, and Environmental Accumulation of Chemicals During JUUL Vaping

“…Symptoms related to the respiratory, neurologic, and cardiovascular systems have been reported on Reddit and Twitter by EC users vaping various JUUL products. , JUUL “Menthol” was associated specifically with throat issues (e.g., burning, harshness, and throat hit) on Twitter . In a survey, participants using JUUL ECs for the first time experienced burning in the throat, coughing, wheezing, and headache . Immediately after vaping JUUL “Menthol”/“Mint” or “Classic Tobacco”, participants reported nausea and dizziness .…”

“…28 In a survey, participants using JUUL ECs for the first time experienced burning in the throat, coughing, wheezing, and headache. 30 Immediately after vaping JUUL "Menthol"/"Mint" or "Classic Tobacco", participants reported nausea and dizziness. 31 Additionally, 40.1% of JUUL adolescent users who vaped in the past 30 days were likely to have nicotine dependence symptoms (e.g., cravings).…”

Assessing the Testability of the Multi-Theory Model (MTM) in Predicting Vaping Quitting Behavior among Young Adults in the United States: A Cross-Sectional Survey

“…Xie and colleagues (2020) found that individuals engaged in vaping had a significantly higher cognitive dissonance than individuals who never smoked [18]. The popular brand, JUUL, is reported to have as much nicotine as twenty traditional cigarettes [1,19]. Such high levels of nicotine exposure are likely to lead to dependence and difficulty quitting [13].…”

How young people in Aotearoa perceive vaping and the associated oral health risks

“…In the wake of the e-cigarette or vaping use-associated lung injury (EVALI) and COVID-19 outbreaks, there has been a heightened awareness of the respiratory risks associated with ECs, which may explain these findings. [32][33][34] In contrast, perception of oral health effects of vaping was generally low. Our sample reported dry mouth followed by teeth staining as associated with vaping, compared to other risks such as oral cancers.…”