Summary
Introduction:
This text is a survey of patients at Stony Brook Children's hospital outpatient clinics regarding the use of pod systems such as JUUL, a popular e-cigarette brand among adolescents. The study also analyzed the nicotine concentration in pod products and measured cotinine, a major metabolite of nicotine, in collected urine samples from exclusive pod users. The survey aimed to characterize the use of pods among adolescents and estimate nicotine exposure in these users.
Key Points:
* The study surveyed 506 patients, and 7.7% reported current daily or some day use of pods.
* The most popular brands of pod systems used by the patients were Juul (79.7%), Bo (36.4%), Phix (18.2%), and Sourin (12.1%).
* Preferred flavors among the users were menthol/mint (24.2%), fruit (21.2%), and candy, desserts, or other sweets (18.2%).
* all tested pod products contained high nicotine concentrations, from 21.8 to 56.2 mg/ml in a form of salt with benzoic acid or levulinic acid.
* Users of prefilled pod systems (Juul, Bo, Phix) may inhale with 10 puffs from 0.77 to 0.85 mg of nicotine, considerably higher than previously reported in older generations of e-cigarettes.
* The median urinary cotinine concentration measured in participants who used pods was 244.8 ng/mL, higher than 155.2 ng/mL reported in adolescents who regularly smoked conventional tobacco cigarettes.
* all analyzed samples had either undetectable or very low levels of the urinary tobacco-specific biomarker, NNaL, confirming lack of exposure to tobacco smoke.
Main Message:
The study provides evidence for significant nicotine exposure among pod users, raising concerns about the potential for earlier and more significant nicotine addiction in teens. The potential health risks of repeated inhalation of high doses of nicotine salts are unknown. The study emphasizes the need for clinicians to educate their patients about the potential long-term sequelae of using e-cigarettes, especially pods. Public health advocates and regulatory agencies must act now to restrict youth access to e-cigarettes before decades of progress in tobacco control are undone.
Citation
Goniewicz ML, Boykan R, Messina CR, Eliscu a, Tolentino J. high exposure to nicotine among adolescents who use Juul and other vape pod systems ('pods’). Tobacco control. 2019;28(6):676-677. doi:10.1136/tobaccocontrol-2018-054565
