Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market

Huang, Jidong; Duan, Zongshuan; Kwok, Julian; Binns, Steven; Vera, Lisa; Kim, Yoonsang; Szczypka, Glen; Emery, Sherry

doi:10.1136/tobaccocontrol-2018-054382

Cited by 498 publications

(429 citation statements)

References 14 publications

(10 reference statements)

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“…10 Middle and high school students, as well as young adults, make up a large fraction of JUUL consumers. 11 This demographic may be attracted to JUUL in part because of its appealing compact design, which resembles a USB drive, and its ability to create relatively small clouds of aerosol making its use indoors and in schools difficult to detect. 12 Unlike many other EC fluids, JUUL products contain high concentrations of nicotine and sufficient acid to protonate most of the nicotine; lower free-base nicotine levels have been associated with increased palatability on inhalation.…”

Section: Introductionmentioning

confidence: 99%

Toxicity of JUUL Fluids and Aerosols Correlates Strongly with Nicotine and Some Flavor Chemical Concentrations

Omaiye

Luo

et al. 2018

Preprint

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While JUUL electronic cigarettes (ECs) have captured the majority of the EC market with a large fraction of their sales going to adolescents, little is known about their cytotoxicity and potential effects on health. The purpose of this study was to determine flavor chemical and nicotine concentrations in the eight currently marketed pre-filled JUUL EC cartridges ("pods") and to evaluate the cytotoxicity of the different variants (e.g., "Cool Mint" and "Crème Brulee") using in vitro assays. Nicotine and flavor chemicals were analyzed using gas chromatography/mass spectrometry in pod fluid before and after vaping and in the corresponding aerosols. 59 flavor chemicals were identified in JUUL pod fluids, and three were >1 mg/mL. Duplicate pods were similar in flavor chemical composition and concentration. Nicotine concentrations (average 60.9 mg/mL) were significantly higher than any EC products we have analyzed previously. Transfer efficiency of individual flavor chemicals that were >1mg/mL and nicotine from the pod fluid into aerosols was generally 35 -80%. All pod fluids were cytotoxic at a 1:10 dilution (10%) in the MTT and neutral red uptake assays when tested with BEAS-2B lung epithelial cells. Most aerosols were cytotoxic in these assays at concentrations >1%. The cytotoxicity of aerosols was highly correlated with nicotine and ethyl maltol concentrations and moderately to weakly correlated with total flavor chemical concentration and menthol concentration. Our study demonstrates that: (1) some JUUL flavor pods have high concentrations of flavor chemicals that may make them attractive to youth, and (2) the concentrations of nicotine and some flavor chemicals (e.g. ethyl maltol) are high enough to be cytotoxic in acute in vitro assays, emphasizing the need to determine if JUUL products will lead to adverse health effects with chronic use.

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Section: Introductionmentioning

confidence: 99%

Toxicity of JUUL Fluids and Aerosols Correlates Strongly with Nicotine and Some Flavor Chemical Concentrations

Omaiye

Luo

et al. 2018

Preprint

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“…This indicates that e-cigarettes have high appeal to young people and a potential reversing trend in smoking prevalence driven by the promotion of e-cigarettes is of major concern. A recent study in the US has demonstrated the extraordinary growth in the use of a specific type of e-cigarette by youth and young adults as a result of a variety of new media marketing [37]. There are concerns about the potential for ecigarette usage to be a gateway to tobacco smoking; this is pertinent since our study has shown that any increase in the rate of smoking would result in a substantial adverse impact on lung cancer mortality rates.…”

Section: Discussionmentioning

confidence: 84%

Lung cancer mortality in Australia in the twenty-first century: How many lives can be saved with effective tobacco control?

et al. 2019

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A B S T R A C TObjectives: To estimate the number of past and future lung cancer deaths that have already been averted by tobacco control initiatives in Australia, and to estimate the number of additional deaths averted under various smoking scenarios. Methods: We predicted lung cancer mortality rates and case numbers to 2100 using a previously validated generalized linear model based on age, birth cohort and population cigarette smoking exposure. We estimated the impact of various tobacco control scenarios: 'actual tobacco control' (incorporating the aggregate effect of past and current taxation, plain packaging, mass media campaigns and other initiatives) and scenarios where 10%, 5% and 0% smoking prevalence was achieved by 2025, all of which were compared to a counterfactual scenario with the highest historical smoking consumption level continuing into the future as if no tobacco control initiatives had been implemented. Results: Without tobacco control, there would have been an estimated 392,116 lung cancer deaths over the period 1956-2015; of these 20% (78,925 deaths; 75,839 males, 3086 females) have been averted due to tobacco control. However, if past and current measures continue to have the expected effect, an estimated 1.9 million deaths (1,579,515 males, 320,856 females; 67% of future lung cancer deaths) will be averted in 2016-2100. If smoking prevalence is reduced to 10%, 5% or 0% by 2025, an additional 97,432, 208,714 or 360,557 deaths could be averted from 2016 to 2100, respectively. Conclusion: Tobacco control in Australia has had a dramatic impact on the number of people dying from lung cancer. Several hundred thousand more lung cancer deaths could be averted over the course of the century if close-to-zero smoking prevalence could be achieved in the next decade.

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“…Fruit-based flavours have increased in popularity since 2015. Pre-filled cartridges (pods) such as JUUL account for 40% of retail sales in the USA but much less in the UK market (Huang et al, 2019). There are considerable differences in usage and practice of vaping in the UK compared to the USA ( Table 2) (Huang et al, 2019).…”

Section: Usage In the Usa And The Ukmentioning

confidence: 99%

“…Pre-filled cartridges (pods) such as JUUL account for 40% of retail sales in the USA but much less in the UK market (Huang et al, 2019). There are considerable differences in usage and practice of vaping in the UK compared to the USA ( Table 2) (Huang et al, 2019). It seems very likely that the discrepant reporting of e-cigarette or vaping product useassociated lung injury in the two countries may relate to one or more of these differences.…”

Section: Usage In the Usa And The Ukmentioning

confidence: 99%

E-cigarette or vaping product use-associated lung injury

Ind

2020

Br J Hosp Med

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E-cigarette or vaping product use-associated lung injury is a recently recognised, acute pulmonary syndrome which has been reported (particularly from June to October 2019) throughout the USA, but not in Europe (although one probable case, in the UK, has been reported; Medicines and Healthcare products Regulatory Agency, 2020 ). It presents acutely, most often in young men, as severe pulmonary consolidation, usually with respiratory failure. The mortality is around 2%. The cause(s) are unknown, but it is associated with vaping, particularly using unlicensed cannabis-containing products with tetrahydrocannabinol. Vitamin E acetate, often present in tetrahydrocannabinol-containing vape products as a solvent, has been implicated, as it has been identified in the bronchoalveolar lavage fluid of patients with e-cigarette or vaping product use-associated lung injury. This article reviews the recent literature, including clinical features, presentation and investigations, and possible mechanisms, in the context of vaping practices in the USA and the UK.

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Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market

Cited by 498 publications

References 14 publications

Toxicity of JUUL Fluids and Aerosols Correlates Strongly with Nicotine and Some Flavor Chemical Concentrations

Toxicity of JUUL Fluids and Aerosols Correlates Strongly with Nicotine and Some Flavor Chemical Concentrations

Lung cancer mortality in Australia in the twenty-first century: How many lives can be saved with effective tobacco control?

E-cigarette or vaping product use-associated lung injury

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