High exposure to nicotine among adolescents who use Juul and other vape pod systems (‘pods’)

Although e-cigarette use among US youth decreased in 2016 for the first time since 2011,1 2 with the introduction of the new generation of nicotine vapourisers, ‘pods,’ this trend may not continue. Pods are compact, lightweight, ultraportable and easy to use inconspicuously. Popularity of these devices has increased in the past year, most notably, one brand, Juul. Use of Juul and similar products (‘ juuling ’) among youth has parents, teachers and the lay public appropriately concerned. However, to date, there are no data on nicotine exposure among youth who use pod systems. ### Survey To characterise the use of pods among adolescents, we surveyed patients 12–21 years seen at three Stony Brook Children’s Hospital outpatient clinics (Long Island, New York) from April 2017 to April 2018. All participants/parents provided written consent. Participants completed a 60-item anonymous questionnaire about personal use of e-cigarettes, including specific product types and brands, and provided a spot urine sample. ### Product analysis Using previously described analytical methods,3 we measured total nicotine concentration in pod products, purchased online, that were popular among our participants. We also measured total nicotine yields in aerosols generated from these products using a smoking machine and standardised laboratory puffing protocol (70 mL puff volume, 2 s puff duration and puff intervals of 10 s).3 We used gas chromatography-mass …