But the social aspects of vaping drives young people to use Juul and other e-cigarettes, according to nearly two-thirds of teens and young adults in a new study. Less than 5% say the availability of fruity flavors drives use of e-cigarettes by members of their generation, and only 10% say that addiction does.
The findings, published in a research letter in JAMA Pediatrics, come from a text-message-based survey of teens and young adults between the ages of 14 and 24 conducted by the University of Michigan’s MyVoice study.
The survey was conducted before the 2019 epidemic of vaping-associated lung injury, and long before suggestions that COVID-19 might pose a greater risk to people who smoke or vape. It was also conducted before the federal ban on sales of all vaping products to people under the age of 21, and on the sale of fruit-flavored vaping pods, but not vaping liquids.
But it still sheds light on what kinds of messaging and interventions might be needed to reduce e-cigarette use in in youths, says senior author Tammy Chang, M.D., M.P.H., M.S.., an assistant professor of family medicine at Michigan Medicine, U-M’s academic medical center.
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“It’s not just about the flavors, it’s about understanding the motivations for using these products, and their attitudes toward risk,” says Chang, a member of the U-M Institute for Healthcare Policy and Innovation. “They’re more savvy than we think they are, and they’re using it because it’s about being cool and about the experimentation that happens naturally in adolescence. Reducing teen and young adult use of these products, especially under current policies, will require an evidence-based approach.”
Assessing knowledge and attitudes
The survey used “juuling” as the term for the activity of using Juul and other e-cigarettes. It asked a nationally representative sample of teens and young adults four questions, and allowed them to answer however they liked. In all, 1,129 young people answered – 92% of those who have volunteered to receive occasional text surveys from the MyVoice study.
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In all, 79% of the respondents said they think juuling is dangerous, and another 7% said it might be. Nearly 72% believe it can lead to use of other substances, including cigarettes and other drugs, and one in four of the rest of the respondents said that people who juul already use other substances.
Georgia Wood, the lead author and undergraduate student at U-M, said: “These findings are critically important because it describes the lived experiences of youth related to Juul, which has been missing. This is the kind of information we need to create policies and programs that work. Youth are depending on us to do that.”
“For policymakers and public health officials who want to focus prevention and cessation messages on the health risks, or who think that bans on flavors will be the answer, these data show that ship has sailed,” says Chang. “We need to use what we now know about what drives youth behavior, and put teeth behind the enforcement of sales bans as we have with alcohol.”