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Research Letter
November 5, 2019

Flavors of e-Cigarettes Used by Youths in the United States

Author Affiliations
  • 1Institute for Addiction Science, University of Southern California, Los Angeles
  • 2Survey Research Center, University of Michigan, Ann Arbor
  • 3Institute for Translational Research on Children’s Mental Health, University of Minnesota, Minneapolis
JAMA. 2019;322(21):2132-2134. doi:10.1001/jama.2019.17968

Adolescent e-cigarette use has increased substantially since 2016.1 To counteract such trends, public health agencies are considering regulatory restrictions of e-cigarettes in flavors popular among youths.2,3 Whether certain flavors warrant inclusion or exemption from regulatory policies is unclear because recent estimates of the specific e-cigarette flavors adolescents use are lacking.

The myriad e-cigarette products available has complicated flavor preference research. JUUL’s e-cigarette product, which has 8 flavor options, constituted 75% of all US e-cigarette sales in late 2018.4 This study estimated the prevalence of JUUL e-cigarette flavors used among US youths in 2019.

The Monitoring the Future (MTF) study surveyed nationally representative samples of US 8th-grade (response rate, 87%), 10th-grade (86%), and 12th-grade (80%) students from February 13 to June 3, 2019.1 By design, every student had a 1-in-3 probability of being randomly assigned a module containing JUUL questions presented via tablet accompanied by pictures of JUUL devices. Weighted prevalences (with 95% CIs) of responses to “Which JUUL flavor do you use most often?” (forced-choice options; see Figure) were analyzed among past 30-day JUUL users by grade and further stratified by past 30-day use frequency (<20 vs ≥20 days). Analyses used Stata MP version 15.1 software (StataCorp) with “svy:” commands to account for MTF’s complex sampling design. The University of Michigan Institutional Review Board approved the study. Informed consent (active or passive, per school policy) was obtained from parents for students younger than 18 years and from students aged 18 years or older.