The purpose of this study is to compare the gender differences of cotinine levels and nicotine dependence between college age men and women who use electronic nicotine delivery systems (ENDS), like JUULs. The study will also examine differences between this population and college-age students who do not use ENDS. ENDS are small battery operated devices that heat liquid containing nicotine to create an aerosol that can be inhaled and smoked (Martinasek, Bowersick & Wheldon, 2018). In the United States ENDS usage has drastically increased in the adolescent and emerging age population (18-25 years old) over the past several years (Ali, King, Vidourek, Merianos & Rao, 2018). Researchers have determined that many traditional tobacco smokers reject ENDS as effective quit tools and instead use both products to obtain more nicotine. In addition, many current ENDS users are first time nicotine users (Pechacek, Nayak, Gregory, Weaver & Eriksen, 2016). Other investigators determined that nearly 10% of all ENDS users never smoked traditionally tobacco products before using ENDS (Weaver, Majeed, Pechacek, Nyman, Gregory & Eriksen, 2016).
There is a lack of knowledge amongst ENDS users about the chemicals they are ingesting and the amount of nicotine variability. “Some [ENDS] deliver very little nicotine while some may exceed the nicotine delivery profile of a tobacco cigarette,” (Cobb, Hendrick & Eissenber, 2015, p.1). This high variability of nicotine can lead to early nicotine dependence in users. The US Food and Drug Administration has cited JUULs specifically for targeting young people and the Surgeon General has declared [ENDS] use among young people “a major public health concern” (Truth Initiative, 2018).
There has been limited investigation surrounding ENDS because they are so new to the market, and different types are continually being developed. Thus, the long-term effects of these products have not been systematically investigated, which increases the risk of use in the emerging age population (Vincent, Potts, Durbin, Moore & Eleys, 2018). One risk that has been established by scientists is the association of flavors used in ENDS with an increased risk for developing restrictive lung disease or bronchiolitis obliterans (Vincent, Potts, Durbin, Moore & Eleys, 2018). There are strong held perceptions that ENDS primary and secondary vapor is safer than that of traditional tobacco products (Martinasek, Bowersick & Wheldon, 2018). This misconception of safety could potentially explain the increased utilization of ENDs in the emerging age population (Camenga, Delmerico, Kong, Cavallo, Hyland, Cummings & Krishnan-Sarin, 2014).
To determine the local culture and beliefs surrounding use of ENDS, we conducted a qualitative survey through the university’s student health clinic. The preliminary findings from this study were used to develop the survey for our current study. From the current study we hope to gain knowledge about use and behaviors surrounding ENDS amongst different emerging population to assist in the development and implementation of health promotion education surrounding the emerging population.
Methods:
This is a cross section study using a convenience sample to examine ENDS usage, nicotine dependency and oral saliva cotinine levels in a sample of undergraduate students (30 males, 30 females) at the University of Kentucky. The participants will be current ENDS users. Oral salivary cotinine levels will be measured through the use of NicAlert oral salivary tests. Participants will also self-report on various ENDS, or juuling, behaviors and usage through the use of an online survey. The Penn State Electronic Cigarette Dependence Index (PSECDI) tool will be used to measure individual levels of nicotine dependence. All participants will receive a $10 gift card as compensation for participating in this study.
Results:
This study is pending IRB approval from the University of Kentucky Medical IRB board and will be conducted November 2018, and data will be analyzed before Sigma’s 2019 Congress.
Conclusion:
We hope that our research will further define nicotine dependence, salivary cotinine level and ENDS use behaviors among our population of undergraduate men and women who use ENDS. We also hope that our data will help to determine if there are gender differences in nicotine dependence or ENDS usage behaviors. These results can help to identify deficits in consumer knowledge of ENDS products and gaps in health education for college-age students concerning ENDS. We also hope this research will have significant implications for health promotion in the college-age population, specifically for educational purposes for tobacco/nicotine cessation interventions.