Smokers who see others using JUUL electronic cigarettes want to smoke

In recent years, electronic cigarettes (e-cigarettes) using nicotine salts have grown in popularity, particularly among young people. Unlike previous electronic nicotine delivery systems (ENDS), this new generation of e-cigarettes bears little resemblance to a cigarette. The most popular brand, JUUL, is thin, compact and looks almost identical to a computer flash card.

Nevertheless, a new study by UCM researchers reveals that watching a young person smoke a JUUL pod mod can still trigger another young current smoker to want to smoke.

“Seeing someone smoke a JUUL is just as potent a smoking trigger as seeing someone smoke a regular cigarette,” said Andrea King, PhD, a psychologist who researches substance use disorders and directs the Clinical Addictions Research Laboratory at the University of Chicago Medicine. “While traditional cigarettes are the most harmful of tobacco products, this study highlights possible trade-offs in the growing use of JUUL and suggests we may have a new generation of people addicted to nicotine.”

This study suggests that young adults who smoke, and even those who have quit smoking, may need to be careful and avoid being around those who smoke or vape in their presence.

The findings, based on a study of 82 current and former smokers and published in the journal Tobacco Control on May 23, may help inform regulatory bodies like the U.S. Food and Drug Administration and local jurisdictions on how e-cigarettes should be marketed and used.

Although far more people smoke traditional cigarettes, about 8 million people in the United States now use e-cigarettes. These products have been marketed for sale in the U.S. since 2011 and may contain fewer toxic substances (like tar and carbon monoxide) than cigarettes. However, because they are not regulated, the e-liquids may contain other harmful chemicals, and most contain the addictive component nicotine, with JUUL containing the highest level of nicotine across all ENDS products.

To study whether watching the use of a JUUL would elicit the desire to vape and smoke among observers, study participants between 18 and 35 years old — all current smokers — were paired with another smoker who had been trained to portray the role of being a participant. This study confederate and the study participant were asked to pick a task from a stack of sealed envelopes and engage in it for five minutes.

For the first round, the task selections were fixed so that the study confederate always picked drinking bottled water – a hand-to-mouth gesture similar to smoking – while the study participant always picked striking up a conversation, receiving topics from the researchers.

For the second round, the study confederate “picked” vaping a JUUL as their task, while the study participant again seemingly selected conversation. Participants completed questionnaires after each round.

At the end of the second round, participants were given a 50-minute period in which they could choose to smoke or receive a small financial reward if they refrained from smoking.

The researchers found that the JUUL cue significantly increased the smokers’ decision to light up: 63 percent of smokers chose to smoke. The most common reason they gave was wanting to smoke (94 percent), followed by seeing someone else smoke/vape (66 percent).

“The percent of participants choosing to smoke and the amount of time in which they made this decision are similar to our prior studies with a traditional cigarette cue,” said King. “One caveat is that the water cue came first before the JUUL cue, so our future studies will include only one cue per session to rule out the possibility that passage of time – although relatively short at 20 minutes – affected smoking desire and behavior.”

Twenty former smokers who hadn’t smoked for roughly one year also participated. Based on their questionnaire answers, they experienced a slight but significant increase in their desire for a cigarette and a JUUL after exposure to JUUL use. For ethical reasons, they were not given the opportunity to smoke afterwards and were instead offered coping skills counseling to reduce their urge to smoke. (None relapsed after participating in the study.)

“This study suggests that young adults who smoke, and even those who have quit smoking, may need to be careful and avoid being around those who smoke or vape in their presence,” added King.

The team’s next National Institutes of Health-funded research aims to study how the exhaled aerosol (or ‘vape cloud’) produced by ENDs use may affect another person’s urge to smoke.

“Exposure to JUUL use: cue reactivity effects in young adult current and former smokers” was written by Andrea King, Ashley Vena, Krista Miloslavich and Meghan Howe of the University of Chicago and Dingcai Cao of the University of Illinois at Chicago. The study was funded by the National Institutes of Health.