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Youth Vaping

Juul and the upsurge of e-cigarette use among college undergraduates


Objective: Examine trends in e-cigarette use, and Juul use specifically, among U.S. college students.

Participants: In 2016, we established a cohort of 529 incoming first-year students to a large Midwestern University. In 2018, these students (now third-years) were re-contacted, and a new sample of 611 incoming first-year students was enrolled.

Methods: First-year students in 2016 completed a survey assessing their e-cigarette use; in 2018, first- and second-year students reported on e-cigarette use, and use of Juul specifically.

Results: From 2016 to 2018, past 30-day e-cigarette use rose from 5.9% to 27.7%. In 2018, for Juul alone, ever use was above 35% and past 30-day use was above 20% for both cohorts. Juul use did not differ by gender, but was associated with higher socioeconomic status (SES) and being White.

Conclusions: Findings present disturbing possibilities for long-term nicotine addiction among the next generation, and underscore the need for a rapid public health response.

Vaping, lung damage, and cytopathology: A new twist in the medical mystery

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Canadian Tobacco and Nicotine Survey, 2019

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Neurotoxicity of e-cigarettes


•Electronic cigarettes (EC) are marketed as alternatives to conventional cigarette (CC) smoking.

•Recent accounts of EC- or vaping-associated lung injury (EVALI) have raised concerns regarding their adverse health effects.

•The increased popularity of EC among adolescents and pregnant women calls for further safety evaluation.

•EC may have neurotoxic effects due to nicotine and other chemicals inherent both to e-liquids and EC aerosols.


It appears that electronic cigarettes (EC) are a less harmful alternative to conventional cigarette (CC) smoking, as they generate substantially lower levels of harmful carcinogens and other toxic compounds. Thus, switching from CC to EC may be beneficial for smokers. However, recent accounts of EC- or vaping-associated lung injury (EVALI) has raised concerns regarding their adverse health effects. Additionally, the increasing popularity of EC among vulnerable populations, such as adolescents and pregnant women, calls for further EC safety evaluation. In this state-of-the-art review, we provide an update on recent findings regarding the neurological effects induced by EC exposure. Moreover, we discuss possible neurotoxic effects of nicotine and numerous other chemicals which are inherent both to e-liquids and EC aerosols. We conclude that in recognizing pertinent issues associated with EC usage, both government and scientific researchers must address this public health issue with utmost urgency.

E-Cigarette Use and Regular Cigarette Smoking Among Youth

Population Assessment of Tobacco and Health Study (2013–2016)


This study examines the association between current e-cigarette use at baseline and regular cigarette smoking at follow-up among U.S. youth.


A longitudinal analysis of youth (aged 12–17 years) data from Waves 1–3 of the Population Assessment of Tobacco and Health Study (2013–2016) was conducted between January 2019 and December 2019. Youth who reported past-30-day current e-cigarette use at baseline were identified and followed for regular cigarette smoking (≥20 days) at follow-up.


Compared with noncurrent e-cigarette users at baseline, current e-cigarette users (cigarette nonsmokers) had 5.0 (95% CI=1.9, 12.8) times higher odds of becoming regular cigarette smokers 1 year later. Additionally, there was a direct linear relationship between the number of days of e-cigarette use at baseline and the number of days of cigarette smoking 1 year later.


Current e-cigarette use among U.S. youth is associated with higher odds of transitioning to regular cigarette smoking, likely reflecting robust transitions rather than experimentation. These results suggest that promoting e-cigarettes as the current practice for tobacco harm reduction will likely have the unintended consequence of initiating youth cigarette smokers.

Prevalence of Electronic Cigarette Use and Its Determinants among 13-to-15-Year-Old Students in Greece

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Does the gateway theory justify a ban on nicotine vaping in Australia?


•The evidence does not provide strong support for the hypothesis that vaping is a significant gateway to smoking in young people.

•Regular vaping by young never-smokers is rare.

•Most young people who use e-cigarettes have already smoked combustible cigarettes.

•A ban on nicotine vaping prevents adult smokers from accessing a potentially lifesaving alternative to smoking.

•A more nuanced regulatory policy could restrict young nonsmokers’ access to vaping while allowing access for adult smokers.


Australia bans the sale, possession and use of liquid nicotine for vaping. One of the major arguments used to justify Australia’s policy is that the availability of nicotine vaping products will lead a substantial number of young people who would otherwise not have smoked cigarettes to take up regular smoking (the gateway theory). In this article, we provide a critical analysis of the use of the gateway theory to justify Australian policy. We argue first that the evidence that vaping serves as a gateway to smoking is unconvincing. Smoking more often precedes vaping than vice versa, regular vaping by never-smokers is rare and the association is more plausibly explained by a common liability model. Second, we argue that even if the evidence were stronger it would not justify a ban on the sale of nicotine to adult smokers because there are other ways of preventing adolescent vaping that do not require a ban. We describe an alternative regulatory model for Australia that would address legitimate concerns about preventing adolescent uptake while allowing adult smokers to access these products for cessation or as an alternative to smoking cigarettes.

Severe Acute Toxicity of Inhaled Nicotine and e-Cigarettes

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Exploring the Point-of-Sale Among Vape Shops Across the United States

Audits Integrating a Mystery Shopper Approach



Vape shops represent prominent, unique retailers, subject to Food and Drug Administration (FDA) regulation in the United States.

Aims and Methods

This study assessed compliance of US vape shop retail marketing strategies with new regulations (eg, required age verification, prohibited free samples) and pre-implementation conditions for other regulations (eg, health warning labels on all nicotine products, required disclosures of e-liquid contents).


95.0% of shops displayed minimum-age signage; however, mystery shoppers were asked for age verification at 35.6% upon entry and at 23.4% upon purchase. Although 85.5% of shops had some evidence of implementing FDA health warnings, 29.1% had signage indicating prohibited health claims, 16.3% offered free e-liquid samples, 27.4% had signage with cartoon imagery, and 33.3% were within two blocks of schools. All shops sold open-system devices, 64.8% sold closed-system devices, 68.2% sold their own brand of e-liquids, 42.5% sold e-liquids containing cannabidiol, 83.2% offered price promotions of some kind, and 89.9% had signage for product and price promotions.


Results indicated that most shops complied with some implementation of FDA health warnings and with free sampling bans and minimum-age signage. Other findings indicated concerns related to underage access, health claims, promotional strategies, and cannabidiol product offerings, which call for further FDA and state regulatory/enforcement efforts.

The truth behind Philip Morris’ cigarette-free future

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