Intentions and Attempts to Quit JUUL E-Cigarette Use

The Role of Perceived Harm and Addiction

Andréa L. Hobkirk, PhD; Brianna Hoglen, MPH; Tianhong Sheng, BS; Ava Kristich; Jessica M. Yingst, DrPH; Kenneth R. Houser, MS; Nicolle M. Krebs, MS; Sophia I. Allen, PhD; Candace R. Bordner, MS; Craig Livelsberger, BS; Jonathan Foulds, PhD


Prev Chronic Dis. 2022;19(2):E06 

In This Article

Abstract and Introduction


Introduction: Research on electronic cigarette (e-cigarette) quit intentions and attempts is limited despite the potential health benefits of quitting, especially for long-term users. The current study aimed to investigate perceptions of harm and addictiveness and tobacco use characteristics associated with quit variables among users of a popular e-cigarette brand, JUUL.

Methods: We surveyed 301 US adult JUUL users on their tobacco use characteristics, perceptions of JUUL harm and addictiveness, and quit variables at 3 time points, from July 2019 to April 2020. We used logistic regression models to assess demographic characteristics, smoking characteristics, and perceptions of JUUL harm and addictiveness as correlates of e-cigarette quit intentions, attempts, importance, and confidence.

Results: Twenty-three percent of the sample had intentions to quit using JUUL within the year, and 22.6% reported making a lifetime quit attempt. The average rating of quit importance was 4.1 and quit confidence was 5.8 on a Likert scale of 1 to 10. More than 90% of the sample indicated that JUUL was at least moderately addictive, whereas less than one-quarter indicated that JUUL was as harmful or more harmful than smoking. Higher levels of perceived JUUL addictiveness were associated with more quit intentions, attempts, and importance. Higher levels of perceived JUUL harm compared with smoking were associated with more quit importance.

Conclusion: Our findings suggest that a small proportion of adult JUUL users are interested in quitting. Self-reported perceptions of JUUL's addiction potential may be related to more quit attempts. Findings highlight the need for evidence-based information on e-cigarette addictiveness and effective strategies for cessation.


An estimated 8.1 million adults currently use electronic cigarettes (e-cigarettes) in the US.[1] Unlike cigarettes, which use combustion to generate tobacco smoke, e-cigarettes aerosolize a nicotine-containing e-liquid for inhalation,[2] resulting in lower intake of carcinogens and toxins for long-term e-cigarette users compared with smokers.[3,4] Although replacing cigarettes with e-cigarettes likely reduces health risks in the short term for current smokers, e-liquids can contain high levels of nicotine and toxic compounds that may contribute to addiction and respiratory damage.[5,6]

Adults' perceptions that e-cigarettes are harmful and addictive have increased over the past decade along with increased messaging about harms.[7–9] For example, the Centers for Disease Control and Prevention website states that e-cigarettes contain toxic and carcinogenic chemicals, cause long-lasting changes in the brain, and are not a method for smoking cessation approved by the US Food and Drug Administration (FDA) (eg,; Data from several national surveys collected in the past decade revealed that the percentage of US adults who believe e-cigarettes are less harmful than cigarettes decreased, while the percentage who believe that e-cigarettes are addictive doubled.[7–10]

Motivation for e-cigarette use cessation is rising in parallel with attention to the potential harms of e-cigarettes and the growing numbers of long-term e-cigarette users. Online and national surveys of adult e-cigarette users found that approximately 30% to 60% expressed some interest in quitting and 10% to 64% had made a previous e-cigarette quit attempt.[11–13] However, research is limited on the factors associated with e-cigarette quit intentions and attempts, including the influence of harm or addiction perceptions.

Given the changing landscape of e-cigarette harm messaging and regulations, and the media attention given to e-cigarettes, the primary objective of the current study was to investigate e-cigarette quit intentions and attempts by identifying associated factors and focusing on adult JUUL users. Of all e-cigarette brands, JUUL has received the most negative attention because of its popularity among adolescents and young adults and its relatively high levels of nicotine.[14] Therefore, we hypothesized that perceptions of JUUL's addictive potential and harm relative to cigarettes would be associated with quit intentions and attempts.