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JUUL use and reasons for initiation among adult tobacco users
  1. Minal Patel1,
  2. Alison Cuccia1,
  3. Jeffrey Willett2,
  4. Yitong Zhou1,
  5. Elexis C Kierstead1,3,
  6. Lauren Czaplicki1,
  7. Barbara Schillo1,
  8. Elizabeth C Hair1,4,
  9. Donna Vallone1,4,5
  1. 1 Schroeder Institute, Truth Initiative, Washington, DC, USA
  2. 2 Health Strategies, American Heart Association Inc, Overland Park, Kansas, USA
  3. 3 Department of Epidemiology and Biostatistics, George Washington University, Milken Institute of Public Health, Washington, DC, USA
  4. 4 Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  5. 5 Global Institute of Public Health, New York University, New York, NY, USA
  1. Correspondence to Dr Minal Patel, Truth Initiative Schroeder Institute, Washington, DC 20001, USA; mpatel{at}


Background The electronic nicotine delivery system (ENDS) JUUL has quickly captured the ENDS market, representing 74.6% of the total dollar share for this category as of November 2018. Although JUUL is marketed as an alternative to cigarettes intended for current adult smokers, evidence suggests that a majority of ENDS users are concurrently current cigarette smokers. Little is known about the dual use of JUUL and cigarettes, as well as the reasons for trying JUUL among adult tobacco users.

Methods A survey fielded via web and phone of 1332 current cigarette, cigar, little cigar or cigarillo (CLCC), and ENDS users aged 18–54 years was conducted from March to May 2018. Weighted descriptive and bivariate analyses examined JUUL use and reasons for trying JUUL by demographics, combustible tobacco use, ENDS use and intention to quit.

Results Approximately 81% of our sample reported current use of two or more tobacco products, including cigarettes, CLCCs or ENDS. Among current tobacco users, 15% ever used JUUL and 12% used JUUL in the past 30 days. Most individuals (74%) reporting ever JUUL use indicated using it for 5 days or fewer in the past 30 days. The most common reason for trying JUUL was trying to quit smoking cigarettes (37%), followed by family, friends or colleagues using the product (32%).

Conclusion Although some tobacco users may be initiating JUUL to decrease combustible use, most were using the product infrequently and concurrently with other products. Findings have significant implications for cessation intervention efforts and policy development to help smokers quit.

  • electronic nicotine delivery devices
  • cessation
  • non-cigarette tobacco products

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  • Contributors MP and AC conceptualised and wrote the paper. YZ contributed to the study design, analysis and revisions. DV, ECH, BS and JW contributed to the conceptualisation. LC and ECK contributed to the writing and revision of the manuscript. All authors reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.