JMIR Publications

ABSTRACT

Background:

Adults who switch completely from smoking cigarettes to use of electronic nicotine delivery systems (ENDS) substantially reduce their exposure to toxicants and carcinogens that are associated with smoking-related disease.

Objective:

In this six-week actual use study—a prospective uncontrolled real world study designed to evaluate naturalistic product use—US adults who smoked cigarettes were provided with JUUL2 ENDS products and switching behavior was assessed.

Methods:

US adults who smoked cigarettes every day but were not necessarily ready to quit (N=1160; mean age [SD] = 39.42 years [11.03]; 55.2% female; 57.5% non-Hispanic White; mean cigarettes/day [SD] = 14.11 [8.96]; only 1% planning to stop smoking within 30 days) were recruited to use JUUL2 ENDS products in one of five flavors (18 mg/mL nicotine) in real world environments for six weeks. Participants were enrolled into one of two study arms located at 24 sites across the US: (1) Traditional Flavors (Virginia Tobacco, Polar Menthol); or (2) Complex Flavors (Autumn Tobacco, Summer Menthol, Ruby Menthol). No instructions regarding JUUL2 product use or cigarette smoking were provided. After a one-week trial period, participants were provided their preferred flavor for six weeks of ad libitum use (10 pods/week). Six weekly surveys assessed switching (smoking abstinence) and smoking reduction; dependence and respiratory symptoms were assessed at baseline and Week 6.

Results:

Across the five JUUL2 flavor groups, rates of complete past 7-day switching away from cigarettes were 38.2%-47.3% at Week 6, and 24.3%-33.9% of participants reported complete past 30-day switching. Past 30-day switchers at Week 6 experienced significant decreases in dependence from cigarettes to JUUL2 products (ps<0.001) and frequency of respiratory symptoms (ps<0.05) relative to when they were smoking cigarettes at baseline. Among participants who continued to smoke at Week 6, 50.9%-62.9% reduced their daily cigarette consumption by at least 50% from baseline. Participants who used menthol-flavored (vs. tobacco-flavored) JUUL2 products had significantly higher rates of past 30-day switching at Week 6 (OR [95% CI]=1.36 [1.04, 1.78]).

Conclusions:

Adoption of JUUL2 ENDS products can help substantial proportions of US adults who smoke switch completely away from cigarettes or meaningfully reduce their cigarette consumption, thereby reducing their dependence on tobacco products and improving their respiratory symptoms.