Young adults vape without knowing what's in their e-cigarettes

A new study shows that young adults often use e-cigarettes without being aware of what is in them or which brand they are using. The study, published online in March 2020 in the Journal of Adolescent Health, raises concerns about the labeling and regulation of vaping products.

The study

The researchers looked at 445 participants in California, aged 17 to 24 years, who were using pod-based devices, about what was in the pods. The questions included specific queries about various products from leading manufacturers like Juul, Suorin Drop, Phix, and Myblu.

Pods are small plastic containers of fluid into which nicotine has been infused, which fits into a vaporizer that runs off a rechargeable battery. The whole contraption is called an e-cigarette and is about the size and shape of a large computer thumb drive.

The data comes from a drive carried out in early 2019, as part of the Tobacco Perceptions Study. This was a longitudinal study among young people in California, intended to assess the use of nicotine and tobacco, perceptions on the part of the user, and their response to marketing strategies.

All the participants were part of the study from 2013 or 2014, as students in the 9th or 12th grades at any of 10 high schools selected across the state. The 2019 data collection was part of the last phase of the study.

The young people completed a detailed questionnaire that inquired about whether they consumed nicotine, in any form, including cigarettes, e-cigarettes that used pods, or other types of e-cigarettes. They were also asked about how they used these products, and how high they thought the nicotine content of these pods was.

The findings

The researchers found that Juul was the product used by over 26% of the participants. In comparison, 24% used conventional cigarettes, 23% other types of e-cigarettes (not pod-based), and the rest used other non-Juul pod-based e-cigarettes.

Just over 51% of Juul users said they had vaped with a Juul e-cigarette at least once over the last 30 days, while among cigarette smokers and non-pod-based e-cigarette users, the corresponding figure was about 29% each.

Among pod users, almost half of them said they shared pods with their friends. The same number admitted not knowing if the pods they used were always the same brand as the device they used.

When asked the reason for using pods, the Number 1 reason was their small size, making it easy to hide them, as reported by 58% of users, closely followed by their weaker smell which makes it less easy to recognize compared to other types of e-cigarettes, cited by about 56% of users.


The message is clear to the researchers. Young people are not concerned primarily about health and safety when it comes to choosing an e-cigarette brand – nor even the flavor. As researcher Bonnie Halpern-Felsher comments, "Teens are not using these pod-based products more than other e-cigarettes because of health or the flavors offered. They tell us, 'It's because we can hide these, and the smell produced is less obvious.' This ability to 'stealth use' is concerning."

But there's worse to come. The questions about the amount of nicotine in a Juul pod, for instance, yielded answers over a wide range of milligrams. Most of the young people had no idea how much nicotine they were inhaling with each pod they used. The Juul labels at the time of the survey stated simply "5%", though now they say "5% nicotine"; but many young people have no idea what this means in terms of the grams of nicotine they inhale, or to make a comparison with the nicotine from a conventional cigarette, according to the survey results.

Comments Halpern-Felsher, "The Juul and other pod-based e-cigarette packaging is so confusing and misleading. The packaging should be regulated."

Another question that the youth found hard to answer, strangely, was about how long a pod lasted them, on average. This is troubling since it could mean that the young people have no idea how much nicotine they are taking in, and don't care whether it is creating an addiction or not.

The study authors are concerned that the vaping industry is poorly regulated when one takes into account its ability to mutate into newer and more attractive forms. Since the study period, says Halpern-Felsher, many manufacturers have turned to Puff Bars and similarly convenient disposable vapes, which have become the mainstay of teenage users in multiple locations. With the current regulations, the manufacturers need not even list all the ingredients on the package.

The authors say they hope these findings will be a wake-up call to the government to regulate the industry.

Journal reference:

How and Why California Young Adults Are Using Different Brands of Pod-Type Electronic Cigarettes in 2019: Implications for Researchers and Regulators McKelvey, Karma et al. Journal of Adolescent Health,

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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