Emerging Vaping Products Tobacco Free Mass Policy Forum Youn Ok Lee, PhD www.rti.org RTI International is a registered trademark and a trade name of Research Triangle Institute.
Vaping nicotine harms young brains
Youth can vape many different kinds of vaping products
New products are changing the market and exposing youth to nicotine
Schools around the country are sounding the alarm on JUUL
The rise of JUUL and the pod mod
JUUL’s company website emphasizes that its product is for adult smokers https://www.juul.com/ Accessed 9/4/2018
Cigarette companies have responded with products to compete with JUUL https://www.markten.com/ https://vusevapor.com/ Accessed 9/4/2018
Other independent brands have also emerged with similar looking nicotine pod mod devices https://phixvapor.com/ Accessed 9/4/2018
Other pod-based products feature “open” refillable pods https://www.suorinusa.com/ Accessed 9/4/2018
Open pod devices can look like JUUL but be designed to deliver cannabis as well https://www.kandypens.com/ Accessed 9/4/2018
Some open pod brands feature cannabis product lines https://www.kandypens.com/ Accessed 9/4/2018
Cannabis pod products can closely resemble JUUL https://www.paxvapor.com/ Accessed 9/4/2018
Emerging research on JUUL
JUUL is now the #1 vaping product brand in the U.S. “In the short 3-year period 2015–2017, JUUL has transformed from a little-known brand with minimum sales into the largest retail e-cigarette brand in the USA, lifting sales of the entire e-cigarette category.” Total sales for JUUL
Pod mods like JUUL can operate very differently than previous vaping products “JUUL and other pod mods use protonated nicotine formulations derived from the nicotine salts in loose-leaf tobacco … Pod mods may deliver an addictive dose of nicotine without an aversive user experience or other tobacco-related deterrents— which may be one reason why 80% of 15-24 year olds who try JUUL continue using the product (Willett et al 2018) and why social media posts saying “addicted to my JUUL” are common (Kavaluru et al 2018).”
JUUL’s rise was accompanied by unprecedented social media promotion “While marketing expenditures for JUUL were moderate, the sales growth of JUUL was accompanied by a variety of innovative, engaging and wide-reaching campaigns on Twitter, Instagram and YouTube, conducted by JUUL and its affiliated marketers.”
JUUL-related social media posts featured interpersonal communication that could normalize use “The most prevalent topic was Person Tagging at 20.48% . . . The topic of Quit Smoking was rare at 0.29%”
Initial research findings highlight several issues � Terms “JUULs” and “JUULing” could affect reporting � Discrete, easy to use in places like schools � High concentrations of nicotine, low awareness � Experimenters continue to use them � Marketing on social media is correlated with sales, exposes young audiences to promotional content
The complex marketing of JUUL on social media
JUUL’s official marketing content is aligned with public health objectives
In contrast, JUUL is also being promoted by retailers, affiliate marketers, and users
Celebrity influence on social media doesn’t need to be paid endorsement
The broad reach of social media platforms could enhance normalization of JUUL use
JUUL inspires users to produce and engage with organic content on social media
Social media provides opportunities for users to brand experiences with the JUUL brand
Challenges and next steps
Addressing youth use of pod mods is challenging � Surveillance surveys need updating to effectively capture use of JUUL and other novel products � We know little about product design and formulation characteristics that appeal to youth or enhance addictiveness � Need to develop evidence-based interventions for addressing youth pod mod use � Affiliate and organic product promotion is difficult to regulate
Continued research on JUUL and other pod mods is needed to address challenges � Continue tracking sales data, new brands & products � Surveys of youth and adults – Are youth underreporting when asked about “e-cigarette” use because they do not include JUULs? – Will knowledge about the nicotine content of JUULs improve over time? Is knowledge associated with ad exposure? – Do youth believe they are addicted to JUUL? – How many of those who try JUUL continue to use? Why? � Experimental studies – What are the effects of ad exposure on behaviors, beliefs, and attitudes? – What product characteristics enhance appeal and addictiveness, especially among youth?
Continued research on JUUL and other pod mods is needed to address challenges � Social media studies – Who is generating promotional content (affiliate marketers, brand ambassadors, users)? – Are youth exposed to vaping company marketing on social media? – Are youth exposed to indirect marketing on social media?
More Information Youn Ok Lee, PhD Social Scientist Center for Health Policy Science and Tobacco Research RTI International younlee@rti.org
References 1 Barrington-Trimis JL, Leventhal AM. Adolescents’ use of “Pod Mod” e-cigarettes— Urgent Concerns. New England Journal of Medicine. 2018 Aug 22. DOI: 10.1056/NEJMp1805758. 2 Huang J, Duan Z, Kwok J, Binns S, Vera LE, Kim Y, Szczypka G, Emery SL. Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market. Tob Control. 2018 May 31. pii: tobaccocontrol-2018-054382. [Epub ahead of print]. 3 Willett JG, Bennett M, Hair EC, Xiao H, Greenberg MS, Harvey E, Cantrell J, Vallone D. Recognition, use and perceptions of JUUL among youth and young adults. Tob Control. 2018 Apr 18. pii: tobaccocontrol-2018-054273. [Epub ahead of print]. 4 Kavuluru R, Han S, Hahn EJ. On the popularity of the USB flash drive-shaped electronic cigarette Juul. Tob Control. 2018 Apr 13. pii: tobaccocontrol-2018-054259. [Epub ahead of print]. 5 Allem JP, Dharmapuri L, Unger JB, Cruz TB. Characterizing JUUL-related posts on Twitter. Drug Alcohol Depend. 2018 Sep 1;190:1-5. doi: 10.1016/j.drugalcdep.2018.05.018. [Epub ahead of print]. 32
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