Intentions and Attempts to Quit JUUL E-Cigarette Use

Table 1. Demographic Characteristics, JUUL Use, JUUL Perceptions, and Quit Variables Across Smoking Status for a Sample of US Adult JUUL Users, 2019–2020 ^a
Characteristic	Never smoker (n = 81)	Current smoker (n = 55)	Former smoker (n = 165)	Total sample (N = 301)	P value^b
Demographic
Female sex, n (%)	35 (43.2)	13 (23.6)	61 (37.0)	109 (36.2)	.06
Age, mean (SD), y	28.8 (8.0)	35.2 (9.5)	32.3 (7.9)	31.9 (8.5)	<.001
JUUL use
No. of months have used e-cigarettes, mean (SD)	20.9 (21.8)	28.7 (22.4)	29.8 (24.6)	27.2 (23.7)	.02
No. of months have used JUUL, mean (SD)	13.5 (13.0)	13.4 (12.5)	14.0 (10.6)	13.8 (11.6)	.93
JUUL use days in past 30 days, mean (SD)	21.1 (8.6)	22.8 (8.7)	24.5 (8.3)	23.3 (8.6)	.01
JUUL use times per day, mean (SD)	10.3 (17.4)	16.2 (53.3)	11.2 (39.1)	11.8 (37.9)	.63
Where purchase JUUL, n (%)
Gas station	22 (27.2)	22 (40.0)	63 (38.2)	107 (35.5)	.06
Vape shop	28 (34.6)	9 (16.4)	52 (31.5)	89 (29.6)
Tobacco store	7 (8.6)	9 (16.4)	14 (8.5)	30 (10.0)
Online	23 (28.4)	11 (20.0)	30 (18.2)	64 (21.3)
Did not purchase	1 (1.2)	4 (7.3)	6 (3.6)	11 (3.7)
Nicotine concentration, n (%)
5% concentration	32 (42.7)	33 (63.5)	81 (51.9)	146 (51.6)	.07
3% concentration	31 (41.3)	11 (21.2)	42 (26.9)	84 (29.7)
Both	12 (16.0)	8 (15.4)	33 (21.2)	53 (18.7)
PSECDI total score, mean (SD)^c	8.0 (4.5)	9.1 (4.4)	8.4 (4.0)	8.4 (4.2)	.31
PSECDI dependence level, n (%)
Not dependent	17 (21.0)	8 (14.5)	20 (12.1)	45 (15.0)	.43
Low dependence	27 (33.3)	15 (27.3)	63 (38.2)	105 (34.9)
Medium dependence	25 (30.9)	19 (34.5)	53 (32.1)	97 (32.2)
High dependence	12 (14.8)	13 (23.6)	29 (17.6)	54 (17.9)
JUUL perceptions
How addictive, n (%)
Not at all addictive	14 (17.3)	4 (7.3)	6 (3.6)	24 (8.0)	.002
Moderately addictive	54 (66.7)	37 (67.3)	111 (67.3)	202 (67.1)
Very addictive	13 (16.0)	14 (25.5)	48 (29.1)	75 (24.9)
How harmful compared with smoking, n (%)
Much less harmful	30 (37.0)	8 (14.5)	43 (26.1)	81 (26.9)	.04
Less harmful	29 (35.8)	31 (56.4)	88 (53.3)	148 (49.2)
Just as harmful	18 (22.2)	13 (23.6)	31 (18.8)	62 (20.6)
Much more harmful	4 (4.9)	3 (5.5)	3 (1.8)	10 (3.3)
Quit variables
Quit attempts, n (%)
No	52 (64.2)	44 (80.0)	137 (83.0)	233 (77.4)	.004
Yes	29 (35.8)	11 (20.0)	28 (17.0)	68 (22.6)	.004
Quit intentions, n (%)
I'll quit JUUL within a year	17 (21.0)	10 (18.2)	41 (24.8)	68 (22.6)	.55
I will continue to use/don't know	64 (79.0)	45 (81.8)	124 (75.2)	233 (77.4)	.55
Quit importance, mean (SD)^d	4.1 (3.0)	4.1 (2.8)	4.2 (2.6)	4.1 (2.8)	.98
Quit confidence, mean (SD)^d	6.4 (2.7)	5.6 (2.8)	5.6 (2.7)	5.8 (2.7)	.07

Abbreviation: PSECDI, Penn State Electronic Cigarette Dependence Index.
^aData source: A 30-minute survey was developed by the study team and administered at 3 time points: July 2019, January 2020, and April 2020.
^b P values determined from variable comparisons across smoking status using 1-way analyses of variance and χ² tests.
^cScores range from 0 to 20, where higher scores indicate greater dependence. Levels of dependence were categorized as not dependent (0–3), low dependence (4–8), medium dependence (9–12), and high dependence (≥13) (17).
^dA 10-point Likert scale ranging from "not at all" to "very." Scores categorized into low (1–3), medium (4–7), and high (8–10) to simplify analysis.

Table 2. Results of Logistic Regression Models of JUUL Addictiveness Perception Among US Adult JUUL Users (N = 301), 2019–2020 ^a
Variable	χ² P value	Odds ratio (95% CI)
Variable	χ² P value	Moderately vs not at all	Very vs not at all
Age	.001	1.05 (0.10–1.12)	0.98 (0.09–1.05)
Sex
Male	.004	0.95 (0.03–1.12)	0.34 (0.01–1.06)
Female	.004	1 [Reference]	1 [Reference]
Smoking status
Current	.002	1.42 (0.04–5.49)	4.02 (0.08–20.19)
Former		4.13 (1.43–11.94)^b	11.66 (3.25–41.88)^c
Never		1 [Reference]	1 [Reference]
PSECDI dependence level^d
Low	<.001	1.69 (0.06–4.60)	5.46 (0.94–31.55)
Medium		6.31 (1.57–25.39)^b	38.33 (5.33–275.41)^c
High		2,356,778 (1,077,123–5,156,700)^c,e	44,203,672 (2,020,259–9,671,854)^c,e
Not dependent		1 [Reference]	1 [Reference]

Abbreviation: PSECDI, Penn State Electronic Cigarette Dependence Index.
^aA 30-minute survey was developed by the study team and administered at 3 time points: July 2019, January 2020, and April 2020. The question on addictiveness was, "Overall, how addictive do you believe using a JUUL is?" with response options "not at all addictive," "moderately addictive," and "very addictive" Estimates of each variable level were determined by using binomial and multinomial logistic regression models. Akaike information criterion = 432.9; residual deviance = 400.9.
^b P < .01; determined by χ² test.
^c P < .001; determined by χ² test.
^dScores range from 0 to 20, where higher scores indicate greater dependence. Levels of dependence were categorized as not dependent (0–3), low dependence (4–8), medium dependence (9–12), and high dependence (≥13) (17).
^eThe odds ratios for high dependence are large because we modeled the log-odds as a linear function of each variable and, therefore, applied an exponential function to the odds ratio calculations. These estimates are reliable and not biased by outliers.

Table 3. Results of Logistic Regression Models of Perceived Harm of JUUL, Compared With Smoking, Among US Adult JUUL Users (N = 301), 2019–2020 ^a
Variable	χ² P value	Odds ratio (95% CI)
Variable	χ² P value	Less vs much less harmful	Just as much vs much less harmful	Much more vs much less harmful
Sex
Male	.01	1.20 (0.66–2.17)	0.72 (0.35–1.47)	0.26 (0.06–1.09)
Female	.01	1 [Reference]	1 [Reference]	1 [Reference]
Smoking status
Current	.02	4.56 (1.75–11.88)^b	3.81 (1.26–11.52)^c	3.78 (0.64–22.45)
Former		2.55 (1.32–4.94)^b	1.71 (0.77–3.78)	0.65 (0.12–3.46)
Never		1 [Reference]	1 [Reference]	1 [Reference]
Days of JUUL use in past 30 days	.09	0.98 (0.94–1.01)	0.96 (0.92–1.00)	0.92 (0.85–0.99)^c
Months of e-cigarette use, square root	.046	0.90 (0.79–1.02)	0.83 (0.70–0.97)^c	1.12 (0.83–1.51)

^aA 30-minute survey was developed by the study team and administered at 3 time points: July 2019, January 2020, and April 2020. The question on harm perception was, "Compared to smoking, would you say that JUUL use is … " with response options "much less harmful," "less harmful," "just as harmful," or "much more harmful." Estimates of each variable level were determined by using binomial and multinomial logistic regression models. Akaike information criterion = 688.6; residual deviance = 652.6.
^b P < .01; determined by χ² test.
^c P < .001; determined by χ² test.

Table 4. Results of Logistic Regression Models of Quit Intentions Among US Adult JUUL Users (N = 301), 2019–2020 ^a
Variable	χ² P value	I'll quit vs I'll continue
Perceived addictiveness of JUUL
Moderately addictive	<.001	3.36 (0.88–22.35)
Very addictive		12.46 (2.92–88.24)^b
Not at all		1 [Reference]
Perceived harm of JUUL, compared with smoking
Less harmful	.14	0.68 (0.33–1.47)
Just as much harm		0.86 (0.36–2.03)
Much more harm		3.37 (0.77–15.91)
Much less harm		1 [Reference]
JUUL use times per day, log	.03	0.70 (0.49–0.97)^c
Months of JUUL use	.51	1.08 (0.85–1.38)
Months of e-cigarette use	.05	0.85 (0.72–1.00)
Survey time point
Time point 2	.06	2.26 (1.01–5.48)
Time point 3		2.75 (1.16–7.00)^c
Time point 1		1 [Reference]

^aA 30-minute survey was developed by the study team and administered at 3 time points: July 2019, January 2020, and April 2020. The question on quit intentions was, "Are you planning to continue using your JUUL electronic cigarette for at least the next year, or quit within that time frame?" with response options "I'll quit using JUUL within a year," "I plan to continue using the JUUL," or "Don't know." Estimates of each variable level were determined by using binomial and multinomial logistic regression models. Akaike information criterion = 306.5; residual deviance = 284.5.
^b P < .01.
^c P < .05.

Table 5. Results of Logistic Regression Models of Quit Attempts Among US Adult JUUL Users (N = 301), 2019–2020 ^a
Variable	χ² P value	Yes vs no
Perceived addictiveness of JUUL
Moderately addictive	.03	5.64 (0.99–107.16)
Very addictive		10.56 (1.62–212.12)^b
Not at all		1 [Reference]
Perceived harm of JUUL, compared with smoking
Less harmful	.10	0.68 (0.30–1.52)
Just as much harm		1.83 (0.76–4.49)
Much more harm		0.97 (0.17–5.26)
Much less harm		1 [Reference]
Smoking status
Current	.007	0.35 (0.14–0.87)^b
Former		0.32 (0.15–0.66)^c
Never		1 [Reference]
PSECDI dependence level^d
Low	<.001	2.96 (0.81–14.52)
Medium		15.16 (4.26–75.04)^e
High		8.85 (2.18–47.39)^c
Not dependent		1 [Reference]
Days of JUUL use in past 30 days	.002	0.94 (0.90–0.98)^c

Abbreviation: PSECDI, Penn State Electronic Cigarette Dependence Index.
^aA 30-minute survey was developed by the study team and administered at 3 time points: July 2019, January 2020, and April 2020. The question on quit attempt was, "Have you ever tried to quit using your JUUL electronic cigarette?" with response options no or yes. Estimates of each variable level were determined by using binomial and multinomial logistic regression models. Akaike information criterion = 280.9; residual deviance = 256.9.
^b P < .05.
^c P < .01.
^dScores range from 0 to 20, where higher scores indicate greater dependence. Levels of dependence were categorized as not dependent (0–3), low dependence (4–8), medium dependence (9–12), and high dependence (≥13) (17).
^e P < .001.

Table 6. Results of Logistic Regression Models of Quit Importance and Quit Confidence Among US Adult JUUL Users (N = 301), 2019–2020 ^a
Variable	χ² P value	Moderate vs low	High vs low
Quit importance^b
Survey time point
Time point 2	.04	2.21 (1.07–4.56)^c	1.16 (0.41–3.33)
Time point 3		3.40 (1.56–7.42)^d	1.29 (0.42–3.99)
Time point 1		1 [Reference]	1 [Reference]
Age	.09	0.99 (0.96–1.02)	1.04 (0.99–1.09)
Place of JUUL purchase
Vape shop	.03	1.03 (0.50–2.10)	1.20 (0.42–3.38)
Tobacco store		0.75 (0.28–2.02)	0.62 (0.15–2.48)
Online		0.54 (0.25–1.18)	0.19 (0.42–0.81)^c
Did not purchase		0.33 (0.05–2.01)	3.97 (0.70–22.45)
Gas station		1 [Reference]	1 [Reference]
Perceived addictiveness of JUUL
Moderately addictive	.02	1.80 (0.58–5.64)	1.95 (0.18–21.27)
Very addictive		1.33 (0.35–5.04)	7.05 (0.54–92.91)
Not at all addictive		1 [Reference]	1 [Reference]
Perceived harm of JUUL, compared with smoking
Less harmful	<.001	4.08 (1.96–8.47)^e	1.65 (0.53–5.16)
Just as much harm		4.30 (1.79–10.35)^d	5.84 (1.71–19.92)^d
Much more harm		11.21 (0.95–131.79)	28.20 (2.46–323.29)^d
Much less harm		1 [Reference]	1 [Reference]
PSECDI dependence level^f
Low	.002	3.70 (1.41–9.72)^d	3.10 (0.59–16.28)
Medium		4.96 (1.78–13.81)^d	13.75 (2.48–76.26)^d
High		4.47 (1.36–14.66)^c	10.43 (1.66–65.42)^c
Not dependent		1 [Reference]	1 [Reference]
Days of JUUL use in past 30 days	.001	0.96 (0.92–0.99)^c	0.90 (0.85–0.96)^e
Months of e-cigarette use	.006	0.81 (0.71–0.93)^d	0.84 (0.70–1.00)
Quit confidence^g
PSECDI dependence level^f
Low	<.001	2.00 (0.63–6.33)	0.68 (0.23–2.02)
Medium		0.98 (0.33–2.90)	0.14 (0.04–0.41)^e
High		0.50 (0.16–1.56)^c	0.08 (0.02–0.26)^e
Not dependent		1 [Reference]	1 [Reference]

Abbreviation: PSECDI, Penn State Electronic Cigarette Dependence Index.
^aA 30-minute survey was developed by the study team and administered at 3 time points: July 2019, January 2020, and April 2020. Estimates of each variable level were determined by using binomial and multinomial logistic regression models.
^bThe question on quit importance was, "How important is it for you to quit electronic cigarette use now?" Akaike information criterion = 552.5; residual deviance = 480.5.
^c P < .05; determined by χ² test.
^d P < .01; determined by χ² test.
^e P < .001; determined by χ² test.
^fScores range from 0 to 20, where higher scores indicate greater dependence. Levels of dependence were categorized as not dependent (0–3), low dependence (4–8), medium dependence (9–12), and high dependence (≥13) (17).
^gThe question on quit confidence was, "How confident are you that you could quit electronic cigarette use now?" Akaike information criterion = 605.5; residual deviance = 589.5.

Authors and Disclosures

Andréa L. Hobkirk, PhD^1–3, Brianna Hoglen, MPH^1,3, Tianhong Sheng, BS⁴, Ava Kristich¹, Jessica M. Yingst, DrPH^2,3, Kenneth R. Houser, MS^1,3, Nicolle M. Krebs, MS^2,3, Sophia I. Allen, PhD^2,3, Candace R. Bordner, MS^2,3, Craig Livelsberger, BS^2,3 and Jonathan Foulds, PhD^1,3

¹Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. ²Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. ³Center for Research on Tobacco and Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. ⁴Department of Statistics, Pennsylvania State University, State College, Pennsylvania.

Corresponding Author
Andréa L. Hobkirk, PhD, Pennsylvania State University College of Medicine, 500 University Dr, Mail Code CH69, Hershey, PA 17033. Telephone: 717-531-0003 ext. 286415. Email: ahobkirk@pennstatehealth.psu.edu.

A.L.H. is supported by a National Institute on Drug Abuse (NIDA) career development award (K23-DA045081). S.I.A. is supported by a NIDA Diversity supplement (U01-DA04551701-S2). J.F., J.M.Y., N.M.K., C.R.B., and C.L. are supported by NIDA grants (U01-DA045517 and R01 DA048428). J.F. has received grants from the National Institutes of Health (NIH); has previously received a grant, personal fees, and nonfinancial support (eg, study drug) from Pfizer Inc, unrelated to this article; in the past (>3 years ago), has done paid consulting for pharmaceutical companies involved in manufacturing smoking-cessation medications (eg, GlaxoSmithKline, Johnson & Johnson); and has acted as a deposed and compensated expert witness on behalf of plaintiffs suing cigarette manufacturers. The authors have no other conflicts of interest to disclose. This project was facilitated by the Penn State Center for Research on Tobacco and Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. No copyrighted material, surveys, instruments, or tools were used in this article.

Intentions and Attempts to Quit JUUL E-Cigarette Use

The Role of Perceived Harm and Addiction

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Intentions and Attempts to Quit JUUL E-Cigarette Use

The Role of Perceived Harm and Addiction

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