Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors

Source:

Hrywna M, Bover Manderski MT, Delnevo CD. Prevalence of Electronic Cigarette Use Among Adolescents in New Jersey and Association With Social Factors. JAMA Netw Open. 2020;3(2):e1920961. doi:10.1001/jamanetworkopen.2019.20961

Key Points

Question  What factors are associated with use of electronic cigarettes (e-cigarettes), including JUUL, among high school students?

Findings  In this survey study of 4183 respondents, inclusion of a JUUL use measure produced higher estimates of current use than assessing the use of e-cigarettes or JUUL alone, and 88.8% of youth reported using the JUUL brand. In addition, current use of other tobacco products, endorsing a tobacco brand on social media, having tobacco-branded merchandise, having close friends who used JUUL, and seeing JUUL used on school grounds were significantly associated with current and frequent e-cigarette use, inclusive of JUUL.

Meaning  These findings suggest that adolescents who report current JUUL use may not report current e-cigarette use, and future measures of e-cigarette use should include specific questions or examples of the most popular brands.

Abstract

Importance  Use of electronic cigarettes (e-cigarettes) is high among adolescents, but the extent to which the JUUL e-cigarette brand accounts for the high prevalence has not been explored using population-based surveys.

Objective  To examine e-cigarette and JUUL use among adolescents in New Jersey.

Design, Setting, and Participants  Survey study using data from the 2018 New Jersey Youth Tobacco Survey, a cross-sectional statewide representative survey of tobacco use. The survey was school based and sampled New Jersey students in grades 9 to 12.

Exposures  Use of tobacco products; JUUL as first tobacco product tried; exposure to JUUL at school; number of friends perceived as JUUL users; liking or following a tobacco brand on social media; and buying or receiving tobacco-branded merchandise.

Main Outcomes and Measures  Prevalence ratio (PR) for current and frequent e-cigarette use, inclusive of JUUL.

Results  In this sample of 4183 adolescents, respondents were 49.6% female and 49.6% non-Hispanic white. Students were evenly distributed across grades 9 through 12. Overall, the estimate for current use of e-cigarettes inclusive of JUUL was higher (24.2%; 95% CI, 22.5%-25.9%) compared with current use assessed by use of e-cigarettes only (17.8%; 95% CI, 16.4%-19.4%) or JUUL use only (21.3%; 95% CI, 19.7%-23.0%). Divergence in e-cigarette use estimates was higher for certain subgroups, including female respondents and non-Hispanic black respondents. Also, 88.8% (95% CI, 86.6%-91.1%) of current e-cigarette users reported JUUL as a brand they used. Hispanic students (PR, 0.78; 95% CI, 0.69-0.89) and non-Hispanic students of other races (PR, 0.64; 95% CI, 0.51-0.81) were significantly less likely than non-Hispanic white students to be current e-cigarette users, and students in 12th grade were more likely than those in 9th grade to be current users (PR, 1.29; 95% CI, 1.11-1.48). Current e-cigarette use was positively associated with current use of other tobacco products (PR, 2.57; 95% CI, 2.24-2.95), endorsing a tobacco brand on social media (PR, 1.43; 95% CI, 1.19-1.72), having tobacco-branded merchandise (PR, 1.70; 95% CI, 1.46-1.97), having close friends who used JUUL (PR, 3.81; 95% CI, 3.17-4.58), and seeing JUUL used on school grounds (PR, 1.43; 95% CI, 1.24-1.65). Estimates of prevalence were greater when modeling frequent use.

Conclusions and Relevance  This study found that prevalence of current and frequent e-cigarette use among adolescents was higher when inclusive of JUUL use, and JUUL was by far the most common e-cigarette brand used, providing support for inclusion of brand-specific questions when assessing e-cigarette use. The results also identify characteristics of adolescents who may be more likely to use e-cigarettes.