Youth and Young Adult Use of Pod-Based Electronic Cigarettes From 2015 to 2019 A Systematic Review

Question What are the factors associated with use of pod-based electronic cigarettes (e-cigarettes) and their potential association with youth and young adult health? Findings In this systematic review, pod-based e-cigarettes enhanced the delivery of nicotine and had greater dependence potential. Youth and young adult use can be attributed to social acceptability, convenient product features, and aggressive social media marketing. Meaning Health communications and restrictions on social media, marketing channels, product design, and youth access are needed to prevent youth uptake of pod-based e-cigarettes. Importance The use of electronic cigarettes (e-cigarettes) has rapidly increased among youth and young adults, but knowledge gaps exist on the potential health effects of using recently introduced pod-based e-cigarettes. Objective To conduct a systematic review of recent peer-reviewed scientific literature on pod-based e-cigarettes. Evidence Review A search of online databases, including PubMed, Web of Science, Embase, and EBSCO HOST, was conducted to identify pod-based e-cigarette-associated articles from June 2015 (the time when JUUL [JUUL Labs] was introduced) to June 2019. We included English-language articles that presented primary data on pod-based e-cigarettes. Findings Pod-based e-cigarettes represent a substantial evolution in design by increasing the efficient delivery of nicotine. While these products may contain less harmful constituents than other types of e-cigarettes and cigarettes, there is no evidence that the levels found are safe among youth. There is evidence for higher nicotine dependence associated with their use. Pod-based e-cigarette brands, compared with other e-cigarette brands, have targeted youth and young adults with social media marketing. There was less discussion about the use of these products as smoking cessation devices or their health risks on social media. The social acceptability and favorable perceptions of pod-based e-cigarettes may underlie the use of these products. Conclusions and Relevance The appeal and dependence potential of pod-based e-cigarettes for youth emphasize the need for stronger regulations on product design, social media, marketing channels, and youth access together with health communications that emphasize the risks of nicotine dependence. This systematic review analyzes factors associated with youth and young adult use of pod-based electronic cigarettes in the US.