Changes in dependence over one year among US adults who smoke cigarettes and switched completely or partially to use of the JUUL-brand electronic nicotine delivery system.

Introduction:
This text provides an analysis of the adult JUUL Switching and Smoking Trajectories (aDJUSST) Study, which examines changes in dependence among US adults who smoked cigarettes and adopted the JUUL electronic nicotine delivery system. The study aims to address two questions: how dependence changes as people transition from cigarette smoking to subsequent use of JUUL, and how the level of dependence on JUUL changes over 12 months of use.

Key Points:

* The aDJUSST Study is a naturalistic observational prospective cohort study of US adults who recently purchased their first JUUL Starter Kit.
* Participants were assessed at baseline and subsequently invited to complete online assessments at 1, 2, 3, 6, 9, and 12 months thereafter.
* The study used the Tobacco Dependence Index (TDI) to compare dependence between cigarettes and JUUL.
* The analysis estimated the minimally important difference (MID) for the TDI by assessing the magnitude of differences in TDI for JUUL associated with subsequent switching away from cigarettes.
* Within-person analyses evaluated changes in dependence from participants' baseline cigarette dependence to dependence on JUUL 1 and 12 months later, separately among switchers and dual users.
* an analysis examined trends in dependence over the year, and an additional analysis evaluated the 12-month trajectory of JUUL dependence in a select sample of participants who reported using JUUL (without smoking) at all six follow-ups.
* The study also assessed these questions in participants who smoked every day versus some days at baseline.

Main Message:
The main message of this text is that dependence on JUUL was lower than baseline cigarette dependence among adults who switched completely or partially from smoking cigarettes to JUUL. Increases in JUUL dependence were small over 12 months of continual use, indicating that ENDS, including JUUL, have lower dependence potential than cigarettes.

Shiffman S, Goldenson NI. Changes in dependence over one year among US adults who smoke cigarettes and switched completely or partially to use of the JUUL-brand electronic nicotine delivery system. Drug and alcohol dependence reports. 2023;6:100137. doi:10.1016/j.dadr.2023.100137