Meghan E Morean1, Krysten W Bold2, Grace Kong2, Ralitza Gueorguieva3, Deepa R Camenga4, Patricia Simon5, Asti Jackson2, Dana A Cavallo2, Suchitra Krishnan-Sarin2. 1. Oberlin College, 120 West Lorain Street, Oberlin, OH, 44074, USA; Yale University School of Medicine, 34 Park Street, New Haven, CT, 06519, USA. Electronic address: meghan.morean@gmail.com. 2. Yale University School of Medicine, 34 Park Street, New Haven, CT, 06519, USA. 3. Yale University School of Public Health, 60 College St, New Haven, CT, 06520, USA. 4. Yale University School of Medicine, 464 Congress Avenue (Suite 260), New Haven, CT, 06519, USA. 5. Yale University School of Medicine, 389 Whitney Avenue New Haven, CT, 06511, USA.
Abstract
BACKGROUND: JUUL e-cigarettes are popular among youth. However, it is unknown whether adolescents understand that 5% JUUL pods contain a high nicotine concentration or consider JUULs to be e-cigarettes. METHOD: 3170 students from 4 Connecticut high schools completed a school-based survey (May-October 2018). Students reported on lifetime and past-month JUUL use and perceived JUUL nicotine strength (low/medium/high/don't know) when no information about nicotine concentration was provided and, subsequently, when informed JUULs contain 5% nicotine. Students reported whether they believe JUULs are e-cigarettes (no/yes/don't know). RESULTS: Students were never JUUL users (56.6%), ever users (13.2%), and past-month users (30.2%). When no information was provided, students reported that JUULs contain low (10.5%), medium (26.9%), or high nicotine levels (31.1%); 31.4% did not know. When informed JUULs contain 5% nicotine, students were more likely to believe JUUL's nicotine strength was low (29.5%) or medium (29.3%) than high (21.3%) and less likely to report not knowing (19.9%). 39% of students believed JUULs are not e-cigarettes or did not know. DISCUSSION: Most students were unaware of JUUL's high nicotine concentration, with more believing that JUULs contain low or medium nicotine concentrations when informed JUULs contain 5% nicotine. Thus, youth may misinterpret the nicotine concentration printed on JUUL pod packaging, raising concerns about inadvertent exposure to high nicotine levels and dependence risk. Further, 39% of adolescents believed JUULs are not e-cigarettes or were unsure. Regulatory efforts are needed to establish understandable nicotine concentration labels, require products to be labeled accordingly, and clarify what products constitute e-cigarettes.
BACKGROUND:JUUL e-cigarettes are popular among youth. However, it is unknown whether adolescents understand that 5% JUUL pods contain a high nicotine concentration or consider JUULs to be e-cigarettes. METHOD: 3170 students from 4 Connecticut high schools completed a school-based survey (May-October 2018). Students reported on lifetime and past-month JUUL use and perceived JUULnicotine strength (low/medium/high/don't know) when no information about nicotine concentration was provided and, subsequently, when informed JUULs contain 5% nicotine. Students reported whether they believe JUULs are e-cigarettes (no/yes/don't know). RESULTS: Students were never JUUL users (56.6%), ever users (13.2%), and past-month users (30.2%). When no information was provided, students reported that JUULs contain low (10.5%), medium (26.9%), or high nicotine levels (31.1%); 31.4% did not know. When informed JUULs contain 5% nicotine, students were more likely to believe JUUL's nicotine strength was low (29.5%) or medium (29.3%) than high (21.3%) and less likely to report not knowing (19.9%). 39% of students believed JUULs are not e-cigarettes or did not know. DISCUSSION: Most students were unaware of JUUL's high nicotine concentration, with more believing that JUULs contain low or medium nicotine concentrations when informed JUULs contain 5% nicotine. Thus, youth may misinterpret the nicotine concentration printed on JUUL pod packaging, raising concerns about inadvertent exposure to high nicotine levels and dependence risk. Further, 39% of adolescents believed JUULs are not e-cigarettes or were unsure. Regulatory efforts are needed to establish understandable nicotine concentration labels, require products to be labeled accordingly, and clarify what products constitute e-cigarettes.
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