US Youth Unaware E-Cigarettes Contain Nicotine, Lack Brand Knowledge

Recently, researchers at Stanford University School of Medicine released a new study indicating that American youth are completely unaware that the e-cigarettes they use contain nicotine and lack specific information about the brands they use.

The study surveyed residents of California and was published on March 16 in the "Journal of Adolescent Health." The research asked 445 participants aged 17 to 24 about their e-cigarette usage, covering specific questions about products from four major companies: Juul, Suorin Drop, Phix, and Myblu.

In our many exploratory cognitions, e-cigarette e-liquids are filled with nicotine-infused liquid that can be vaporized using a rechargeable battery-powered device. However, American youth completely lack this exploratory cognition.

The study's author, Dr. Bonnie Halpern-Felsher, a senior professor of pediatrics, expressed surprise that these young people did not know they were consuming nicotine.

Data for this study began to be collected in early 2019 and has continued for over a year as part of the "Tobacco Perception Study," which is a longitudinal study on California youth's use, perception, and sensitivity to marketing of tobacco and nicotine. Participants were initially recruited for the study in 2013 and 2014, and data collection is now in its final stages.

The study found that 26.3% of participants had used Juul; 24% had smoked traditional cigarettes; and 23% had used pod-based e-cigarettes, with a smaller proportion using other small devices.

58% of users indicated that the reason for choosing pod-based e-cigarettes was their ease of concealment. The second reason was that the odor they produce is less noticeable than traditional cigarettes.

Halpern-Felsher stated: “They told our research team that they chose to use e-cigarettes because they can be hidden and the smoke smell is not obvious. This situation is concerning.”

Unknown Nicotine Content

Halpern-Felsher also mentioned that perhaps the most concerning finding is that young people do not know how much nicotine is in the products they use. At the time of the survey, Juul packaging only stated “5%,” but this 5% did not specifically refer to nicotine. Subsequently, Juul labels were changed to “5% nicotine.” However, young people were unable to calculate the actual nicotine content and could not accurately compare it to the content in combustible cigarettes.

Additionally, more than half of the participants were unsure how long it typically takes to finish a pod. The research team expressed concern over this finding, believing it may indicate that young people prefer to share and use these products with friends without considering dosage, nicotine levels, or addiction potential.

Halpern-Felsher pointed out that e-cigarette regulations have not kept pace with industry innovation; over the year since data collection began, many youths have shifted to using small devices like Puff Bars. “I really hope these findings will be used to further regulate e-cigarettes.”

Halpern-Felsher is a member of the Stanford Maternal and Child Health Research Institute and the Stanford Cancer Institute.

This study was supported by grants from the National Institutes of Health (1P50CA180890 and U54 HL147127), the Food and Drug Administration (FDA), and the Stanford Maternal and Child Health Research Institute.