'Juuling' phrase makes it difficult to measure electronic cigarette use, Rutgers study finds

While Juul is a type of electronic cigarette (e-cigarette), some high school students think otherwise, according to a recent Rutgers study.

The term “Juuling” has made it difficult to measure e-cigarette use, possibly leading health officials to underestimate teen e-cigarette use, according to the release. Researchers found when Juul-specific questions were added to a survey on e-cigarette use, students reported higher use. This was most noticeable in responses from female students and Black students, according to the release.

“All of these terms (Juuls, vapes and e-cigarettes) can refer to electronic cigarettes and I would argue that there is no standard terminology defining or describing these devices. Although the term vapes is also used when consuming cannabis,” said Dr. Mary Hrywna, lead author and assistant professor at the Center for Tobacco Studies and the School of Public Health. 

With so many varieties of e-cigarette products on the market and the rapid changes in the devices, types of liquids and nicotine concentrations available, terminology is changing over time, Juul’s impact stands out, Hrywna said.

“The innovation ushered in by Juul was the use of nicotine salt-based solutions which makes it much easier to consume higher levels of nicotine. Combined with its sleek product design, Juul captured the majority of the e-cigarette market and then the market soon started producing lots of copycat products,” she said.

Juul’s early marketing was very effective at growing the brand’s popularity, Hrywna said. In 2018, this led to the verb “Juuling” and terminology that affects how officials accurately measure e-cigarette use. Some students who reported current use of JUUL did not report current use of e-cigarettes, even though Juul is a brand of e-cigarette, according to the study, Hrywna said.

“We’ve suspected that the brand Juul contributed to the increase of e-cigarette use among teens, but I think we were surprised at the extent of the brand’s popularity among young people,” Hrywna said. “(Approximately) half of current e-cigarette users said Juul was the first e-cigarette product they tried and more than half of the high (school) students reported seeing people use Juul on school grounds.”

Current and frequent e-cigarette use was highest in high school seniors, according to the study. One in 10 high school seniors said they used e-cigarettes on more than 20 out of 30 days preceding a New Jersey Youth Tobacco Survey (NJYTS), according to the study.

The NJYTS is conducted every two years to monitor and study youth trends in tobacco usage in New Jersey, Hrywna said.

Approximately 4000 students in New Jersey high schools participated in the NJYTS and, with an overall participation rate of 66 percent, provided a representative sample, according to Hrywna.

“The NJYTS employs a two-stage cluster sample design to select a representative sample of public high school students. In 2018, the overall participation rate, calculated by multiplying the school participation rate (75.0 percent) by the student participation rate (86.8 percent), was 66.0 percent which yielded a sample of 4183 high school students. The data (was) weighted to adjust for non-response and the varying probabilities of selection,” she said.

Trends on e-cigarette use and specific brands must continue to be monitored, Hrywna said. 

“We need to think more carefully about how future questions are constructed when assessing e-cigarette use among teens,” she said. “Policymakers must understand how certain brands have driven e-cigarette use and carve out policies that address restrictions by age and location as well the high nicotine concentrations in these products if we hope to reduce these prevalence rates.”

In New Jersey, changes in policies have been made and resources like the Tobacco Dependence Program are designed to help individuals quit e-cigarette use, including Juuling, said Hrywna.

“Beginning Feb. 1, the FDA banned the manufacture, distribution and sale of all flavored cartridge-based e-cigarettes, with the exception of menthol and tobacco flavors but New Jersey state law will ban the sale of all flavored e-cigarettes (including menthol) by late April,” she said.