1. The use of electronic cigarettes is highly prevalent among adolescents and young adults through the advent of JUUL, which has unique implications for this young and susceptible age group.
Evidence Rating Level: 1 (Excellent)
Adverse effects of nicotine on overall health, as well as neurodevelopment during critical stages, are well-known. However, adolescents and young adults are facing greater peer and societal pressures with the advent of electronic cigarettes (e-cigarettes), including JUUL and products that add flavors to their products. Given that e-cigarettes are now more popular on a sales basis than traditional cigarettes, this study of two nationally-representative longitudinal samples of adolescents and young adults sought to determine the prevalence of e-cigarette use and risk factors associated with their use. This particular study sample was extracted from the Truth Longitudinal Cohort, which was designed to determine the effectiveness of its similarly-named prevention media campaign. Analyses included 14,379 participants from Wave 7 (mean [SD] age = 24.3 [0.9] years, 51% female) and 12,114 participants from Wave 8 (mean [SD] age = 24.5 [0.10] years, 50.1% female). Approximately 61.6% of this sample was Caucasian, 51.1% were between the ages of 25 and 34 years, and 76.9% were either “living comfortably” or “meeting needs with a little left over”. Lastly, 78.8% of the sample reported not living with anyone else who smokes in any form. Findings showed that 33.2% of Wave 8 reported use of any type of e-cigarette, 12.4% of whom reported current use. JUUL use was highest among the 18-20-year-old age group, with a significant difference between those who have used JUUL at least once and those who currently use (difference 11.1%, p<0.001). Hispanic participants were the ethnic group with the highest use rates of e-cigarettes and JUUL, as were males and those who identified as gay, lesbian, or bisexual. Participants who believed that cigarettes were more harmful than e-cigarettes had the highest lifetime use (21.6%) and current use (12.4%). Comparing Waves 7 and 8, which were exactly one year apart, there was a significant increase in lifetime e-cigarette use (difference 3.6%, p<0.001) as well as current e-cigarette use (difference 4.3%, p<0.001). Lifetime JUUL use increased during this year by 123.7% (p<0.001), with current use rates significantly increasing for each age group except for the group 15 to 17 years of age. Compared to the oldest age group studied (25 to 34 years), all younger groups demonstrated greater odds of lifetime use (adjusted OR range = 1.82 to 4.91, p<0.05) and current use (adjusted OR range = 10.11 to 20.64, p<0.01). Wave 8 smokers in general were more likely to have used JUUL than those who reported no smoking in Wave 7 (adjusted OR range = 2.20 to 3.60, p<0.01; adjusted OR range = 2.22 to 3.03, p<0.5, respectively). Sensation-seeking behavior was also significantly associated with greater odds of lifetime use (adjusted OR = 1.75, p<0.01) and current use (adjusted OR = 1.94, p<0.01) of JUUL. Lastly, those with friends also demonstrated greater odds of JUUL lifetime (adjusted OR = 1.84, p<0.01) and current use (adjusted OR = 2.53, p<0.01). This study highlights the prominence of JUUL in the e-cigarette trend and the risk factors associated with use among adolescents and young adults. Given the risks involved, particularly among these age groups, prevention efforts must be targeted to ensure that use rates do not continue to rise.
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