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      Sources of youth access to JUUL vaping products in the United States

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          Highlights

          • In a survey of 9865 adolescents aged 13–17 years in the United States 79.6% of those who reported having used the JUUL vaporizer in the last 30 days obtained the JUUL device from at least one social source (e.g. ‘someone bought for me, someone offered to me) in the past 30 days.

          • 20.0% of current JUUL using adolescents bought JUUL products themselves.

          • Among youth who bought JUUL products themselves, the most common place of purchase was ‘a gas station or convenience store’.

          • Reducing youth access to JUUL vaping products will require a greater focus on measures that deter or penalize legal-age purchasers who give or sell products to minors.

          Abstract

          Introduction

          This study assessed sources of youth access to JUUL vaping products, the highest selling brand of the most commonly used tobacco product among adolescents in the United States.

          Methods

          A cross-sectional online survey assessed use of JUUL vaping products in a non-probability, nationally representative sample of 9865 adolescents aged 13–17 years in the United States. Past 30-day JUUL users (n = 1537) were asked how they got the JUUL vaping products they had used in the past 30-days. Those who reported having bought JUUL products themselves were asked about the places and people from whom they had bought products. Population-weighted percentages and 95% confidence intervals are reported for each source of access.

          Results

          An estimated 79.6% (95% CI = 77.5–81.6%) of current JUUL users obtained JUUL products from at least one social source (e.g. ‘someone bought for me, someone offered to me) in the past 30 days. By comparison, 20.0% [95% CI = 18.0–22.0%) of current users bought JUUL products themselves. Of 1322 youth who reported obtaining JUUL products from at least one source or by buying products themselves in the past 30 days, 77.5% (95% CI = 75.3–79.8%) had obtained JUUL products exclusively from social sources (i.e. they did not buy products directly), 17.2% (95% CI = 15.2–19.3%) obtained JUUL products exclusively by buying the products themselves (i.e. they did not obtain products from any social sources), and 5.2% (95% CI = 4.0–6.4%) had obtained JUUL products both from social sources and from buying the products themselves. Among youth who bought JUUL products themselves, the most common place of purchase was ‘a gas station or convenience store’ [53.1% (95% CI = 47.5– 58.6%)].

          Conclusions

          Youth who are currently using JUUL vaping products obtain these products predominantly through social sources, such as friends and peers. Youth sources of access to JUUL vaping products appear to mirror youth sources of access to other tobacco products. Reducing youth use of JUUL vaping products will require a greater focus on measures that deter or penalize legal-age purchasers who give or sell products to minors.

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          Most cited references10

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          Prevalence and correlates of JUUL use among a national sample of youth and young adults

          To estimate the prevalence of JUUL use and identify demographic and psychosocial correlates of use among youth and young adults in the USA. A national, probability-based sample was recruited via address-based sampling, with subsamples recruited from an existing probability-based online panel. Participants (N=14 379) ages 15–34 were surveyed about JUUL use, tobacco use, electronic nicotine delivery system (ENDS) harm perceptions, sensation seeking and demographic characteristics. Data were collected February–May 2018. Χ 2 analyses assessed differences in JUUL use by demographic and psychosocial characteristics. Logistic regressions identified significant correlates of ever and current JUUL use. Overall, 6.0% reported ever JUUL use, and 3.3% reported past 30-day (ie, current) use. Rates were higher among participants aged 15–17 and 18–21 years, with 9.5% and 11.2% reporting ever use, and 6.1% and 7.7% reporting current use, respectively. Among current users aged 15–17 years, 55.8% reported use on 3 or more days in the past month, and over a quarter reported use on 10–30 days. Significant correlates of use included younger age, white race, greater financial comfort, perceptions of ENDS as less harmful than cigarettes, household ENDS use, high sensation seeking and current combustible tobacco use. JUUL use was significantly higher among young people, with those under 21 having significantly higher odds of ever and current use. Frequency of use patterns suggest youth may not be experimenting with the device but using it regularly. Given the high nicotine content of JUUL, there is concern over the potential for addiction and other serious health consequences among young people. Findings suggest strong regulatory actions are needed to prevent youth and young adult uptake.
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            Which interventions against the sale of tobacco to minors can be expected to reduce smoking?

            Signatories of the Framework Convention on Tobacco Control have committed themselves to prohibiting the sale of tobacco to minors. The tobacco industry has a long history of legal challenges to such restrictions claiming that they cannot be expected to reduce youth smoking. The object of this study was to determine if disrupting the sale of tobacco to minors can be expected to reduce tobacco use by youths. A comprehensive literature search was conducted for studies that evaluated the impact on youth tobacco use of efforts to disrupt the sale of tobacco to youths. There was little evidence that merely enacting a law without sufficient enforcement had any impact on youth tobacco use. There was no evidence that merchant education programmes had any impact on youth older than 12 years of age. There was no evidence that enforcement efforts that failed to reduce the sale of tobacco to minors had any beneficial impact. All enforcement programmes that disrupted the sale of tobacco to minors reduced smoking among youth. Government officials can expect that enforcement programmes that disrupt the sale of tobacco to minors will reduce adolescent smoking.
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              Sources of tobacco for youths in communities with strong enforcement of youth access laws.

              To determine how youths obtain tobacco in communities with strong enforcement of tobacco sales laws. Ten communities in Massachusetts with merchant compliance rates at or above 90%. Paper surveys and focus group discussions with 68 adolescent smokers. Parents and friends are the primary sources of tobacco for new smokers. When stealing from parents can no longer satisfy the need for cigarettes, young adolescents ask strangers to buy them tobacco. For high school age smokers, teenage store clerks are a major source. Teenage clerks sell to other teenagers, steal tobacco, and help their friends steal from their employers. Friends who are 18 years of age or over are a second major source for older adolescents. Parents often purchase tobacco for older adolescents. Recommended actions include raising the minimum age for the purchase of tobacco to 21 years, and prohibiting individuals less than 21 years of age from selling tobacco.
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                Author and article information

                Contributors
                Journal
                Addict Behav Rep
                Addict Behav Rep
                Addictive Behaviors Reports
                Elsevier
                2352-8532
                11 November 2019
                December 2019
                11 November 2019
                : 10
                : 100232
                Affiliations
                Centre for Substance Use Research, 4.04 West of Scotland Science Park, 2317 Maryhill Road, Glasgow G20 0SP, United Kingdom
                Author notes
                [* ]Corresponding author at: Centre for Substance Use Research, 4.04 West of Scotland Science Park, 2317 Maryhill Road, Glasgow G20 0SP, United Kingdom. mckeganey@ 123456csures.org
                Article
                S2352-8532(19)30137-3 100232
                10.1016/j.abrep.2019.100232
                6889684
                31832537
                3244c97c-dd33-4949-a7e8-d195f4e83f7a
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 14 July 2019
                : 29 October 2019
                : 7 November 2019
                Categories
                Research Paper

                youth,e-cigarette,tobacco,prevention,sources
                youth, e-cigarette, tobacco, prevention, sources

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