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Do JUUL and e-cigarette flavours change risk perceptions of adolescents? Evidence from a national survey
  1. Kiersten Strombotne1,
  2. John Buckell2,
  3. Jody L Sindelar3
  1. 1 Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2 Health Economics Research Centre, University of Oxford Nuffield Department of Population Health, Oxford, Oxfordshire, UK
  3. 3 Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Dr Kiersten Strombotne, Health Law, Policy & Management, Boston University School of Public Health, Boston, MA 02118, USA; kiersten{at}


Introduction Use of JUULs and e-cigarettes is growing rapidly, particularly among adolescents. Research suggests that flavours may increase the appeal of these products, but little is known about how flavours influence perception. We examined whether youth perceptions about the health risks of JUULs and e-cigarettes vary with flavours.

Methods We conducted a national survey in 2018 of 1610 high-school students aged 14–18 who had ever heard of either JUULs or e-cigarettes. Respondents were asked to rate the lung cancer risk, the harm of second-hand vapour, potential for addiction and healthiness of differently flavoured JUUL and e-cigarette products. We investigated the relationship among flavour, risk perception and socio-demographic information.

Results We found that risk perceptions for both JUULs and e-cigarettes differ significantly by flavour type. Youths perceive fruit flavours to be less likely to lead to lung cancer (−0.909 (0.065)), have harmful second-hand vapour (−0.933 (0.060)) and be more addictive (1.104 (0.094)) relative to tobacco flavours. Candy, menthol/mint and alcohol flavours show similar patterns of risk association, although the magnitude is slightly smaller than for fruit flavours.

Conclusions Youths believe that flavours are related to the health risks of both JUULs and e-cigarettes despite the fact that these differences in risk by flavour have not been scientifically or systematically established. A policy concern is that misperceptions based on flavour may result in increased vaping by youths. The findings from this study support the assertion that banning fruit, menthol or mint and sweet flavours could reduce the appeal of JUULs and e-cigarettes to youth, with concomitant health protections.

  • electronic nicotine delivery devices
  • public policy
  • prevention

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  • Contributors All authors contributed equally to this work.

  • Funding Research reported in this publication was supported in part by grant number P50DA036151 to Yale from the National Institute on Drug Abuse and FDA Center for Tobacco Products.

  • Disclaimer The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. All authors made equal contributions to the design, analysis, and write-up of this research. No financial disclosures were reported by the authors of this paper.

  • Competing interests No, there are no competing interests.

  • Patient consent for publication Not required.

  • Ethics approval The Yale Human Subjects Committee approved this study.

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

  • Data availability statement No data are available. No data sharing is possible, as our IRB required the following information in the assent language: 'Being in this survey will bring you no harm. All of your responses will be anonymous. Only the researchers involved in this study and those responsible for research oversight will have access to the information you provide'.