RT Journal Article SR Electronic T1 Differences in flavourant levels and synthetic coolant use between USA, EU and Canadian Juul products JF Tobacco Control JO Tob Control FD BMJ Publishing Group Ltd SP 453 OP 455 DO 10.1136/tobaccocontrol-2019-055500 VO 30 IS 4 A1 Hanno C Erythropel A1 Paul T Anastas A1 Suchitra Krishnan-Sarin A1 Stephanie S O'Malley A1 Sven Eric Jordt A1 Julie B Zimmerman YR 2021 UL http://tobaccocontrol.bmj.com/content/30/4/453.abstract AB Background ‘Juul’ is the dominant US e-cigarette brand and was recently introduced to Canada, UK, France, Germany and Italy, with several flavours available across countries. US/Canadian products are sold with 5%, 3% and 1.5% (Canada only) nicotine content, whereas European Union (EU) regulation limits nicotine content to 1.7%. The differential nicotine content raises the question if flavour profiles and Juul device power output differ between countries.Methods ‘Mint’, ‘Vanilla’ and ‘Mango’ e-liquids from all six countries were purchased in 2019 and analysed by GC/MS for their principal flavourant and nicotine content. In addition, device power specifications were compared for devices purchased from the respective countries.Results Compositions of Juul e-liquids from the USA and Canada were identical and differed from the EU-marketed liquids, in which principal flavourant concentrations were significantly lower. EU Juul ‘Mint’ e-liquids contained a synthetic coolant, N-ethyl-p-menthane-3-carboxamide (WS-3), absent in US/Canadian products. US/Canadian ‘Mango’ e-liquid contained triethyl-citrate, an emulsifier. Nicotine contents matched label information, and devices had identical power specifications.Conclusions Tested US/Canadian Juul e-liquids contained higher flavour concentrations than EU products, likely reflecting adaptation to user preferences. In EU, ‘Mint’ e-liquid, menthol is partially substituted with the synthetic coolant WS-3 that elicits a cooling effect like menthol but lacks its distinct ‘minty’ odour. The inhalational safety of WS-3 is unknown. The use of an emulsifier in US/Canadian ‘Mango’ Juul e-liquid may be necessary to keep the product homogeneous. Similar power specifications of devices between countries suggest that nicotine aerosol delivery is likely proportional to the e-liquid nicotine content.All data relevant to the study are included in the article.