[A]s Vermont prepares to launch a new program to educate youth about electronic cigarettes, a new study says some of those devices may be more addictive than previously thought.
The study, produced by two New York health care institutions, says so-called “pod” devices – including the increasingly popular JUUL device – deliver far more nicotine than older e-cigarettes.
The study also found evidence of “high exposure to nicotine” among young people who had recently used the devices. Those levels “raise concerns about the potential for earlier and more significant nicotine addiction in teens,” the report says.
A Vermont health official said she wasn’t surprised by the study’s findings, and she said the study confirms the need for a new state initiative aimed at reducing e-cigarette use.
“It underscores the importance of education and restricting access to youth as much as we can,” said Rhonda Williams, chronic disease prevention chief at the Vermont Department of Health.
Among public health officials and some educators, concerns about e-cigarettes have grown even as youth smoking rates have declined.
Vermont’s most recent Youth Risk Behavior Survey found that, in grades nine through 12, smoking rates declined from 11 percent in 2015 to 9 percent in 2017. Also, the number of high schoolers who said they were currently using an electronic vapor product decreased from 15 percent to 12 percent.
But the number of high school students who said they had ever tried an electronic vapor product increased from 30 percent to 34 percent. And 9 percent of middle schoolers said they had tried such a product, up from 7 percent two years prior.
State and federal health advocates say nicotine-delivery devices present health risks for youth, but officials say those products are not fully understood by many. “What we have been hearing from school personnel and from those who work closely with students in other ways and from students themselves, there’s lack of awareness of how addictive they are,” Williams said.
The new study, conducted by Stony Brook Children’s Hospital and Roswell Park Comprehensive Cancer Center, may offer more evidence on that front.
The study focuses on “pods,” a newer generation of e-cigarette that is “compact, lightweight, ultraportable and easy to use inconspicuously.” Among more than 500 youth surveyed, the most popular pod device was the JUUL product.
Researchers looked at those products on two fronts – nicotine-delivery capacity and physical effects.
The study found that users could inhale 0.77 to 0.85 milligrams of nicotine per 10 puffs on a pod product. In older e-cigarette models, the rates were much lower – 0.02 to 0.51 milligrams per 10 puffs.
Williams said that’s further evidence that electronic vapor products have become more efficient over time, delivering more nicotine more quickly. That, she said, is “appealing to youth.”
Among the young people surveyed in the Stony Brook study, researchers selected 22 who reported using pods within the past seven days. They conducted a urine analysis on those subjects in order to measure cotinine, a metabolite of nicotine.
The study found a median urinary cotinine concentration more than 57 percent higher than that of previously studied adolescents who smoked conventional cigarettes. This provides “physiological evidence for significant nicotine exposure among pod users,” the report’s authors wrote.
The study has limitations including a small sample size and a “convenience sample” of youth in one geographic location. The findings are “not representative of the entire population of U.S. adolescents,” the report says.
Still, Williams said it provides supporting documentation for a public health problem. The issue officials are seeing with JUUL “is that high nicotine content paired with this lack of perception around these devices containing nicotine,” she said.
That’s one reason Vermont officials are budgeting $180,000 from newly allocated tobacco-control money to mount an educational campaign focused on young people and the risks of e-cigarette use. That campaign “is in development, and it should launch in January,” Williams said.
E-cigarette makers have denied marketing their products to youth. Earlier this year, JUUL announced a $30 million effort “dedicated to independent research, youth and parent education and community engagement efforts” in order to combat underage use.
Asked for comment on the Stony Brook study, a JUUL spokesperson on Monday sent a statement emphasizing the product’s role in helping adults quit smoking.
“Cigarette smoking is still the leading cause of preventable death worldwide. In the United States alone, more than 480,000 people die each year from smoking-related illnesses. JUUL is intended for current adult smokers only,” the statement said.
The spokesperson added that “we cannot be more emphatic on this point: No minor or non-nicotine user should ever try JUUL. Our packaging includes a prominent nicotine label and clearly states for adult smokers.”
But the U.S. Food and Drug Administration reportedly is investigating whether JUUL engaged in youth marketing. And experts have pointed to vapor and tobacco companies’ use of social media as another way of reaching young people.
Williams said health officials don’t buy the notion that youth marketing isn’t part of the vapor product playbook.
“I’ve heard they have become more [vigilant] in recent months around identity checks on the JUUL site for purchasing,” she said. “However, I think that has come with the increased scrutiny from the FDA and other concerned groups that have spoken up about what has happened.”
