Pod-based e-cigarette use among college-aged adults in the United States: A survey on the perception of health effects, sociodemographic correlates, and interplay with other tobacco products

Introduction E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the United States (US). Using an online survey, we aimed to explore the socio-behavioral correlates, predisposing factors, and addictive behaviors among young adult pod-mod users within a University in Maryland, USA. Methods 112 eligible college students aged 18-24 years recruited from a University in Maryland who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past-30-day use. Descriptive statistics were used to analyze participants’ responses. Results Of the 112 participants with mean age 20.5±1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8±1.4 years, while the mean age of regular use was 18.5±1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were below the age of 21. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio (aOR):4.52; 95%CI:1.76,11.64), JUUL use (aOR:2.56; 95%CI:1.08,6.03), and menthol flavor (aOR:6.52; 95%CI:1.38,30.89) were associated with reduced nicotine autonomy, a measure of addiction. Conclusion Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (NIH) and the FDA Center for Tobacco Products (CTP) under Awards P50HL120163 and U54HL120163. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the Johns Hopkins University's gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.