In the new study, participants answered questions about both their use and their perception of traditional cigarettes and e-cigarettes, including the market leader Juul. In addition, participants who used any form of e-cigarette also completed a standardized questionnaire to assess their degree of nicotine dependence.
When asked about the use of tobacco products over the past seven or 30 days, the participants reported using Juul about twice as often as smoking conventional cigarettes. The teens also reported a general belief that e-cigarettes were “less harmful or addictive” than other products mentioned in the survey.
Among the participants who had tried Juul, 58.8 percent reported that they had used Juul within the last 30 days. In comparison, about 30.1 percent reported using other e-cigarettes and 28.3 percent had used conventional cigarettes over this same period.
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While the sample size is small, the numbers suggest a significant difference between Juul users and users of other e-cigarettes and conventional cigarettes. This may reflect higher rates of addiction among Juul users, suggested Stanford professor of pediatrics Bonnie Halpern-Felsher, senior author of the study.
“I was surprised and concerned that so many youths were using Juul more frequently than other products,” Halpern-Felsher said in a statement. "We need to help them understand the risks of addiction. This is not a combustible cigarette, but it still contains an enormous amount of nicotine — at least as much as a pack of cigarettes.”
Juul issued a statement in response to the Stanford study.
“We agree that underage use of Juul is completely unacceptable and it is directly opposed to our mission of eliminating cigarettes by offering existing adult smokers a true alternative to combustible cigarettes,” the company said. “We stand committed to working with those who want to keep nicotine products out of the hands of young people.”
The Stanford research was funded by the National Cancer Institute, the U.S. Food and Drug Administration Center for Tobacco Products, the Child Health Research Institute, and Stanford’s Department of Pediatrics.
As e-cigarette use continues to grow, it’s a sure bet that more research will be forthcoming in the next few months and years. Meanwhile, the Stanford team has developed a free tobacco prevention toolkit for educators and parents, which is available online.