Rutgers Study Suggests Underreporting of E-Cigarette Use Among NJ High Schoolers

Ron Marsico | February 20, 2020 | Health Care
Researchers found some users of the JUUL brand of e-cigarette may not consider themselves to be e-cigarette users
Credit: Twenty20
The Rutgers study surveyed 4,183 Garden State high school students, grades 9-12, in late 2018.

There may be a far higher prevalence of vaping than previously reported among youngsters in New Jersey, according to a Rutgers University study, which found that nearly 90% of adolescents surveyed have used JUUL brand e-cigarettes.

Researchers found the “ubiquity of the term ‘JUULing’’’ may lead some JUUL users to not consider themselves e-cigarette users, thus leading to a significant underestimation of the actual numbers of high school students in New Jersey who are vaping. E-cigarette use among female and African American students, in particular, was found to be higher with the inclusion of JUUL use.

“The rapid growth in e-cigarette use among young people coincides with the meteoric rise of JUUL, a type of pod-based device that now dominates the market,’’ asserted the Rutgers study, published this month in JAMA Network Open, a monthly open access medical journal of the American Medical Association. “By fall 2018, JUUL had captured more than 70% of the branded e-cigarette market, increasing from approximately 25% market share just one year earlier.’’

The study’s authors added, “The appeal of JUUL may be its use of nicotine salts, discreet design making it easy to conceal, and variety of flavors.’’

Kevin Harris, JUUL’s senior communications director, disputed any suggestion JUUL has targeted youngsters in New Jersey or nationwide to expand its sales of e-cigarettes.

Spokesman: JUUL never designed ‘to appeal to youth’

“We never designed our product to appeal to youth and do not want any current non-nicotine users to try our products, as they exist only as an alternative to cigarettes for adult smokers,’’ said Harris.

The Rutgers’ findings come amid rising nationwide alarm over the potential dangers of vaping over the past year, as dozens of Americans — including a New Jersey woman — have died from lung-burning injuries traced to some e-cigarettes. However, many of these cases involved street-purchased or tampered products, or the use of THC — the psychoactive ingredient in marijuana — instead of nicotine to create the inhaled vapors.

Gov. Phil Murphy and state legislators have responded by pushing for laws to further regulate e-cigarette sales and ban flavored vaping products, which have proven especially attractive to young users. Efforts, however, to suspend sales of menthol flavors in the state have stalled.

Responses for the Rutgers survey came from 4,183 Garden State high school students, grades 9-12, in a late 2018 tobacco-focused study, which showed 88.8% of respondents had used a JUUL product — many in the prior 30 days.

Credit: Raymond Clinkscale
Dr. Mary Hrywna

Dr. Mary Hrywna, the study’s lead author and an assistant professor at the Center for Tobacco Studies and the Rutgers School of Public Health, said a combination of factors seems to have led to JUUL’s preeminence among New Jersey’s youth.

“JUUL kind of hit the jackpot here and created a pretty innovative product,’’ said Hrywna, citing its sleek design, easy ability to be concealed and reduced vapors.

“And it’s got really high nicotine delivery without the harshness of traditional tobacco products,’’ continued Hrywna, noting JUUL’s early novel use of nicotine salts. “And so, I think the combination of those factors … made it very appealing for adolescents. I think JUUL also was very successful in using social media platforms, at least in the beginning.’’

But Harris, JUUL’s spokesperson, countered the company’s technology and nicotine levels were configured to help reduce traditional uses of tobacco.

“We developed our e-liquid formulation, including the nicotine strengths, to give adult smokers a viable alternative to cigarettes and facilitate their transition from combustible use,’’ he said.

Harris also asserted the company has worked intensively to ensure its products only are used as intended.

“We remain focused on resetting the vapor category in the U.S. and earning the trust of society by working cooperatively with attorneys general, regulators, public health officials, and other stakeholders to combat underage use and transition adult smokers from combustible cigarettes,’’ said Harris.

“As part of that process in the U.S., we are preparing comprehensive and scientifically rigorous Premarket Tobacco Product Applications, stopped the sale of flavored JUULpods other than Tobacco and Menthol, halted our television, print and digital product advertising, implemented a $1 billion restructuring plan, refrained from lobbying the (Trump) Administration on its draft flavor guidance and support the final policy,” added Harris.

Flavor bans only a start

Hrywna, the study’s lead author, said that while the flavor bans are a start, far more needs to be done to curtail the unauthorized use of e-cigarettes, such as restricting advertising. While JUUL has voluntarily halted such ads, she noted that other e-cigarette manufacturers have not.

“We have to do more to sort of reduce the access of the products and the appeal of the products,’’ said Hrywna. “So, I’d like to see more active enforcement at age of sale. I think these products could be moved to age-restricted locations. I think we could be restricting the level of nicotine in these products, like other countries do.”

But Hrywna stressed “the one glimmer of hope here’’ is the continued declines in traditional tobacco use in New Jersey and nationally.

“We are making significant declines in the most dangerous tobacco products, which are cigarettes and cigars,’’ said Hrywna, encouraging individuals addicted to nicotine to take advantage of state “quit centers” throughout New Jersey.

Relating to e-cigarettes, Hrywna added, “We need to do a better job of sort of balancing protecting kids from ever using these products, but still making them available for adult (cigarette and cigar) smokers who might want to quit.”