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      Evidence of Nicotine Dependence in Adolescents Who Use Juul and Similar Pod Devices

      brief-report

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          Abstract

          Background: The use of high-nicotine content e-cigarettes (so-called pods, such as Juul) among adolescents raises concerns about early onset of nicotine addiction. Methods: In this analysis of adolescents surveyed from April 2017–April 2018, we compare survey responses and urinary cotinine of pod vs. non-pod using past-week e-cigarette users aged 12–21. Results: More pod users categorized themselves as daily users compared to non-pod users (63.0% vs. 11.0%; p = 0.001); more pod than non-pod users had used e-cigarettes within the past day (76.2% vs. 29.6%; p = 0.001). More pod users responded affirmatively to nicotine dependence questions (21.4% vs. 7.1%; p = 0.04). Urinary cotinine levels were compared among those responding positively and negatively to dependence questions: those with positive responses had significantly higher urinary cotinine levels than those responding negatively. Conclusions: Adolescents who used pod products showed more signs of nicotine dependence than non-pod users. Pediatricians should be vigilant in identifying dependence symptoms in their patients who use e-cigarettes, particularly in those using pod devices.

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          Nicotine and the adolescent brain.

          Menglu Yuan, Sarah J Cross, Sandra Loughlin … (2015)
          Adolescence encompasses a sensitive developmental period of enhanced clinical vulnerability to nicotine, tobacco, and e-cigarettes. While there are sociocultural influences, data at preclinical and clinical levels indicate that this adolescent sensitivity has strong neurobiological underpinnings. Although definitions of adolescence vary, the hallmark of this period is a profound reorganization of brain regions necessary for mature cognitive and executive function, working memory, reward processing, emotional regulation, and motivated behavior. Regulating critical facets of brain maturation are nicotinic acetylcholine receptors (nAChRs). However, perturbations of cholinergic systems during this time with nicotine, via tobacco or e-cigarettes, have unique consequences on adolescent development. In this review, we highlight recent clinical and preclinical data examining the adolescent brain's distinct neurobiology and unique sensitivity to nicotine. First, we discuss what defines adolescence before reviewing normative structural and neurochemical alterations that persist until early adulthood, with an emphasis on dopaminergic systems. We review how acute exposure to nicotine impacts brain development and how drug responses differ from those seen in adults. Finally, we discuss the persistent alterations in neuronal signaling and cognitive function that result from chronic nicotine exposure, while highlighting a low dose, semi-chronic exposure paradigm that may better model adolescent tobacco use. We argue that nicotine exposure, increasingly occurring as a result of e-cigarette use, may induce epigenetic changes that sensitize the brain to other drugs and prime it for future substance abuse.
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            Association Between Electronic Cigarette Use and Myocardial Infarction

            Talal Alzahrani, Iván M Peña, Nardos Temesgen … (2018)
            Introduction: Electronic cigarettes (e-cigarettes) are promoted as a less risky alternative to conventional cigarettes and have grown in popularity. Experimental and clinical evidence suggests that they could increase the risk of myocardial infarction. Methods: The National Health Interview Surveys of 2014 ( n =36,697) and 2016 ( n =33,028) were used to examine the cross-sectional association between e-cigarette use (never, former, some days, daily) and cigarette smoking (same categories) and myocardial infarction in a single logistic regression model that also included demographics (age, gender, BMI) and health characteristics (hypertension, diabetes, and hypercholesterolemia) using logistic regression. Data were collected in 2014 and 2016 and analyzed in 2017 and 2018. Results: Daily e-cigarette use was independently associated with increased odds of having had a myocardial infarction (OR=1.79, 95% CI=1.20, 2.66, p=0.004) as was daily conventional cigarette smoking (OR=2.72, 95% CI=2.29, 3.24, p <0.001). Former and some day e-cigarette use were not significantly associated with having had a myocardial infarction ( p =0.608 and p =0.392) whereas former (OR=1.70, p <0.001) and some day cigarette smoking (OR=2.36, p <0.001) were. Odds of a myocardial infarction were also increased with history of hypertension (OR=2.32, p <0.001); high cholesterol (OR=2.36, p <0.001); and diabetes (OR=1.77, p <0.001); and age (OR=1.65 per 10 years, p <0.001). Women (OR=0.47, p <0.001) had lower odds of myocardial infarction. Conclusions: Daily e-cigarette use, adjusted for smoking conventional cigarettes as well as other risk factors, is associated with increased risk of myocardial infarction.
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              Adolescents’ and Young Adults’ Use and Perceptions of Pod-Based Electronic Cigarettes

              Karma McKelvey, Mike Baiocchi, Bonnie L Halpern-Felsher (2018)
              Importance Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among adolescents and young adults, and the new pod-based e-cigarette devices may put adolescents and young adults at increased risk for polytobacco use and nicotine dependence. Objective To build an evidence base for perceptions of risk from and use of pod-based e-cigarettes among adolescents and young adults. Design, Setting, and Participants In a survey study, a cross-sectional analysis was performed of data collected from April 6 to June 20, 2018, from 445 California adolescents and young adults as part of an ongoing prospective cohort study designed to measure the use and perceptions of tobacco products. Exposures Use of pod-based e-cigarettes, e-cigarettes, and cigarettes. Main Outcomes and Measures Ever use, past 7-day use, and past 30-day use and co-use of pod-based e-cigarettes, e-cigarettes, and cigarettes; use of flavors and nicotine in pod-based e-cigarettes and e-cigarettes; and associated perceptions of risks, benefits, and nicotine dependence. Results Among 445 adolescents and young adults (280 females, 140 males, 6 transgender individuals, and 19 missing data; mean [SD] age, 19.3 [1.7] years) who completed wave 6 of the ongoing prospective cohort study, ever use information was provided by 437 respondents, of which 68 (15.6%) reported use of pod-based e-cigarettes, 133 (30.4%) reported use of e-cigarettes, and 106 (24.3%) reported use of cigarettes. The mean (SD) number of days that pod-based e-cigarettes were used in the past 7 days was 1.5 (2.4) and in the past 30 days was 6.7 (10.0). The mean (SD) number of days that other e-cigarettes were used in the past 7 days was 0.8 (1.8) and in the past 30 days was 3.2 (7.4). The mean (SD) number of days that cigarettes were used in the past 7 days was 0.7 (1.8) and in the past 30 days was 3.0 (7.6). Among ever users of pod-based e-cigarettes, 18 (26.5%) reported their first e-liquid was flavored menthol or mint and 19 (27.9%) reported fruit (vs 13 [9.8%] and 50 [37.6%] for other e-cigarettes). The mean perceived chance of experiencing social risks and short-term and long-term health risks from the use of either pod-based e-cigarettes or other e-cigarettes was 40% and did not differ statistically by e-cigarette type. Among 34 adolescents and young adults reporting any loss of autonomy from nicotine, there was no difference in mean (SD) Hooked On Nicotine Checklist scores between those using pod-based e-cigarettes (2.59 [3.14]) and other e-cigarettes (2.32 [2.55]). Conclusions and Relevance Use by adolescents and young adults of newer types of e-cigarettes such as pod-based systems is increasing rapidly, and adolescents and young adults report corresponding misperceptions and lack of knowledge about these products. Rapid innovation by e-cigarette manufacturers suggests that public health and prevention efforts appear to be needed to include messages targeting components common to all current and emerging e-cigarette products to increase knowledge and decrease misperceptions, with the goal to try to ultimately reduce e-cigarette use among adolescents and young adults.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Environ Res Public Health
                Journal ID (iso-abbrev): Int J Environ Res Public Health
                Journal ID (publisher-id): ijerph
                Title: International Journal of Environmental Research and Public Health
                Publisher: MDPI
                ISSN (Print): 1661-7827
                ISSN (Electronic): 1660-4601
                Publication date (Electronic): 17 June 2019
                Publication date (Print): June 2019
                Volume: 16
                Issue: 12
                Electronic Location Identifier: 2135
                Affiliations
                [1 ]Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Catherine.Messina@ 123456stonybrookmedicine.edu
                [2 ]Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; Maciej.goniewicz@ 123456RoswellPark.org
                Author notes
                [* ]Correspondence: Rachel.Boykan@ 123456stonybrookmedicine.edu ; Tel.: +011-631-444-7884
                Author information
                https://orcid.org/0000-0002-9183-7599
                https://orcid.org/0000-0001-6748-3068
                Article
                Publisher ID: ijerph-16-02135
                DOI: 10.3390/ijerph16122135
                PMC ID: 6617161
                PubMed ID: 31212888
                SO-VID: 258e82b0-a538-4954-8a2e-504172f02d33
                Copyright © © 2019 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 15 May 2019
                Date accepted : 14 June 2019
                Categories
                Subject: Brief Report

                ScienceOpen disciplines: Public health
                Keywords: e-cigarette,nicotine,dependence,tobacco
                Data availability:
                ScienceOpen disciplines: Public health
                Keywords: e-cigarette, nicotine, dependence, tobacco

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