Who is JUULing and Why? An Examination of Young Adult Electronic Nicotine Delivery Systems Users

Reasons for multiple tobacco product and cannabis co-use among Texas young adults

OBJECTIVE

This study examines differences in reasons for e-cigarette, cigarette, and cannabis use across exclusive, dual, co-, and poly co-users.

METHODS

Participants were 645 young adults who reported past 30-day (P30D) use of e-cigarettes, cigarettes, or cannabis at wave 14 (Fall, 2021) of the Texas Adolescent Tobacco Marketing and Surveillance System (TATAMS). Exclusive users reported P30D use of one product, dual users reported P30D use of e-cigarettes and cigarettes, co-users reported use of cannabis and one tobacco product, and poly co-users reported P30D use of all three products. Participants were asked if they agreed with a series of reasons for using their respective products. Multinomial logistic regression analyses were conducted to examine associations between reasons for use and pattern of use, controlling for sex, race/ethnicity, and lifetime product use.

RESULTS

26.36 % of P30D users reported cannabis and tobacco use. Poly co-users were more likely to report using e-cigarettes because their friends do than e-cigarette co-users (aRRR = 2.64; 95 %CI = 1.19-5.83) and dual tobacco users (aRRR = 5.11; 95 %CI = 1.73-15.12). Poly co-users were more likely to smoke cigarettes while drinking alcohol (aRRR = 4.68; 95 %CI = 1.06-20.72) or to experience a pleasurable buzz (aRRR = 5.48; 95 %CI = 1.62-18.57) than exclusive cigarette users. Poly co-users more often reported using cannabis for taste (aRRR = 3.13; 95 %CI = 1.51-6.51), because their friends use it (aRRR = 2.19; 95 %CI = 1.08-4.42), and while drinking alcohol (aRRR = 2.13; 95 %CI = 1.03-4.41) than exclusive cannabis users.

CONCLUSIONS

Given that reasons for use differ significantly among types of multiple product users and exclusive users, interventions should be tailored to address the specific tobacco and cannabis use practices of young adults.

Is Maintenance or Switching Between Freebase and Nicotine Salt Liquid Associated with Electronic Nicotine Delivery Systems Dependence?

BACKGROUND

Electronic nicotine delivery systems (ENDS) use one of two formulations of nicotine-freebase or nicotine salt. This study examines whether maintenance or switching between nicotine formulations is associated with ENDS dependence using longitudinal survey data.

METHODS

543 U.S. adults (21+) using ENDS frequently (5+ days/week) self-reported and uploaded photos of their most used ENDS liquids in wave 3-5 online surveys from September 2021 to April 2023. Nicotine formulation from photo data was used if available; otherwise, self-reported data were used. ENDS dependence was measured in each wave by a 4-item E-cigarette Dependence Scale (EDS: range 0-4, 4 being most dependent). Data were analyzed using ANCOVA.

RESULTS

Participants using nicotine salt liquids in three waves reported the highest EDS in wave 5 (49.3%, EDS = 2.59), followed by participants switching from salt to freebase (3.2%, EDS = 2.58), participants switching from freebase to salt (10.1%, EDS = 2.52), participants using freebase in three waves (34.9%, EDS = 2.18), and participants changing back and forth (2.4%, EDS = 2.11). After controlling for smoking status, participants stably using nicotine salt and participants switching from freebase to salt reported significantly higher EDS than those stably using freebase (p < 0.01).

CONCLUSIONS

Over an 18-month period, people consistently using nicotine salt liquids and participants switching from freebase to nicotine salt were more likely to have a higher ENDS dependence than those consistently using freebase liquids. Understanding how switching between nicotine formulations relates to ENDS dependence can inform nicotine formulation and concentration regulations that may impact addiction.

Physical activity, organized sport participation and active transportation to school among Canadian youth by gender identity and sexual attraction

INTRODUCTION

Regular physical activity is associated with a wide range of health benefits in youth. While previous studies have identified disparities in physical activity among youth by gender identity and sexual attraction, these have seldom been explored in Canadian youth.

METHODS

Data from the 2019 Canadian Health Survey on Children and Youth were used to assess prevalence of and time spent in organized sports participation, total physical activity and active transportation by gender identity (non-cisgender vs. cisgender) among youth aged 12 to 17, and by sexual attraction (nonheterosexual attraction vs. heterosexual attraction) among youth aged 15 to 17.

RESULTS

There was no difference in average minutes of total physical activity per week between non-cisgender and cisgender Canadian youth. Non-cisgender youth (which represent 0.5% of the population) averaged significantly fewer minutes of organized sports per week than their cisgender counterparts. There was some evidence of increased active transportation to school among non-cisgender youth, but insufficient power to detect significant differences. Canadian youth reporting any nonheterosexual attraction (which represent 21.2% of the population, including mostly heterosexual youth) were less likely to be regularly physically active and participate in organized sports than youth reporting exclusive heterosexual attraction. Differences were larger among males than females. Males reporting nonheterosexual attraction were more likely to use active transportation to get to school than their heterosexual counterparts.

CONCLUSION

Non-cisgender youth and youth reporting nonheterosexual attraction tended to participate less in organized sports than their counterparts, but may have engaged in more active transportation. Mitigating the barriers associated with sport participation could increase physical activity among these groups.

Actual and perceived E-cigarettes behaviors among a national sample of U.S. college students

Objective: Electronic cigarette use represents an important college health concern. This investigation assessed demographic and behavioral correlates associated with actual and perceived e-cigarette use among a national sample of American college students. Methods: Respondents (n = 19,861) comprised college students from over 40 distinct American higher education institutions. Multivariable logistic regression assessed whether (1) alcohol, tobacco or marijuana use were associated with e-cigarette use; (2) perceived peer use of alcohol, tobacco or marijuana were associated with perceived e-cigarette use. Results: Approximately 5% of survey respondents self-reported using e-cigarettes within the past month. More than 7 out of every 10 respondents, however, thought the 'typical student' was an e-cigarette user. As perceptions of typical student substance use increased, respondents were far more likely to contend the typical student used e-cigarettes. Discussion: In addition to adopting smoke-free campus policies, university officials should disseminate accurate information regarding e-cigarette behaviors of students.

Examining intention to quit using Juul among emerging adults

OBJECTIVES

(1) Describe intention to quit, (2) identify relationships between various factors and intention to quit, (3) explore if Theory of Planned Behavior-informed constructs are associated with intention to quit, and (4) discover if descriptive norms strengthen association with intention to quit among emerging adults currently using Juul. Participants: First-year students currently using Juul at a large public university (N = 182). Methods: A November 2018 online survey assessed sociodemographic characteristics, social influences, patterns of use, quit intention, and attitudes, norms, and perceived behavioral control toward Juul. Results: A quarter of participants reported current use, with nearly half intending to quit within six months. Recent quit attempts was the only factor related to intention. Two models were created that showed association with intention to quit, but only perceived behavioral control was individually significant. Conclusions: Cessation-focused campaigns and interventions are needed on college campuses and could be less tailored than prevention.

JUUL preference among Korean adult tobacco users and its effect on attempts to quit tobacco: A follow-up survey four months post JUUL launch

INTRODUCTION

This study examined the various factors in the selection of JUUL (and/or), a pod-mod type electronic cigarette (EC), and the changes in EC patterns before and after the JUUL debut on 24 May 2019, using follow-up survey data of adult tobacco users in South Korea.

METHODS

This study examined transition outcomes among tobacco users and factors associated with future JUUL use. Convenience sample data were collected from adult tobacco users in South Korea, from March-April 2019 (baseline, n=2173) to September 2019 (follow-up, n=779). Results were obtained from the 779 respondents in the follow-up survey, and user data of one or more tobacco products were analyzed. The changes in the proportion of EC and JUUL use during this period were calculated, and multivariate logistic regression analysis was conducted to investigate the selection factors of JUUL.

RESULTS

Four months after the JUUL launch, the proportion of current EC and JUUL users among the whole sample increased by 10.3% (42.6-52.9%, p<0.001) and 17.7 % (4.0-21.7%, p<0.001), respectively, while the proportion of triple users doubled (18.7% vs 37.5%, p<0.001). Among current EC users, the percentage of quitting EC within one month decreased from 18.7% to 8.7%; this change was more pronounced among concurrent JUUL users than non-JUUL users (p<0.001). In the multivariate logistic analysis with adjustment for possible confounders, JUUL use was significantly associated with male sex, young and middle age, and metropolitan residency status at the baseline survey.

CONCLUSIONS

After the launch of JUUL in South Korea, EC users, including JUUL and triple users, increased significantly, but the intention to stop EC decreased significantly. Given the serious interests of the tobacco industry in these products, additional regulation is warranted.

Juul use among emerging adults transitioning from high school to college

Objective: Assess the prevalence, perceptions, sociodemographic/personal factors that influence Juul use among incoming freshmen.Participants: Incoming undergraduate students (N = 1,706) attending a public university in the southeastern U.S.Methods: Cross-sectional survey administered August 2018. Bivariate relationships assessed using chi-square test of association. Multinomial logistic regression to determine factors associated with Juul use status.Results: 41% had ever used Juul, 24% had used within the past month. Among current users, one-third had used 20-30 days. Risk factors for current use: heterosexual orientation (relative to other sexual orientation) AOR = 2.16, 95% CI: 1.20-3.91), those who planned to join sorority/fraternity (relative to those who did not plan to; AOR = 2.15, 95% CI: 1.59-2.90), current smokers (relative to nonsmokers; AOR = 24.39, 95% CI: 7.52-76.92), current marijuana users (compared with nonusers of marijuana; AOR = 6.45, 95% CI: 3.92-10.64) and alcohol users (compared with nondrinkers; AOR = 7.81, 95% CI: 5.75-10.54).Conclusion: Prevention and treatment efforts are needed for emerging adults transitioning to college.

Trends in e-cigarette brands, devices and the nicotine profile of products used by youth in England, Canada and the USA: 2017-2019

BACKGROUND

The e-cigarette market has rapidly evolved, with a shift towards higher nicotine concentration and salt-based products, such as JUUL; however, the implications for youth vaping remain unclear.

METHODS

Repeat cross-sectional online surveys were conducted in 2017, 2018 and 2019, with national samples of youth aged 16-19 years recruited from commercial panels in Canada (n=12 018), England (n=11 362) and the USA (n=12 110). Regression models examined differences between countries and over time in the types of e-cigarette products used (design and nicotine content), reasons for using brands and differences in patterns of use, sociodemographics and dependence symptoms by brand/nicotine content.

RESULTS

In 2019, the use of pod- or cartridge-style e-cigarettes was greater in Canada and the USA than England, with Smok and JUUL the leading brands in all countries. In 2019, youth vapers in England were less likely to report using e-cigarettes with ≥2% nicotine (12.8%) compared with Canada (40.5%; adjusted OR (AOR)=4.96; 95% CI 3.51 to 7.01) and the USA (37.0%; AOR=3.99, 95% CI 2.79 to 5.71) and less likely to report using nicotine salt-based products (12.3%) compared with Canada (27.1%; AOR=2.77, 95% CI 1.93 to 3.99) and the USA (21.9%; AOR=2.00, 95% CI 1.36 to 2.95). In 2019, self-reported use of products with higher nicotine concentration was associated with significantly greater frequency of vaping, urges to vape and perceived vaping addiction (p<0.05 for all).

CONCLUSIONS

The use of high-nicotine salt-based products is associated with greater symptoms of dependence, including JUUL and other higher-nicotine brands. Greater use of high-nicotine salt-based products may account for recent increases in the frequency of vaping among youth in Canada and the USA.

Electronic nicotine delivery systems (ENDS) dependence among Texas Young Adults, 2014-2019: Increasing trajectory after the 2017 surge in vape pod popularity

INTRODUCTION

Use of electronic nicotine delivery systems (ENDS) increased significantly after 2017. The increase is attributed to a surge in popularity of vape pods containing nicotine salts, which are high nicotine concentration ENDS that may heighten risk for dependence. However, little is known about changes in ENDS dependence before and after the 2017 surge. We examined the trajectory of ENDS dependence among young adults from 2014 to 2019.

METHODS

Participants were 1700 18-25-year-olds (57.6 % female) from 24 Texas colleges who reported past 30-day ENDS use in at least one of eight study waves. ENDS dependence was assessed at all waves with one item, use of ENDS within 30 min of waking. A discontinuous growth curve model was fit to test the hypothesis that the ENDS dependence trajectory would increase only after 2017, from 2018 to 2019. The model included socio-demographic and cigarette dependence covariates RESULTS: The proportion of young adults reporting ENDS dependence ranged from 2.3 % in 2014 to 8.2 % in 2019. Results from the discontinuous growth curve model indicated that the ENDS dependence trajectory was flat from fall 2014 to spring 2017. However, the post-2017 trajectory, from spring 2018 to spring 2019, was positive and significant indicating that the proportion of young adults reporting ENDS dependence increased after 2017.

CONCLUSIONS

The increase in ENDS dependence after 2017 likely resulted from the surge in popularity of vape pods containing nicotine salts. These vape pods are a disruptive technology that may result in more young adults developing nicotine dependence symptoms than do earlier generation devices.

"Can I hit that?" Vaping knowledge, attitudes and practices of college students

Objective: Vaping rates among college students have been increasing significantly in recent years, due in large part to the diffusion of pod vaping devices (i.e., JUUL, Suorin) on American college campuses. In this study, we explore the ecological system of knowledge, attitudes, and practices in regards to this trend. Participants: Participants were 26 undergraduate students at the University of Minnesota. Method: Following a KAP (knowledge, attitudes, practices) approach, 8 focus groups were conducted in April/ May 2019. Results: Knowledge themes include awareness of the addictiveness of the devices and uncertainty regarding the health risks. Attitudinal themes include a dual perspective, wherein social use is acceptable, but everyday use is stigmatized. Practice themes included three evident stages: social connection, wherein the devices were used to achieve social advantage with peers; addiction, characterized by solitary, habitual use; and detachment, sometimes marked by a dramatic, public action filmed for social media. Conclusions: As we consider intervention points on college campuses, an understanding of knowledge, attitude, and practice themes can guide our approach. Recommendations for college vaping campaigns are discussed.

Primed for positive perceptions? Applying the acquired preparedness model to explain college students' e-cigarette use and dependence

OBJECTIVE

College students use electronic nicotine delivery systems (ENDS) more often than any other US demographic group. In a novel application of the acquired preparedness model, we examined how proximal (e.g., cognitions) and distal (e.g., dispositional) influences accounted for ENDS use and dependence.

PARTICIPANTS

Undergraduates (N = 1075; 72% female, 74% White) from seven US campuses completed an online survey between October 2019-March 2020.

METHODS

We modeled ENDS use and dependence, respectively, as zero-inflated Poisson distributions with impulsivity as an independent variable and perceived risks and benefits of e-cigarettes as mediators.

RESULTS

Students higher in impulsivity perceived more benefits and, in turn, reported greater ENDS use and dependence. Curiosity and friends' use motivated ENDS initiation; stress management and nicotine motivated continued use.

CONCLUSIONS

ENDS interventions should be tailored to students higher in impulsivity, as they hold more favorable perceptions of ENDS, and should enhance skills to manage stress and nicotine cravings.

Potential risk factors for cigarette use among a sample of college JUUL users

Objective: To examine the relationship between demographics, other tobacco use, and JUUL dependency on combustible cigarette use among college JUUL users. Participants: Undergraduates (n = 595) at a large southwestern university who used JUUL weekly completed a cross-sectional online survey in March 2019. Methods: Logistic regressions examined associations between covariates and ever use/past 30-day use of cigarettes. Results: As age increased, odds of ever trying a cigarette increased (AOR = 1.87; 95% CI = 1.45-2.41); however, as age of JUUL initiation increased, odds of ever (AOR = 0.80; 95% CI = 0.65-0.99) or past 30-day (AOR = 0.78; 95% CI = 0.63-0.97) cigarette use decreased. Those moderately (AOR = 2.03; 95% CI = 1.07-3.82) or highly (AOR = 8.01; 95% CI = 3.08-20.83) dependent on JUUL were more likely to have tried cigarettes than those not dependent. However, dependence was not associated with past 30-day use. Conclusions: JUUL users may not transition to combustible cigarettes during college. Longitudinal studies are needed to examine transitions in JUUL users' tobacco product use after college.

A Comprehensive Review of Vaping Use in Pediatric Patients and Recent Changes in Regulatory Laws

The use of electronic cigarettes (e-cigarettes), also known as vapes, by adolescents and young adults has dramatically increased over the past several years. E-cigarettes continue to be the most used form of tobacco among youth. As a result of this concerning trend, policies at both the state and federal levels have been implemented to limit availability in this population. Additionally, the coronavirus disease 2019 (COVID-19) pandemic has had some positive and negative effects on the youth vaping epidemic with adolescent consumers reporting limited access to retail sites during the stay-at-home executive orders, but easier access with online purchasing because age verification was often not required. Complications resulting from vaping have been reported and include e-cigarette or vaping product use–associated lung injury (EVALI) and thrombotic events. Data suggest that the use of vaping devices can lead to both short- and long-term respiratory morbidity in the pediatric population. This review serves to provide a comprehensive examination of vaping use in pediatric patients and recent changes in regulatory laws to equip pharmacists with the knowledge to be aware of the different devices and products available, ask their pediatric patients regularly about use, and counsel and educate on the potential harmful effects.

Factors Associated with Quit Interest and Quit Attempts among Young Adult JUUL Users

Despite reports suggesting young people are interested in quitting e-cigarettes, little work has examined predictors of quit outcomes. This study aimed to identify factors associated with quit outcomes among JUUL e-cigarette users in a longitudinal sample of young adults. We assessed undergraduate past-30-day JUUL users during autumn 2018 (N = 225); Our outcomes included short-term quit attempts and interest (spring 2019), and long-term quit attempts (spring 2020). We used logistic regression to examine the associations between our outcomes and JUUL use characteristics, other tobacco use, and sociodemographic factors. Findings indicated 76% of users were interested in quitting JUUL, and more than 40% reported a quit attempt. Quit outcomes were not related to sociodemographics. Short-term quit outcomes were more likely among freshmen and less likely among recent cigarillo users. Heavy JUUL users were more likely to report short- and long-term quit attempts, but JUUL device owners were less likely to report short- and long-term quit attempts. Higher nicotine dependence reduced the likelihood of a long-term quit attempt. There is a need for policy level actions that address tobacco control among this population. Findings suggest a range of unique factors that can inform such policies and programs to curb young adult e-cigarette use.

Examining Cannabis, Tobacco, and Vaping Discourse on Reddit: An Exploratory Approach Using Natural Language Processing

Background: Perceptions of tobacco, cannabis, and electronic nicotine delivery systems (ENDS) are continually evolving in the United States. Exploring these characteristics through user generated text sources may provide novel insights into product use behavior that are challenging to identify using survey-based methods. The objective of this study was to compare the topics frequently discussed among Reddit members in cannabis, tobacco, and ENDS-specific subreddits. Methods: We collected 643,070 posts on the social media site Reddit between January 2013 and December 2018. We developed and validated an annotation scheme, achieving a high level of agreement among annotators. We then manually coded a subset of 2,630 posts for their content with relation to experiences and use of the three products of interest, and further developed word cloud representations of the words contained in these posts. Finally, we applied Latent Dirichlet Allocation (LDA) topic modeling to the 643,070 posts to identify emerging themes related to cannabis, tobacco, and ENDS products being discussed on Reddit. Results: Our manual annotation process yielded 2,148 (81.6%) posts that contained a mention(s) of either cannabis, tobacco, or ENDS with 1,537 (71.5%) of these posts mentioning cannabis, 421 (19.5%) mentioning ENDS, and 264 (12.2%) mentioning tobacco. In cannabis-specific subreddits, personal experiences with cannabis, cannabis legislation, health effects of cannabis use, methods and forms of cannabis, and the cultivation of cannabis were commonly discussed topics. The discussion in tobacco-specific subreddits often focused on the discussion of brands and types of combustible tobacco, as well as smoking cessation experiences and advice. In ENDS-specific subreddits, topics often included ENDS accessories and parts, flavors and nicotine solutions, procurement of ENDS, and the use of ENDS for smoking cessation. Conclusion: Our findings highlight the posting and participation patterns of Reddit members in cannabis, tobacco, and ENDS-specific subreddits and provide novel insights into aspects of personal use regarding these products. These findings complement epidemiologic study designs and highlight the potential of using specific subreddits to explore personal experiences with cannabis, ENDS, and tobacco products.

Cue Reactivity to Electronic Cigarettes: A Systematic Review

Cue reactivity to Electronic Nicotine Delivery Systems (ENDS) has been studied by several researchers, yet the variability in user types (smokers, former smokers, dual users, exclusive ENDS users) and ENDS designs used between the studies may have undermined consistent results. This systematic review aims to give an overview of ENDS cue reactivity and how smoking status and device design may moderate this. A systematic search of Medline, Embase, Web of Science, PubMed and Cochrane was completed. All studies which reported findings on reactivity to ENDS cues in the form of craving or desire for ENDS or cigarettes, attention to cue, delay of gratification or economic decisions were included. Exclusion criteria were non-human subjects, non-adult participants or participants with comorbidities. Literature selection was carried out by 2 independent reviewers. The risk of bias and study quality were assessed using tools developed by Cochrane, BMJ and NHLBI. A total of 711 papers were screened and 22 studies were included in the current review. Study design, research question(s), population of interest, number of participants, dependent variable(s), ENDS generation and nicotine content used and study results were extracted. ENDS cues reliably induced ENDS craving, with no clear moderation by smoking status and no apparent moderation by device generation. In about half of the studies, ENDS cues induced craving for conventional cigarettes. Most studies used a smoker sample, thus limiting the conclusions that can be drawn on the moderation of cue reactivity by smoking status. The quality varied among studies but comparing the findings against the outcomes of only high-quality studies did not yield any different results. The results of this review support the notion of cue reactivity to ENDS, identifies gaps in current research on different user types and implies that ENDS design iterations have little impact on cue reactivity.

Rising vape pod popularity disrupted declining use of electronic nicotine delivery systems among young adults in Texas, USA from 2014 to 2019

AIMS

To examine the longitudinal trajectory of young Texan (US) adults' electronic nicotine delivery systems (ENDS) use from 2014 to 2019, and to determine if there are changes in the trajectory among younger and older young adults post-2017, when vape pods surged in popularity in the United States.

DESIGN

Nine-wave longitudinal study, with 6 months between each of the first eight waves and 1 year between the last two waves. Discontinuous, or piecewise, growth curve models were used to test the hypotheses that (a) the overall current/past 30-day ENDS use trajectory would decline from 2014 to spring 2017 but then increase from fall 2017 to 2019, and (b) the increasing trajectory from 2017 to 2019 would occur only for younger participants, but not older participants. All models included socio-demographic covariates of sex, race/ethnicity, type of college attended at baseline (2- or 4-year) and time-varying age.

SETTING AND PARTICIPANTS

A total of 5218 students (aged 18-25 years at baseline; 63.7% female) from 24 colleges in the five counties surrounding Austin, Dallas/Fort Worth, Houston and San Antonio, Texas, USA.

MEASUREMENTS

Participants completed on-line surveys regarding past 30-day ENDS use at all nine waves.

FINDINGS

Current ENDS use significantly declined from 2014 to spring 2017 [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.59-0.68], and then significantly increased from autumn 2017 to 2019 (OR = 1.14, 95% CI = 1.01-1.29). Further examination indicated the increase in current ENDS use from autumn 2017 to 2019 occurred only for younger [-1 standard deviation (SD) below the mean age, 22.6 years old], but not older (+1 SD above the mean age, 26.2 years old), participants.

CONCLUSION

The surge in the popularity of vape pods in the United States in late 2017 may have contributed to increasing use of electronic nicotine delivery systems among younger young adults (below 22.6 years) from late 2017 to 2019.

Methods and Statistical Analyses in Studies of Motivation for E-Cigarette Use Among University Students: An Integrative Review

Understanding the motivations for e-cigarette use among college and university students is essential for developing and implementing effective interventions. Evaluating existing literature is necessary to identify methodological gaps and limitations and improve the quality of future research. We aimed to evaluate the quality of the methods and statistical analyses and integrate evidence addressing motivations for e-cigarette use among college and university students. An integrative literature review was conducted by two researchers to identify and evaluate peer-reviewed, quantitative, and mixed methods research exploring motivations for e-cigarette use among college and university students. A systematic analytic method of data reduction was used to identify alignment and divergence of the data, gaps in the literature, and methodological limitations. Fifteen quantitative studies and three mixed methods studies published between 2015-2020 were included. Most studies were cross-sectional, used convenience sampling, and lacked psychometric and assumptions testing. Half performed regression analyses, however, very few adhered to research and statistical reporting standards. Current literature provides a foundation for developing and implementing interventions aimed to prevent e-cigarette use and encourage cessation. Future research should incorporate stronger sampling methods and research designs, as well as the use of rigorous statistical analyses in conjunction with thorough reporting. Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1990332.

A one year prospective examination of risk factors for pod-vape use among young adults

BACKGROUND

Young adults have the highest prevalence of pod-vape use, compared to adolescents and older adults. Despite the increased use of pod-vapes among young adults, very few studies have explored the determinants associated with pod-vape use.

PURPOSE

The purpose of the current study was to examine the roles of social norms and risk perceptions in subsequent pod-vape use one year later among a cohort of 21-34-year-old young adults.

METHOD

Participants were 3543 young adults from the last two waves (spring 2018 and 2019) of the Marketing and Promotions across Colleges in Texas project (M-PACT). A multivariable logistic regression model was used to examine the role of social norms and risk perceptions on subsequent pod-vape use one year later.

RESULTS

The prevalence of current pod-vape use in the present sample increased by 139.3% between 2018 and 2019. The social norm variables of close friends' pod-vape use and inclination to date someone that uses pod-vapes, but not social acceptability of pod-vapes, predicted subsequent pod-vape use one year later. Neither of the risk perception variables predicted subsequent pod-vape use.

CONCLUSION

The current study highlights the importance of social norms as predictors of subsequent pod-vape use among older young adults (21-34 years old). The rise in pod-vape use indicates that preventative efforts that target young adults are warranted, especially those that consider the role of peers in pod-vape use.

Conceptual model for the evaluation of attractiveness, addictiveness and toxicity of tobacco and related products: The example of JUUL e-cigarettes

Many new tobacco and related products (nTRP) have emerged on the market, with unknown health risks. Here, we present a conceptual model containing the factors and relations between them that contribute to the nTRP's health effects. Factors that determine attractiveness, addictiveness and toxicity of nTRP were defined based on previous assessments, literature, and expert discussions. Our model will aid in identifying key risk factors contributing to increased risk of adverse health effects for a product in a qualitative manner. Additionally, it can gauge attractiveness for specific user groups, as a determinant for population prevalence of use. Our model can be used to identify aspects of nTRP that require attention for public information or product regulation. As an example, we applied this to JUUL, a popular e-cigarette in the US. Aspects of concern for JUUL are its attractive and discrete shape, user-friendly prefilled pods, flavors, high aerosol nicotine levels, and liquids containing nicotine salts instead of free-based nicotine. The addictiveness and especially attractiveness are sufficiently high to have a large potential impact on population health due to its contribution to use and hence exposure. Products and their use can change over time; therefore market research and monitoring are crucial.

Changes in knowledge, perceptions and use of JUUL among a cohort of young adults

OBJECTIVE

E-cigarettes have gained popularity, most recently with pod-style devices, such as JUUL. We examined changes in JUUL awareness, use, perceptions, nicotine content knowledge, number of days a pod lasts and exposure to JUUL retail advertising over a 6-month period in a cohort of young adults.

METHODS

In spring and fall 2018, 1836 young adults completed online surveys on tobacco use, including JUUL perceptions and use behaviours. Demographics, tobacco use and JUUL advertising exposure in spring 2018 were examined as predictors of current JUUL use in fall 2018.

RESULTS

Ever and current JUUL use doubled in 6 months (5.9% vs 12.7%, p<0.001; 1.6% vs 3.4%, p<0.001). The number of days a JUUL pod lasts significantly changed (p=0.049). Although there was an increase in those reporting JUUL has as much or more nicotine than a pack of cigarettes, 58% are 'not sure' of JUUL's nicotine content. Exposure to JUUL's advertising significantly increased (31.8% to 46.4%; p<0.001). In multivariable models, those perceiving JUUL as or more harmful than cigarettes, and former and never cigarette smokers had significantly lower odds of current JUUL use at 6 months compared with their respective counterparts (p<0.0001). Those reporting exposure to JUUL's advertising had significantly increased odds of current JUUL use 6 months later (p<0.03).

CONCLUSIONS

Findings demonstrate changes in knowledge of JUUL's nicotine content, perceptions and use over a short period of time, suggesting frequent measurement is necessary. Additionally, efforts are needed to regulate retail advertising and ensure consumer education about product risks as they are associated with current use.

Nicotine dependence symptoms in U.S. youth who use JUUL E-cigarettes

PURPOSE

To estimate the prevalence, patterns, and correlates of self-reported nicotine dependence symptoms among U.S. youth who use JUUL - a widely-sold e-cigarette brand - in 2019 and compare findings to nicotine dependence symptoms in youth who smoke cigarettes.

METHODS

Data were from a nationally-representative subsample of 8th, 10th, and 12th grade students in the Monitoring the Future Study who had used JUUL or cigarettes in the past 30 days. Participants self-reported presence/absence of 9 different nicotine dependence symptoms for JUUL or cigarettes. Weighted percentages for JUUL or cigarette nicotine dependence symptom status (≥1 vs. 0 symptoms) and severity (count, range: 0-9) were calculated. Among JUUL users, we estimated associations of sociodemographic characteristics and other substance use with nicotine dependence and severity.

RESULTS

Among 1,748 past 30-day JUUL users, 41.3 % screened positive for ≥1 nicotine dependence symptoms; the mean symptom count was 1.6 (SD = 2.6). Non-nicotine substance use and more frequent JUUL use was associated with significantly greater odds of dependence and more severe dependence symptoms in multivariable models. The severity distribution of most (craving) and least (inability to quit) dependence symptom types observed in JUUL dependence paralleled those observed in analysis of combustible cigarette dependence symptoms in past 30-day smokers.

CONCLUSION

A substantial proportion of U.S. adolescent JUUL users reported symptoms of nicotine dependence, which is greater for those who vape more frequently and use other substances. Nicotine dependence screening, prevention, and regulatory policies addressing use of JUUL or similar e-cigarette products should be considered to protect U.S. youth.

Nicotine Inhalation and Suicide: Clinical Correlates and Behavioral Mechanisms

BACKGROUND AND OBJECTIVES

Extensive evidence links smoking and suicide independently of psychiatric diagnoses, but there are questions about the pathophysiology and specificity of this relationship. We examined characteristics of this linkage to identify potential transdiagnostic mechanisms in suicide and its prevention.

METHODS

We reviewed literature that associated suicide with smoking and e-cigarettes, including the temporal sequence of smoking and suicide risk and their shared behavioral risk factors of sensitization and impulsivity.

RESULTS

Smoking is associated with increased suicide across psychiatric diagnoses and in the general population, proportionately to the number of cigarettes smoked per day. Rapid nicotine uptake into the brain through inhalation of conventional cigarettes, electronic cigarettes (e-cigarette), or even second-hand smoke can facilitate long-term sensitization and short-term impulsivity. Both impair action regulation and predispose to negative affect, continued smoking, and suicidal behavior. Intermittent hypoxia, induced by cigarettes or e-cigarettes, synergistically promotes impulsivity and sensitization, exacerbating suicidality. Two other shared behavioral risks also develop negative urgency (combined impulsivity and negative affect) and cross-sensitization to stressors or to other addictive stimuli. Finally, early smoking onset, promoted by e-cigarettes in never-smokers, increases subsequent suicide risk.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Prevention or cessation of nicotine inhalation can strategically prevent suicidality and other potentially lethal behavior regardless of psychiatric diagnoses. Medications for reducing smoking and suicidality, especially in younger smokers, should consider the neurobehavioral mechanisms for acute impulsivity and longer-term sensitization, potentially modulated more effectively through glutamate antagonism rather than nicotine substitution. (Am J Addict 2021;30:316-329).

The consequential impact of JUUL on youth vaping and the landscape of tobacco products: The state of play in the COVID-19 era

JUUL is a groundbreaking electronic cigarette (e-cig) and the preeminent vaping product on the market. We present an overview of the rapid and spectacular rise of JUUL and its remarkable fall within the timespan of 2015 - 2020. We highlight JUUL's entering the market in June 2015, becoming the industry leader in mid 2017, and experiencing a litany of setbacks by late 2019 through to early 2020. We address the role played by JUUL in the ongoing epidemic of youth vaping. We also feature competing views on the public health impact of JUUL use (in particular), and e-cig vaping (in general). We further highlight the latest trends in youth vaping and sales records for JUUL and tobacco cigarettes. In view of the ongoing pandemic of COVID-19, we briefly summarize the existing evidence on the relationship between vaping and smoking and the prevalence, disease course, and clinical outcomes of COVID-19.

Assessing Young Adults' ENDS Use via Ecological Momentary Assessment and a Smart Bluetooth Enabled ENDS Device

INTRODUCTION

The assessment of electronic nicotine delivery systems (ENDS) use poses unique challenges that go beyond established assessment methods for tobacco cigarettes. Recent studies have proposed using ecological momentary assessment (EMA), a method to collect self-reported data on mobile devices, or data passively collected by "smart" Bluetooth enabled ENDS to assess use. The current study sought to compare ENDS use data using EMA and puff counts collected from a smart device.

AIMS AND METHODS

We recruited 18 young adult ENDS users (age M = 23.33; 44.4% female) from the San Francisco Bay Area. For a total of 30 days, participants completed daily diaries by EMA and used a second-generation smart Bluetooth enabled ENDS that collected puff data. Repeated measures correlations, multilevel regressions, and paired t tests assessed concordance of EMA reports and ENDS data. A subset of four highly compliant participants were selected for sensitivity analyses.

RESULTS

Among all 18 participants, completion of EMA daily diaries was high (77.4%). The ENDS device collected approximately twice as many puffs per day as participants reported. Compared with self-reported number of sessions and amount of e-liquid used, self-reported puff counts had the highest correlation with device-collected puff counts (rrm = 0.49; p < .001). Correlations between self-reported and device-collected puff counts improved among the subset of four highly compliant participants (rrm = 0.59; p < .001).

CONCLUSIONS

Self-reports potentially underestimate use of ENDS. Puff counts appear to be the best self-reported measure to assess ENDS use compared with number of sessions or liquid volume.

IMPLICATIONS

The comparison of EMA self-reports and passively collected ENDS device data can inform future efforts to assess ENDS use. Self-reported puff counts are preferable over number of sessions or amount of liquid used, but compared with objective usage data, self-reported puff counts may still underestimate actual use. ENDS use behavior is likely higher than users estimate and report. Future research on improved measures of ENDS use is needed.

College Students' Reasons for Using JUULs

PURPOSE

To identify reasons that college students use JUUL and explore associations between reasons for using JUUL and social and behavioral (tobacco use) factors.

DESIGN

On-line, cross-sectional survey.

SETTING

Large southwestern university in the US.

SUBJECTS

Undergraduate students (n = 605) who owned JUUL and used it weekly.

MEASURES

The study measured age of JUUL initiation, JUUL dependence, and use of other e-cigarettes and other tobacco products. Participants described reasons for JUUL use as brief open-ended responses.

ANALYSIS

Responses were categorized by 2 researchers using an inductive procedure. Logistic regressions examined associations between demographics and use frequency and categorized reasons for using JUUL.

RESULTS

Four reasons for using JUUL emerged: self-help (48.4%), social (30.4%), experience (42.8%), and substance use/addiction (42.3%). Daily JUUL users were 1.66 (95% CI: 1.05-2.63) times as likely to use JUUL for self-help than those who used JUUL 1-3 days/week. Those who had never tried a cigarette were twice (OR = 2.08; 95% CI: 1.22-3.54) as likely as cigarette-first users to use JUUL for social reasons. Males (OR = 1.87; 95% CI: 1.32-2.65) had higher odds of using JUUL for the experience than females, and JUUL and other e-cigarettes users were 4.37 (95% CI: 1.83-10.45) times as likely as JUUL-only users to use JUUL due to substance use/addiction.

CONCLUSION

JUUL users report unique reasons for use (e.g., addiction) not previously reported for older models of e-cigarette devices.

Trends in E-Cigarette Use by Age Group and Combustible Cigarette Smoking Histories, U.S. Adults, 2014-2018

INTRODUCTION

The trends in e-cigarette prevalence and population count of users according to cigarette smoking histories are unknown. These data are needed to inform public health actions against a rapidly changing U.S. e-cigarette market.

METHODS

Data collected between 2014 and 2018 (analyzed in 2020) from cross-sectional, nationally representative National Health Interview Surveys were used to estimate current e-cigarette prevalence, adjusted prevalence differences (percentage points), and population counts of users. Analyses were stratified by age group (younger, 18-29 years, n=25,445; middle age, 30-49 years, n=47,745; older, ≥50 years, n=79,517) and cigarette smoking histories (current smokers, recent quitters [quit <1 year ago], near-term quitters [quit 1-8 years ago], long-term quitters [quit >8 years ago], never smokers).

RESULTS

Among younger adults, e-cigarette use increased in all groups of smokers, with notable increases between 2014 and 2018 among never smokers (1.3%-3.3%, adjusted prevalence difference=2%, p<0.001) and near-term quitters (9.1%-19.2%, adjusted prevalence difference=8.8%, p=0.024). Conversely, the only substantial increase in e-cigarette use between 2014 and 2018 among middle-aged (5.8%-14.4%, adjusted prevalence difference=8.2%, p<0.001) and older (6.3%-9.5%, adjusted prevalence difference=3.3%, p=0.045) adults was among near-term quitters. The largest absolute population increase in e-cigarette users between 2014 and 2018 was among younger-adult never smokers (0.49-1.35 million), followed by near-term quitters among middle-aged (0.36-0.95 million), younger (0.23-0.57 million), and older (0.35-0.50 million) adults.

CONCLUSIONS

The continuous increase among younger-adult never smokers suggests a rise in primary nicotine initiation with e-cigarettes. The concomitant increase among near-term quitters of all age groups suggests continuing e-cigarette use among smokers who may have switched from cigarettes previously.

Social Media Message Designs to Educate Adolescents About E-Cigarettes

PURPOSE

E-cigarette use is increasing among adolescents, despite potential harms. Social media messages are a promising way to educate youth about e-cigarettes, yet little is known about what message topics and formats will have beneficial impacts for message reception, reach, e-cigarette knowledge, and beliefs about harms.

METHODS

A national convenience sample of adolescents (n = 928, aged 15-18 years) in high school was recruited for an online experiment. In October 2019, participants were randomized to view one of three social media formats (visual based, quiz, and text only) or a no-message control. Participants in format conditions viewed six unique topics in a random order. Outcomes were e-cigarette knowledge and beliefs. Message reactions and sharing preferences were also assessed among youth who saw social media messages.

RESULTS

Social media messages led to greater knowledge (Cohen's f = .19; p < .001) and beliefs (f = .16; p < .001) about harms of e-cigarettes compared with the control, regardless of format. Almost four in five adolescents (79%) reported they would share the social media messages, most likely in person (49%) and with friends (52%). Message topics for missing out because of lung damage, having uncontrolled moods, and ingesting specific harmful chemicals elicited higher intended message reactions.

CONCLUSIONS

Social media messages can educate about e-cigarette harms. Social media campaigns are a promising e-cigarette education strategy to reach youth, directly and potentially through peer-to-peer sharing.

Young adults' intention to quit using JUUL

BACKGROUND

With research indicating some young audiences may desire to quit using JUUL, a high-nicotine e-cigarette, we sought to explore factors that may motivate them to quit.

METHODS

This sequential, mixed methods study included a cross-sectional online survey of college students (n = 631) followed by in-person interviews (n = 51) with survey participants. Data were collected March-April 2019. The survey asked about intention to quit using JUUL. A latent class analysis (LCA) identified participant groups who would quit for various reasons. Participants were also asked 'Can you be too old to JUUL?' during the survey. During the interviews, participants were provided preliminary survey findings and asked about their perceptions of the data. Interview participants were also asked about their expectations for future use of JUUL.

RESULTS

Four classes emerged from the LCA, indicating costs to self (i.e., harm to lungs/brain, price; 46.8%), financial costs (36.6%), all costs (e.g., social, monetary, health; 9.3%), and harm to self (7.3%) may have influenced our sample's decision to quit using JUUL. Interviewees affirmed desires to quit using JUUL, especially after leaving college. Only 27.19% of survey participants reported an age threshold for using JUUL (M = 31.8 years, SD = 10.0); however, several interviewees explained that although someone could not be too old to JUUL, it would be 'immature' or 'childish' for adults who were not trying to quit smoking to use JUUL socially.

DISCUSSION

Comprehensive tobacco control strategies such as taxing e-cigarettes, marketing campaigns, and nicotine cessation programs are needed to help nicotine dependent young adults quit using high-nicotine e-cigarettes.

JUUL E-Cigarette Quit Attempts and Cessation Perceptions in College Student JUUL E-Cigarette Users

PURPOSE

This study describes the frequency of JUUL e-cigarette (referred to as JUUL) quit attempts and identifies characteristics associated with confidence in quitting and perceived difficulty quitting JUUL.

DESIGN

Cross-sectional study from a self-administered online survey.

SETTING

Two public southern California universities.

PARTICIPANTS

A total of 1,001 undergraduate students completed the survey from February to May 2019.

MEASURES

Self-report measures about JUUL included use, history of quit attempts, time to first use, perceived difficulty with cessation/reduction, and confidence in quitting.

ANALYSIS

Binary logistic regressions were used to identify demographic and tobacco-related behavioral correlates of JUUL cessation-related perceptions and behaviors.

RESULTS

Nearly half of ever-JUUL users (47.8%) reported a JUUL quit attempt. Adjusting for demographic factors and other tobacco product use, shorter time to first JUUL use after waking was associated with lower confidence in quitting JUUL (aOR = 0.02, 0.00-0.13) and greater perceived difficulty in quitting JUUL (aOR = 8.08, 2.15-30.35). Previous JUUL quit attempt history was also associated with greater odds of perceived difficulty quitting JUUL (aOR = 5.97, 1.74-20.53).

CONCLUSIONS

History of JUUL quit attempts among college students was common. Those who had previously tried quitting were more likely to perceive difficulty with cessation. Time to first JUUL use, a marker of dependence, was linked with greater perceived cessation difficulty and lower confidence in quitting. These findings suggest that there is a need for cessation and relapse prevention support for college student JUUL users.

Investigating the Attitudes of Adolescents and Young Adults Towards JUUL: Computational Study Using Twitter Data

Background

Increases in electronic nicotine delivery system (ENDS) use among high school students from 2017 to 2019 appear to be associated with the increasing popularity of the ENDS device JUUL.

Objective

We employed a content analysis approach in conjunction with natural language processing methods using Twitter data to understand salient themes regarding JUUL use on Twitter, sentiment towards JUUL, and underage JUUL use.

Methods

Between July 2018 and August 2019, 11,556 unique tweets containing a JUUL-related keyword were collected. We manually annotated 4000 tweets for JUUL-related themes of use and sentiment. We used 3 machine learning algorithms to classify positive and negative JUUL sentiments as well as underage JUUL mentions.

Results

Of the annotated tweets, 78.80% (3152/4000) contained a specific mention of JUUL. Only 1.43% (45/3152) of tweets mentioned using JUUL as a method of smoking cessation, and only 6.85% (216/3152) of tweets mentioned the potential health effects of JUUL use. Of the machine learning methods used, the random forest classifier was the best performing algorithm among all 3 classification tasks (ie, positive sentiment, negative sentiment, and underage JUUL mentions).

Conclusions

Our findings suggest that a vast majority of Twitter users are not using JUUL to aid in smoking cessation nor do they mention the potential health benefits or detriments of JUUL use. Using machine learning algorithms to identify tweets containing underage JUUL mentions can support the timely surveillance of JUUL habits and opinions, further assisting youth-targeted public health intervention strategies.

ENDS use among college students: Salivary biomarkers and persistent cough

Though e-cigarette aerosol has been associated with altered lung cell function, few studies have examined the effects of use on immune response and respiratory symptoms. The purpose of this study was to examine if recent persistent cough or cytokine levels are related to Electronic Nicotine Delivery Systems (ENDS) use in college students. In April 2019, 61 undergraduate students at the University of Kentucky completed surveys and provided a salivary sample to evaluate cytokine levels (Interleukin (IL-) 2, 4, 6, 8, 10, 12, 13 and TNFα, INFγ), using quota sampling to obtain comparable numbers of ENDS users and non-ENDS users. Data analysis included chi-square tests and multivariable logistic and linear regression. All ENDS users reported JUUL as their primary product. ENDS users were more likely to be younger, use cigarettes and marijuana, and report a persistent cough. Controlling for cigarette and marijuana use, there was a trend toward greater likelihood of persistent cough among ENDS users. Compared with nonusers, salivary IL-2 and INFγ were elevated and IL-4 was decreased, controlling for cigarette and marijuana use. There was a trend toward lower IL-12p70 values among ENDS users with these covariates. Findings reveal dysregulation of salivary immune profiles toward a T_H1 phenotype in emerging adult ENDS users and short-term immune function may be dysregulated in young adult e-cigarette users.

Electronic cigarette dependence and demand among pod mod users as a function of smoking status

Electronic cigarette (e-cigarette) use continues to proliferate with fast-paced product evolution. Pod mod e-cigarettes emerged in the market in 2015 and have changed the tobacco landscape again. However, little is known regarding their addiction potential among users. The current study describes e-cigarette dependence and demand among pod mod users as a function of smoking status (current smokers/dual users, former smokers, and never smokers). Participants were 593 young adult (M_age = 25.9 years) JUUL users recruited via Amazon's Mechanical Turk. Respondents were specifically recruited based on current use of pod mods (but may also be using other e-cigarette devices) and smoking status (never, former, and current/dual users). Participants completed online measures assessing e-cigarette dependence and demand. Dual users of pod mods and cigarettes displayed greater e-cigarette dependence compared to current pod mod users with no history of cigarette smoking (p = .033). Similarly, dual users showed the greatest levels of e-cigarette demand compared to both former smokers and those without a history of smoking (ps < .05). Dual users displayed the greatest e-cigarette dependence and demand. Future research should directly assess potential mechanisms for this effect and continue to monitor e-cigarette dependence as the tobacco landscape changes with the emergence of new e-cigarette products and innovations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors

IMPORTANCE

Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys.

OBJECTIVE

To examine e-cigarette and JUUL use among adolescents in New Jersey.

DESIGN, SETTING, AND PARTICIPANTS

Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12.

EXPOSURES

Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise.

MAIN OUTCOMES AND MEASURES

Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL.

RESULTS

In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use.

CONCLUSIONS AND RELEVANCE

This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.