By Linda Carroll

(Reuters Health) – Between 2018 and 2019, use of JUUL vaping devices doubled among U.S. young people aged 18 to 20 and more than tripled among those aged 21 to 24, a new study finds.

Among 18-to-20-year-olds, JUUL use went from 11.9% to 23.9%. Among 21-to-24-year-olds, use went from 5.6% to 18.1%, researchers report in JAMA Pediatrics.

Use of the vaping devices also climbed among those aged 25 to 34, from 3.2% to 8.2%, but was still much lower than in younger groups.

“This data is consistent with other national datasets,” said the study’s lead author, Donna Vallone, chief research officer of the Schroeder Institute at the Truth Initiative in Washington, DC. “What’s really frightening is that more people are vaping frequently, that is, 10 or more days a month.”

Between 2018 and 2019, JUUL users who vape at least 10 days a month shot up from 26.1% to 37.6%.

Unlike other recent research, the new study focused both on e-cigarette use in general and on JUUL use in particular, Vallone said. “That’s because JUUL is the market leader,” she explained.

The prevalence is highest in the 18-to-20-year-olds, Vallone said. “That’s college age, when people are starting out using substances and, unfortunately, have the possibility of developing lifelong addictions.”

U.S. public health officials have expressed concern about “epidemic” rates of e-cigarette use among youth.

JUUL Labs, Inc., maintains that it wants to be part of the solution to the problem.

“JUUL Labs understands the urgent need to continue resetting the vapor category and earn trust by working cooperatively with regulators, Attorneys General, public health officials, and other stakeholders to combat underage use and help adult smokers transition away from combustible cigarettes,” Kevin Harris, a spokesperson for the company, said in an email. “Our customer base is the world’s one billion adult smokers and we do not intend to attract underage users.”

To take a look at the impact of JUUL on youth vaping patterns, Vallone and her colleagues turned to data from the Truth Longitudinal Cohort, an annual nationally-representative survey completed by 14,379 young people in 2018 and 12,114 in 2019.

Comparing surveys from 2018 to 2019, researchers found current use of any e-cigarette (including JUUL) had increased by 22.8%, whereas current JUUL use had increased by 82.9%. Among participants aged 21 to 24, current use of any e-cigarette rose by 31.2%, whereas current use of JUULs increased by 60.9%. The difference was even more dramatic among those aged 25 to 34: current use of any e-cigarette rose by 22.9%, while current use of JUUL devices rose by 245.4%.

Overall, ever use of any e-cigarette rose by 12.3% between 2018 and 2019, whereas ever use of JUULs during the same time period rose by 123.7%. Ever use of any e-cigarette among those aged 21 to 24 rose by 14.7%, as compared to JUUL use, which rose by 232.2%

The new study highlights the role of JUUL in the developing youth vaping epidemic, said Andrew Stokes, an assistant professor in the department of global health at the Boston University School of Public Health.

“One remarkable finding of this study is that it clearly shows that the increase in e-cigarette use between 2018 and 2019 is almost fully driven by the increasing use of JUUL,” Stokes said. “Policies to prevent e-cigarette use should be focusing on products made by JUUL specifically.”

It shouldn’t be a surprise that young people are drawn to JUUL, Stokes said. “At the time period of the article, JUUL came in with an array of youth-appealing flavors, including mango, mint and cucumber. It’s quite clear from (earlier studies) that flavor is an important driver of pod products’ popularity.”

“But it’s not the only driver. JUUL is an extremely sleek and modern-looking device.”

As of November 2019, JUUL stopped selling all non-tobacco flavored pods except for menthol in the U.S., Harris noted.

While new regulations to rein in the use of e-cigarettes are needed, lawmakers need to be careful, Stokes said. “We have a large group of addicted youth,” he added. “If they lose access to the products they are using, what will they switch to?”

“Any policy limiting pod-based products should also build in comprehensive addiction services,” Stokes said.

SOURCE: JAMA Pediatrics, online January 21, 2020.