E-cigs
Different categories of e-cigarettes: a closed system, disposable (top left); an open system, rechargeable and refillable tank system (top right); an open system, rechargeable and refillable (bottom right); and a closed system, rechargeable, cartridge based (bottom left).

By Alan Burns

A new paper published in Pediatrics looks at adolescent use of e-cigarettes, their trends, and the crackdown launched by the Federal Drug Administration.


E-cigarettes, one of today’s fastest growing fads, is the focus of a recent paper by Dr. Robert McMillen, Principal Investigator of Mississippi Tobacco Data (MTD). According to information from the Centers for Disease Control’s (CDC) 2017 National Youth Tobacco Survey, more than 2 million middle school, high school, and college students are currently using the e-cigarette devices.

“E-cigarettes, or vapes, are battery-powered devices that either use cartridges or a re-fillable tank in order to heat up liquid that produces an inhalable nicotine vapor,” explained McMillen. “What we set out to do with this research was to see what kids are actually using and prefer, so we know how better to handle the epidemic.”

The paper, which was published in September in Pediatrics, used data from a longitudinal survey conducted by the Roswell Park Cancer Institute and funded by the Federal Drug Administration (FDA) and National Institutes of Health (NIH), the Population Assessment of Tobacco and Health. This study monitors patterns in the tobacco industry, as well as tobacco product nicotine use in yearly studies.

“This was a huge survey. It interviewed both adolescents, younger adults, and older adults; however, we focused on the adolescent data and questions surrounding the products that they use. We found that most teenagers that are using these products have been migrating towards the tank system vapes.” McMillen said.

The appeal of the tank system is both the customization of the product and the varying flavored liquids that can be used. Their study of the data from the Population Assessment of Tobacco and Health showed that more than two-thirds of adolescents preferred refillable devices, as well as more than three-quarters preferred flavored e-cigarettes.

However, McMillen notes that there have been some fast-paced changes in the industry since the survey was conducted and their paper produced.

“Our paper is very relevant in highlighting just how dynamic and fast-paced this industry is at the moment,” he said. “A paper that was cutting edge just six months ago, when we completed it, now needs an addendum about the JUUL product, which has skyrocketed in popularity.”

The JUUL, a product of JUUL Labs released in 2015, has quickly become one of the most popular e-cigarette products in the last year. According to McMillen, this product is one of the first e-cigarettes that is extremely efficient at producing potent nicotine levels while being easy to use and maintain. This, coupled with the fact that the product is available in several flavors and is small and concealable, has helped drive popularity. Nielsen, a global measurement and data analytics company, stated earlier this year that JUUL controls around 72% of the e-cigarette market.

An announcement in September by the FDA targeted JUUL Labs and four other makers of popular vaping devices to prove that they are being proactive in keeping their products out of the hands of minors. The notice was targeted at both makers and sellers of e-cigarettes, whom the FDA claims has created “an epidemic” by getting adolescents and teenagers hooked on the nicotine producing devices with their flavored products.

Even before the FDA launched their notices to the industry in September, McMillen had expressed that he believed targeting the flavored products was going to be a key to adolescent use prevention. He also sees the use of flavored products as a problem, one that has been a popular topic surrounding the use of e-cigarettes for years.

“I think that if we’re going to be interested in proactive prevention of adolescent nicotine use, we need to focus on the products they are using, and the data shows that is overwhelmingly the flavored products,” he explained.

“While the flavors are safe for consumption orally, it becomes a different topic when you begin to heat those chemicals up and ingest them by inhalation,” McMillen continued. “These companies that produce the flavorings that are being used in the nicotine products are adamant about the fact that those products are not to be inhaled and that doing so is at your own risk.”

For now, McMillen plans to continue monitor trends in e-cigarette use and preferences, in order to further develop the regulatory science to inform policy and prevention efforts.


Visit mstobaccodata.org for more information on tobacco usage in Mississippi. The journal article used is cited below:

McMillen, R., Tanski, S., Wilson, K., Klein, J. D., & Winickoff. J. P. (2018). Adolescent use of different e-cigarette products. Pediatrics. doi.org/10.1542/peds.2018-0260.

New Paper Looks at Adolescent Use of E-Cigarettes