Background
An estimated 10–44% of youth and young adults have ever used JUUL, the leading e-cigarette brand in the US,[1] while 8–9% reported past-30 day use of JUUL.[2–5] Although there is growing attention on the prevalence of JUUL use, prevalence of using other brands of pod-based vaping devices is unknown. This information is important to assess whether newer brands are gaining popularity among young people and to complement sales data which do not track online purchases and sales through non-participating retailers or provide information about characteristics of users.[1] This study assesses the prevalence of current use of JUUL, Suorin, and Vuse across demographic and tobacco use characteristics among US youth and young adults.
Methods
Study population and procedure.
Data came from 2000 US youth and young adults recruited through the SSRS national online opt-in survey panel[6]: 15–17 year-olds (500 ever smokers, 500 never smokers) or 18–24 year-olds (500 who smoked within the past 30 days and had smoked ≥100 lifetime cigarettes, 500 who did not smoke in the past 30 days or had smoked <100 lifetime cigarettes). Participants completed an online survey from December 2018-January 2019.
Measures.
Participants were asked if they have ever used JUUL, Suorin, and Vuse. The question for Vuse referred to using the brand of e-cigarettes in general and was not limited to the pod-based sub-brand (i.e., Vuse Alto). Response options were past 30-day use, ever use but not in the past 30 days, aware of the product but never used it, or not aware of the product. We computed a derived variable indicating past 30-day use of any of the three brands (yes/no).
Analyses.
We estimated the prevalence of using JUUL, Suorin, and Vuse, stratified by youth and young adults and by individual characteristics. Data were weighted to reflect the distribution of the US population of these age groups by demographics and smoking status.[7,8] A final adjustment was made so that the youth and young adult groups are representative of the nationwide age distribution.[9]
Results
Of the three brands, JUUL use was most prevalent among youth (12.9%) and young adults (18.1%), followed by Suorin (4.4% and 6.7%, respectively), and Vuse (2.1% and 6.2%, respectively; Figure 1). Overall, 15.0% of youth and 22.0% of young adults reported using any of these three brands in the past 30 days. Prevalence of using JUUL and Vuse were significantly higher among young adults than youth. Over three in four youth (76.4%) and two in three young adults (68.8%) are aware of JUUL. In comparison, less than half the youth are aware of Suorin (36.7%) and Vuse (42.2%). Among young adults, 37.0% are aware of Suorin and 51.9% are aware of Vuse. Among youth, ever and past 30-day smokers and ever tried non-cigarette tobacco products were associated with JUUL, Suorin, and Vuse use (Table 1). Additionally, non-Hispanic white youth were more likely to use JUUL (compared to other races/ethnicities), while youth in 11th or 12th grades were more likely to use Suorin (compared to 10th grade or below). Among young adults, being male and ever tried non-cigarette tobacco products was associated with JUUL, Suorin, and Vuse use. Furthermore, ever and past 30-day smoking was associated with JUUL use, while past 30-day smoking was associated with Suorin use.
Figure 1 –
Weighted Prevalence of Current Use (Past 30-days) of JUUL, Suorin, and Vuse among US Youth (N=1000) and Young Adults (N=1000)
Note. *Statistically significant difference in prevalence between youth and young adults (p<0.05).
Table 1 –
Participant Characteristics and Weighted Prevalence of Past 30-Day Use JUUL, Vuse, and Suorin By Characteristics of Youth and Young Adults
| Youth (N=1000) | Young Adult (N=1000) | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Participant Characteristics | N (%) or Mean (SD) | JUUL Use (%) | Suorin Use (%) | Vuse Use (%) | N (%) or Mean (SD) | JUUL Use (%) | Suorin Use (%) | Vuse Use (%) | |
| Age | 16.3 (0.7) | - | - | - | 20.9 (2.0) | - | - | - | |
| Gender | |||||||||
| Male | 397 (39.7) | 13.3 | 4.6 | 1.9 | 436 (43.6) | 23.3* | 9.3* | 9.2* | |
| Female | 544 (54.4) | 13.2 | 4.3 | 1.8 | 540 (54.0) | 12.8* | 4.2* | 3.3* | |
| Transgender or other gender identities | 57 (5.7) | 8.2 | 4.1 | 5.8 | 24 (2.4) | 19.2* | 3.6* | 1.9* | |
| Missing | 2 (0.2) | - | - | - | 0 (0.0) | - | - | - | |
| Sexual orientationa | |||||||||
| Heterosexual | - | - | - | - | 795 (79.5) | 17.4 | 7.2 | 6.6 | |
| Lesbian or gay | - | - | - | - | 40 (4.0) | 20.9 | 4.7 | 2.1 | |
| Bisexual | - | - | - | - | 133 (13.3) | 24.7 | 4.0 | 2.6 | |
| Something else | - | - | - | - | 14 (1.4) | 10.7 | 0.0 | 0.0 | |
| Missing | - | - | - | - | 18 (1.8) | - | - | - | |
| Race/ethnicity | |||||||||
| Non-Hispanic white | 448 (44.8) | 16.1* | 5.6 | 1.6 | 490 (49.0) | 19.8 | 7.2 | 5.6 | |
| Non-Hispanic black | 179 (17.9) | 6.3* | 2.9 | 2.2 | 184 (18.4) | 11.7 | 7.1 | 7.2 | |
| Hispanic | 215 (21.5) | 12.1* | 2.3 | 3.4 | 219 (21.9) | 19.9 | 4.7 | 6.8 | |
| Non-Hispanic other races | 158 (15.8) | 7.1* | 4.5 | 1.8 | 107 (10.7) | 14.8 | 7.9 | 6.3 | |
| Highest grade of school completion | |||||||||
| 9th grade or below | 191 (19.1) | 9.5 | 2.2* | 1.1 | 24 (2.4) | 16.4 | 9.1 | 4.7 | |
| 10th grade | 286 (28.6) | 13.4 | 3.2* | 1.7 | 18 (1.8) | 0.0 | 0.0 | 12.7 | |
| 11th grade | 331 (33.1) | 13.2 | 7.0* | 2.4 | 34 (3.4) | 10.1 | 5.9 | 2.3 | |
| 12th grade/High school degree/GED | 169 (16.9) | 17.2 | 6.3* | 4.6 | 377 (37.7) | 17.9 | 8.4 | 7.3 | |
| Some college, but no degree | 0 (0.0) | - | - | - | 303 (30.3) | 21.4 | 7.3 | 5.5 | |
| Associate degree | 0 (0.0) | - | - | - | 94 (9.4) | 15.2 | 6.3 | 6.3 | |
| Bachelor’s degree and above | 0 (0.0) | - | - | - | 141 (14.1) | 20.9 | 2.0 | 4.6 | |
| Missing | 23 (2.3) | - | - | - | 9 (0.9) | - | - | - | |
| Cigarette smoking status | |||||||||
| Never Smoker | 500 (50.0) | 6.7* | 1.9* | 1.0* | 292 (29.2) | 7.8* | 5.1* | 5.1 | |
| Ever but not past 30-day Smoker | 379 (37.9) | 28.8* | 9.7* | 4.8* | 159 (15.9) | 27.0* | 5.1* | 4.8 | |
| Past 30-day Smokerb | 121 (12.1) | 50.3* | 22.0* | 9.0* | 549 (54.9) | 30.0* | 12.5* | 10.2 | |
| Ever tried other tobacco productsc | |||||||||
| No | 644 (64.4) | 8.3* | 3.1* | 1.4* | 363 (36.3) | 10.9* | 4.9* | 2.0* | |
| Yes | 343 (34.3) | 40.6* | 12.4* | 6.2* | 628 (62.8) | 32.6* | 10.3* | 14.4* | |
| Missing | 13 (1.3) | - | - | - | 9 (0.9) | - | - | - | |
Notes.
Youth participants were not asked the sexual orientation question.
This category included all participants who smoked in the past 30 days, including those who may not have smoked 100 lifetime cigarettes.
Other tobacco products include hookah or waterpipe, cigars, cigarillos, or little cigars, smokeless (chew, snuff, or dip), roll-your-own, pipe, snus, dissolvables, and bidi.
Chi-square tests significant at p<0.05.
Discussion
The findings of higher rates of awareness and current use of JUUL compared with Suorin and Vuse e-cigarettes are aligned with JUUL as the market leader,[1] being the most popular device among high-school youth who ever used e-cigarettes,[10] increased media and news coverage, promotion on social media platforms,[1] online engagement about JUUL,[11,12] and sharing about JUUL via word-of-mouth in recent years.[13] The worrisome trend of social normalization of e-cigarette use among young people could potentially renormalize combustible cigarette use due to a 4-fold increased odds of initiating smoking among e-cigarette users.[14] The high nicotine content of newer pod-based vaping devices may further increase the risks of nicotine addiction and initiating smoking.[15] Efforts to restrict access of pod-based devices, ban flavors that appeal to young people, and counter-marketing campaigns on the addictiveness of vaping are needed to stem this growing trend. Surveillance of not just the use of JUUL but also other popular pod-based brands (e.g., Suorin, Bo, and PHIX)[16] is recommended to more accurately assess the prevalence of vaping among young people.
Limitations of this study include a non-probability-based sample, although we recruited a large sample nationally and weighted analyses to match the US population in this age group. We were not able to assess prevalence of using all available brands of pod-based vaping devices. Current use was based on self-reported measures which are subject to recall bias.
In sum, this study contributes new evidence on the prevalence of using JUUL, Suorin and Vuse among a national sample of US youth and young adults to inform future surveillance and intervention efforts.
What this study adds.
Past 30-day JUUL use was most prevalent, followed by Suorin, and Vuse among youth and young adults.
Past 30-day use of pod-based vaping devices were associated with current smoking, ever use of other tobacco products among youth and young adults.
Non-Hispanic white and youth who completed 11th grade or high school had higher rates of using JUUL and Suorin use, respectively.
Young adult men had higher rates of JUUL, Suorin, and Vuse use.
Financial support:
Data collection and Dr. Moran’s effort were supported by the National Institute on Drug Abuse and Food and Drug Administration Center for Tobacco Products (K01DA037903). Dr. Moran is serving as an expert witness for the prosecutor (Public Health Advocacy Institute) in litigation in which RJ Reynolds Tobacco Company was the defendant. Dr. Choi’s effort is supported by the National Institute on Minority Health and Health Disparities Division of Intramural Research. Funding sources did not have any role in the study design; collection, analysis and interpretation of data; writing the report; and the decision to submit the report for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the US Government, the Department of Health and Human Services, the Food and Drug Administration, or the National Institutes of Health.
Footnotes
Competing interests: None.
Ethics approval and informed consent: The Johns Hopkins University Bloomberg School of Public Health’s Institutional Review Board reviewed and approved the study protocol (IRB00008763). Youth and young adult participants read an information sheet on the first page of the survey and clicked a button indicating they agreed to take the survey. We had a waiver of parental consent.
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