High school students' use of JUUL pod flavors before and after JUUL implemented voluntary sales restrictions on certain flavors in 2018

Objectives In November 2018, JUUL, Inc. restricted sales of mango, fruit medley, creme brulee, and cucumber pods to its website. Physical/online sales of tobacco, menthol, and mint pods continued. We examined rates of adolescent JUUL device and flavored pod use before and after restrictions were implemented to examine their potential impact. Methods Students from 4 Connecticut high schools completed cross-sectional surveys in 2018 (N = 3170) and 2019 (N = 3074). Results Compared to 2018, current (past-month) JUUL use decreased in 2019 (30.2-25.6%). Among current JUUL users, restricted flavor use (mango [62.8-36.9%]; cucumber [27.7-11.9%]; fruit [23.5-11.4%]; creme brulee [12.3-5.0%]) and the total number of flavors used (2.09[SD = 1.71]-1.51[SD = 1.33]) decreased (p-values < .001), while mint pod use increased (62.0-68.6%, p < .01). Tobacco and menthol pod use remained stable. Conclusions Following voluntary sales restrictions implemented by JUUL, Inc., restricted flavor use and the total number of flavors used decreased among JUUL users while mint use increased. Results suggest flavor restrictions may impact adolescents' e-cigarette use. While 2020 Food and Drug Administration restrictions on mint pods may further limit youth JUUL use, research is needed to determine where youth acquire restricted flavors and if restrictions prompt increased popularity of unrestricted devices/e-liquids.