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Changes in knowledge, perceptions and use of JUUL among a cohort of young adults
  1. Kimberly G Wagoner1,
  2. Jessica L King2,
  3. Cynthia K Suerken3,
  4. Beth A Reboussin3,
  5. Jennifer Cornacchione Ross1,
  6. Erin L Sutfin1
  1. 1 Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
  3. 3 Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Kimberly G Wagoner, Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; kwagoner{at}


Objective E-cigarettes have gained popularity, most recently with pod-style devices, such as JUUL. We examined changes in JUUL awareness, use, perceptions, nicotine content knowledge, number of days a pod lasts and exposure to JUUL retail advertising over a 6-month period in a cohort of young adults.

Methods In spring and fall 2018, 1836 young adults completed online surveys on tobacco use, including JUUL perceptions and use behaviours. Demographics, tobacco use and JUUL advertising exposure in spring 2018 were examined as predictors of current JUUL use in fall 2018.

Results Ever and current JUUL use doubled in 6 months (5.9% vs 12.7%, p<0.001; 1.6% vs 3.4%, p<0.001). The number of days a JUUL pod lasts significantly changed (p=0.049). Although there was an increase in those reporting JUUL has as much or more nicotine than a pack of cigarettes, 58% are ‘not sure’ of JUUL’s nicotine content. Exposure to JUUL’s advertising significantly increased (31.8% to 46.4%; p<0.001). In multivariable models, those perceiving JUUL as or more harmful than cigarettes, and former and never cigarette smokers had significantly lower odds of current JUUL use at 6 months compared with their respective counterparts (p<0.0001). Those reporting exposure to JUUL’s advertising had significantly increased odds of current JUUL use 6 months later (p<0.03).

Conclusions Findings demonstrate changes in knowledge of JUUL’s nicotine content, perceptions and use over a short period of time, suggesting frequent measurement is necessary. Additionally, efforts are needed to regulate retail advertising and ensure consumer education about product risks as they are associated with current use.

  • addiction
  • electronic nicotine delivery devices
  • prevention
  • public policy

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  • Contributors KW and ELS designed the study. All authors contributed to the implementation of the study. BAR and CKS performed the statistical analyses. All authors contributed to writing and revising the manuscript.

  • Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R01CA141643.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Wake Forest School of Medicine Institutional Review Board.

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

  • Data availability statement There is currently no publicly available data for this study.

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