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Adolescents’ Awareness of the Nicotine Content of JUUL E-cigarettes

Fri, March 22, 7:45 to 9:15am, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Introduction: JUUL e-cigarettes resemble USB flash drives and use disposable pods containing a very high concentration of nicotine salt (5% by weight or 59mg/ml) and flavors (e.g., mint, mango). Currently, JUUL is the most popular American e-cigarette brand. JUUL Labs Inc. claims that JUULs are a “satisfying alternative to cigarettes” for adult smokers. However, JUULs are popular among youth, and the use of the term “JUULing” instead of “vaping” raises questions about whether youth even view JUULs as e-cigarettes. Although JUUL packaging lists the nicotine concentration as 5%, it is unknown how youth interpret this information. Thus, we examined adolescents’ perceptions of JUULs’ nicotine strength when no information about nicotine concentration was explicitly provided versus when adolescents were informed that JUULS contain 5% nicotine. We also examined whether current users are aware of the nicotine content of JUULs when presented in terms of any nicotine (no/yes) and as mg/ml. Finally, we evaluated whether adolescents view JUULs as e-cigarettes.

Methods: A computerized survey was administered in 2 Connecticut high schools in May-June 2018 (N=1960). Participants described the nicotine strength of JUULs (low, medium, high, don’t know), first when no information about nicotine concentration was provided (accompanied by a picture of a Juul), and, subsequently, when informed that JUULs contain 5% nicotine (accompanied by a picture of JUUL’s packaging with the nicotine content highlighted). Past-month JUUL users reported whether they used nicotine in their JUUL in the past 30 days (no/yes) and what specific concentration(s) they used (3, 6, 12, 18, 24, >24 mg/ml). Participants also reported whether they believe Juuls are e-cigarettes (no, yes, I don’t know).

Results: The sample comprised 56.0% never JUUL users, 12.7% experimenters (lifetime use but no past-30-day use), and 31.2% past-30-day users (Table 1). Most students underestimated JUULs’ nicotine strength, with a greater percentage underestimating strength when they were informed that JUULs contain 5% nicotine (no information: 74.5%; 5% nicotine: 82.9%). Although 72.9% of current users reported using a JUUL containing nicotine, only 32.4% correctly identified the nicotine concentration as >24mg/ml. Finally, only 55% of adolescents believed that JUULs are e-cigarettes.

Conclusions: Most adolescents, including current JUUL users, were unaware of JUUL’s high nicotine strength, raising concerns about inadvertent exposure to high levels of nicotine and risk for developing nicotine dependence. Past-30-day users also underestimated JUUL’s nicotine concentration when it was presented in mg/ml, suggesting that youth also have difficulty understanding this metric. These findings suggest that efforts to establish comprehensible definitions of nicotine levels, label products accordingly, and educate youth about the negative consequences of nicotine exposure are needed. Finally, 45% of adolescents did not consider JUULs to be e-cigarettes or were unsure, suggesting that additional efforts are needed to help clarify for youth what products constitute e-cigarettes.

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