I wake up and hit the JUUL: Analyzing Twitter for JUUL nicotine effects and dependence

Background: JUUL-a novel electronic nicotine delivery system (ENDS) comprises most of the ENDS market share. Additionally, JUUL has a high nicotine content and utilizes a patented nicotine salt formulation aimed to speed absorption. Many JUUL users are not aware of the nicotine content and therefore may not be expecting acute nicotine effects or potential for dependence. This study sought to analyze Twitter messages (tweets) regarding nicotine, symptoms of dependence, and withdrawal related to JUUL use. Methods: Data were collected from Twitter's Filtered Streams interface 4/11-6/16/2018 by retrieving tweets matching the terms juul, juuls, and juuling that also used words consistent with nicotine effects, symptoms of dependence, and withdrawal. A random 5% subsample (n = 1986) was coded by 2 independent coders. Cohen's kappa for inter-rater reliability ranged 0.62-1.00 for all coded variables. Tweets were assessed using a qualitative content analysis approach. Results: A total of 335 tweets mentioned dependence-related themes, including use upon waking and compulsion to use. A total of 189 tweets mentioned themes related to nicotine, with almost 15% of these tweets describing physical effects. Additionally, 42 tweets mentioned themes related to quitting JUUL and/or withdrawal from JUUL. Discussion: This qualitative analysis suggests that users of JUUL are experiencing symptoms of nicotine exposure and dependence. Considering the high nicotine content of JUUL and the rising popularity among young people, more research around initiation of and dependence on JUUL, as well as the impact of recent FDA policy changes, should be conducted.