At the outset, it needs to be highlighted that five of the six names on the research paper work for Juul Labs. This doesn’t mean that the science is flawed, or the findings are invalid - the science should be addressed on its merits alone, and publication in a respected journal opens up the opportunity for academics to do just that.
Their study (1) opens with four simple statements:
- Cigarette smoking remains the leading cause of preventable morbidity and mortality worldwide
- Smoking is persistent, with very low likelihood of cessation for any given quit attempt
- Nicotine is the primary constituent that maintains cigarette smoking
- Nicotine itself is not the major source of the harms of smoking
The authors begin from the premise that tobacco harm reduction (THR) means moving smokers who struggle to quit smoking to safer nicotine delivery products. By removing the toxic combustion products, successful switchers decrease their level of harm exposure.
They compared how well UK and American smokers fared when using the maximum strength pods available in their countries. In the States, Juul users are allowed to access 59 mg/mL pods while here at home users are limited to 20 mg/mL, in practice they can only buy 18 mg/mL pods.
The team looked at smokers who had smoked over 100 cigarettes during a past 30 day period, reported smoking some or every day, and were over the age of 21.
Successful switching was measured by participants self-reporting that they had not smoked in the past 30 days (“even one or two puffs”).
Participants were signed up to the study if they had purchased a starter kit directly from stores using a recruitment card or online following a post-purchase email.
The researchers’ findings were stark: “In this longitudinal study of adult smokers who purchased JUUL, rates of past 30-day switching 3 and 6 months following initial purchase were significantly lower in the UK, where nicotine concentrations are limited to 20 mg/mL, than in N.Am., where smokers were using higher nicotine levels in their JUUL devices.”
This led them to conclude: “The findings of this study support the hypothesis that the higher nicotine concentrations used by N.Am. smokers, primarily 59 mg/mL, may contribute to the higher switching rates observed in N.Am. as compared with the UK. This result is consistent with experimental data that suggests that the substitutability of ENDS for combustible cigarettes increases with nicotine concentration.”
- Differences in Switching Away From Smoking Among Adult Smokers Using JUUL Products in Regions With Different Maximum Nicotine Concentrations: North America and the United Kingdom - https://academic.oup.com/ntr/advance-article/doi/10.1093/ntr/ntab062/6276234