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Original Investigation
January 21, 2020

Electronic Cigarette and JUUL Use Among Adolescents and Young Adults

Author Affiliations
  • 1Schroeder Institute, Truth Initiative, Washington, District of Columbia
  • 2Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland
  • 3College of Global Public Health, New York University, New York
JAMA Pediatr. Published online January 21, 2020. doi:10.1001/jamapediatrics.2019.5436
Key Points

Questions  How has the use of JUUL among adolescents and young adults changed from 2018 to 2019?

Findings  In this nationally representative cohort study of adolescents and young adults, with 14 379 participants in 2018 and 12 114 participants in 2019, JUUL use increased in every age group but was highest among those aged 18 to 20 years and 21 to 24 years.

Meaning  Findings of this study suggest that urgent action is needed to curb youth use of electronic cigarettes and prevent a new generation from becoming addicted to nicotine.


Importance  The increasing use rates of electronic cigarettes (e-cigarettes) among young people in the United States have been largely associated with the emergence of high-nicotine-delivery device JUUL. Relevant data are needed to monitor e-cigarette, specifically JUUL, use to help inform intervention efforts.

Objective  To estimate the prevalence, patterns, and factors associated over time with e-cigarette use among adolescents and younger adults in the United States.

Design, Setting, and Participants  Two nationally representative longitudinal samples of adolescents and younger adults aged 15 to 34 years were drawn from the Truth Longitudinal Cohort, a national, probability-based cohort. Participants in this cohort were recruited through address-based sampling, and subsamples were recruited from a probability-based online panel. The present cohort study used data from follow-up online surveys, specifically, wave 7 (N = 14 379; collected from February 15, 2018, to May 25, 2018) and wave 8 (N = 12 114; collected from February 10, 2019, to May 17, 2019). Respondents reported their use of e-cigarettes, JUUL, and combustible tobacco products as well as their harm perceptions, household smoking status, sensation-seeking, friends’ e-cigarette use, and demographic information.

Main Outcomes and Measures  The main outcomes were ever and current (past 30 days) JUUL use. χ2 Analyses assessed differences in JUUL use by psychosocial and demographic characteristics. Logistic regression models identified the significant factors associated with wave 8 ever and current JUUL use among wave 7 e-cigarette–naive participants.

Results  A total of 14 379 participants (mean [SD] age, 24.3 [0.09] years; 8142 female [51.0%]) were included in wave 7 and 12 114 (mean [SD] age, 24.5 [0.10] years; 6835 female [50.1%]) in wave 8. JUUL use statistically significantly increased from wave 7 to wave 8 among ever users (6.0% [n = 1105] to 13.5% [2111]; P < .001) and current users (3.3% [680] to 6.1% [993]; P < .001). JUUL use increased among every age group and was highest among those aged 18 to 20 years (23.9% [491] ever users and 12.8% [340] current users) and 21 to 24 years (18.1% [360] ever users and 8.2% [207] current users). Users reported a higher prevalence of frequent use in wave 8 compared with wave 7 (37.6% vs 26.1%; P < .01). Significant factors associated with future JUUL use among e-cigarette–naive participants included younger age, combustible tobacco use, lower harm perceptions, sensation seeking, and friends’ e-cigarette use.

Conclusions and Relevance  This study found that the e-cigarette device JUUL appears to be associated with the youth e-cigarette epidemic, attracting new users and facilitating frequent use with their highly addictive nicotine content and appealing flavors. Findings of this study underscore the critical need for increased e-cigarette product regulation at the federal, state, and local levels.

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