The rise of e-cigarettes, pod mod devices, and JUUL among youth: Factors influencing use, health implications, and downstream effects

Background: Electronic cigarettes (e-cigarettes) were first introduced in the U.S. market in 2006, with the more recent evolution of pod-mod e-cigarettes such as JUUL introduced in 2015. Although marketed as a smoking cessation tool, e-cigarettes are rarely used for this purpose in youth. This review aims to synthesize the literature regarding e-cigarette use among youth, and provides a resource for clinicians, educators, and families that helps answer commonly asked questions about e-cigarettes. Methods: PubMed, Scopus, and PsycINFO search was performed using search terms Electronic Nicotine Delivery Systems, e cigarettes, e-cigarettes, electronic cigarettes, vaping, JUUL, e-cigs, and vape pens. Search results were filtered to only include those related to adolescents and young adults. Results: E-cigarette use among youth is common, with rates of use increasing from 1.5% in 2011 to 20.8% in 2018. Pod mod devices such as JUUL have gained favor among youth for their sleek design, user-friendly function, desirable flavors, and ability to be used discreetly in places where smoking is forbidden. Adolescents are often uninformed about the constituents of e-cigarettes, and little is known about the long-term effects of e-cigarettes. Studies have suggested a gateway effect for combustible cigarettes and cannabis use. Conclusions: E-cigarette use is becoming increasingly common among youth, leading to a myriad of questions and concerns from providers, educators, and family members. More research is needed to determine the ultimate public health impact of e-cigarette use. The authors provide a summary table of frequently asked questions in order to help clarify these common concerns.