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Compared with young adults, underage teens had roughly 16-times the odds of reporting current use of the electronic cigarette JUULs in a national, probability-based sample.

Anecdotal reports have long suggested that the electronic cigarette brand is wildly popular among teens, but the newly published study by researchers with the anti-tobacco group Truth Initiative is among the first to provide numbers to back up those reports.

The survey findings, published online in the journal , also suggest that underage users aren't just experimenting with JUULs -- they are becoming frequent users.

More than half of 15- to 17-year-olds who reported using JUULs said they used the e-cigarette on 3 or more days within the past month and almost half said they used it on 10 or more days.

The sample included 14,379 teens and young adults ages of 15 and 34 asked about their ever- and current-use of JUUL e-cigarettes, tobacco use, and use of other electronic nicotine delivery systems (ENDS).

Truth Initiative CEO and president Robin Koval told 口袋女优 that the survey findings represent the first large, probability-based sample to examine JUUL usage among teens and young adults.

"This really refutes the rhetoric that we are hearing from [manufacturer] JUUL Labs about not only who is using this product, but whether marketing has influenced usage patterns," she said. "It is not easy to build a user base, and I don't think it's a coincidence that JUUL usage is skewed so significantly toward young people."

Truth Initiative researcher Donna Vallone, PhD, and colleagues used address-based sampling (ABS) combined with online data collection to identify a representative sample of teens and young adults for the survey and to address significant challenges that have emerged in the survey research attributable to the evolving communications landscape.

Branded and tested mail-based recruitment materials were designed to bring respondents online for screening, consent and surveying. Once enrolled, respondents completed online surveys every 6 months via computer, tablet, or smartphone.

The study is among the first to employ this hybrid ABS-to-online methodology to recruit and retain youth and young adults in a probability-based online cohort panel.

The survey findings revealed:

• Overall, 6.0% of those responding reported ever JUUL use, and 3.3% reported past 30-day (current) use

• Usage rates were higher among participants ages 15-17 and 18-21, with 9.5% and 11.2% reporting ever use, and 6.1% and 7.7% reporting current use, respectively

• Rates of JUUL ever use and current use among those ages 25-34 were 3.2% and 0.6%, respectively

• Among current users ages 15-17, 55.8% reported use on 3 or more days in the past month, and over a quarter reported use on 10 to 30 days

• Significant correlates of use included younger age, white race, greater financial comfort, perceptions of ENDS as less harmful than cigarettes, household ENDS use, high sensation seeking and current combustible tobacco use

"Despite JUUL being illegal to sell to those under age 18 (and under 21 in some jurisdictions), and JUUL's marketing claims that it does not aim to attract youth users, the prevalence of ever JUUL use among those ages 15-17 years reaches almost 10%, which is higher than both of the older age categories," Vallone and colleagues wrote. "This is further highlighted with the results suggesting those ages 15-17 years have over 16 times greater odds of reporting current use of JUUL, compared with those in the oldest age group."

Koval said that "JUUL Labs makes it seem like teen use was a big accident, but I have my doubts about that," adding that the brand's high nicotine content, combined with its availability in flavors that appeal to teens, has the potential to addict a generation of young users.

She called on the FDA to take action to protect teens from JUUL (and a growing number of copycat e-cigarette products) by banning e-cigarette flavorings and online sales and fully regulating the products to bring them into compliance "sooner rather than later."

FDA Commissioner Scott Gottlieb, MD, recently announced that agency officials are considering these and other moves to address underage use of the products.

In September, to JUUL Labs and four other e-cigarette manufacturers requesting that they submit plans for curtailing e-cigarette sales to minors within 60 days. And early this month, the FDA conducted a surprise inspection of JUUL Labs' San Francisco headquarters, seizing thousands of documents believed to be related to sales and marketing practices.

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