JUUL: Spreading Online and Offline



      The increasing popularity of the JUUL electronic nicotine delivery system among youth poses several potential public health concerns. Social media can be used to better understand the spread of information related to JUUL. This study examined whether adolescents (age < 18) are following JUUL's official Twitter account and subsequently sharing (retweeting) JUUL's posts to their followers. We also assessed various patterns in which adolescents share information on JUUL with each other.


      We collected 3,239 tweets from JUUL's official Twitter account (@JUULVapor) for one full year from February 2017 to January 2018. These tweets were shared by Twitter users to their followers 1,124 times by 721 unique users. Users were determined to be either adolescent (age <18) or adult (≥18) based on a systematic procedure involving double coding. We used social network analysis to explore the relationships between users retweeting JUUL.


      One-quarter (25%) of users were determined to be adolescents. Social network analysis revealed a maximum path length of 4 and a positive assortativity (r = .29). There were 25 (9%) instances of an adolescent retweeting content from another adolescent, 35 (12%) of an adolescent retweeting from an adult, and 30 (11%) of an adult retweeting from an adolescent.


      JUUL's official Twitter account is being followed—and its messages are being shared—by adolescents. Rigorous policies and prevention programs are needed to curb adolescent exposure to JUUL content and discussions online.


      To read this article in full you will need to make a payment


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Greenhill R
        • Dawkins L
        • Notley C
        • et al.
        Adolescent awareness and use of electronic cigarettes: a review of emerging trends and findings.
        J Adolesc Health. 2016; 59: 612-619
        • Office of the Surgeon General
        E-cigarette use among youth and young adults: a report of the surgeon general.
        2016 (Washington, DC)
        • Rubinstein ML
        • Delucchi K
        • Benowitz NL
        • et al.
        Adolescent exposure to toxic volatile organic chemicals from e-cigarettes.
        Pediatrics. 2018; 141e20173557
        • Yuan M
        • Cross SJ
        • Loughlin SE
        • et al.
        Nicotine and the adolescent brain.
        J Physiol. 2015; 593: 3397-3412
        • Lopez AA
        • Hiler MM
        • Soule EK
        • et al.
        Effects of electronic cigarette liquid nicotine concentration on plasma nicotine and puff topography in tobacco cigarette smokers: a preliminary report.
        Nicotine Tob Res. 2016; 18: 720-723
        • Willett JG
        • Bennett M
        • Hair EC
        • et al.
        Recognition, use and perceptions of JUUL among youth and young adults.
        Tob Control. 2018; (tobaccocontrol-2018-054273)
        • Soneji S
        • Barrington-Trimis JL
        • Wills TA
        • et al.
        Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults.
        JAMA Pediatr. 2017; 171: 788
        • Primack BA
        • Soneji S
        • Stoolmiller M
        • et al.
        Progression to traditional cigarette smoking after electronic cigarette use among US adolescents and young adults.
        JAMA Pediatr. 2015; 169: 1018
        • Leventhal AM
        • Strong DR
        • Kirkpatrick MG
        • et al.
        Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence.
        JAMA. 2015; 314: 700
        • Dai H
        • Catley D
        • Richter KP
        • et al.
        Electronic cigarettes and future marijuana use: a longitudinal study.
        Pediatrics. 2018; 141e20173787
      1. Juul is the fastest-growing e-cigarette on the US market - Business Insider. 2017. Available at: Accessed April 28, 2018.

        • Huang J
        • Duan Z
        • Kwok J
        • et al.
        Vaping versus JUULing: how the extraordinary growth and marketing of JUUL transformed the US retail e-cigarette market.
        Tob Control. 2018; (tobaccocontrol-2018-054382)
        • Kavuluru R
        • Han S
        • Hahn EJ
        On the popularity of the USB flash drive-shaped electronic cigarette Juul.
        Tob Control. 2018; (tobaccocontrol-2018-054259)
      2. Kavuluru R, Han S, Hahn EJ. On the popularity of the USB flash drive-shaped electronic cigarette Juul. Tob Control 2018:1–3.

      3. What's Juul in School : juul. 2017. Available at: Accessed April 9, 2018.

        • Allem J-P
        • Dharmpuri L
        • Unger JB
        • et al.
        Characterizing Juul-related posts on Twitter.
        Drug Alcohol Depend. 2018; 190: 1–5;
        • Mantey DS
        • Cooper MR
        • Clendennen SL
        • et al.
        E-cigarette marketing exposure is associated with e-cigarette use among US youth.
        J Adolesc Heal. 2016; 58: 686-690
        • Nicksic NE
        • Harrell MB
        • Perez A
        • et al.
        Recall of e-cigarette advertisements and adolescent e-cigarette use.
        Tob Regul Sci. 2017; 3: 210-221
        • Padon AA
        • Meloney EK
        • Cappella JN
        Youth-targeted e-cigarette marketing in the US.
        Tob Regul Sci. 2017; 3: 95-101
      4. Pew Research Center. Teens, Social Media & Technology 2018. Available at: Accessed July 28, 2018.

        • Allem J
        • Escobedo P
        • Chu K
        • et al.
        Campaigns and counter campaigns: reactions on Twitter to e-cigarette education.
        Tob Control. 2017; 26: 226-229
        • Chu K
        • Unger JB
        • Allem JP
        • et al.
        Diffusion of messages from an electronic cigarette brand to potential users through Twitter.
        PLoS One. 2015; 10
        • Schumacher KR
        • Lee JM
        Harnessing social media for child health research.
        JAMA Pediatr. 2016; 170: 5
        • Hébert ET
        • Case KR
        • Kelder SH
        • et al.
        Exposure and engagement with tobacco- and e-cigarette-related social media.
        J Adolesc Health. 2017; 61: 371-377
        • Marynak K
        • Gentzke A
        • Wang TW
        • et al.
        Exposure to electronic cigarette advertising among middle and high school students - United States, 2014-2016.
        MMWR Morb Mortal Wkly Rep. 2018; 67: 294-299
        • Soneji S
        • Yang J
        • Knutzen KE
        • et al.
        Online tobacco marketing and subsequent tobacco use.
        Pediatrics. 2018; 141e20172927
        • McPherson M
        • Smith-Lovin L
        • Cook JM
        Birds of a feather: homophily in social networks.
        Annu Rev Sociol. 2001; 27: 415-444
        • Culotta A
        • Ravi NK
        • Cutler J
        Predicting Twitter user demographics using distant supervision from website traffic data.
        J Artif Intell Res. 2016; 55: 389-408
        • Sloan L
        • Morgan J
        • Burnap P
        • et al.
        Who Tweets? Deriving the demographic characteristics of age, occupation and social class from Twitter user meta-data.
        PLoS One. 2015; 10e0115545
        • Cohen J
        A coefficient of agreement for nominal scales.
        Educ Psychol Meas. 1960; 20: 37-46
      5. Milgram S. The small-world problem: (400002009-005). 1967.

        • McPherson M
        • Smith-Lovin L
        • Cook JM
        Birds of a teather: homophily in social networks.
        Annu Rev Sociol. 2001; 27: 415-444
        • Newman MEJ
        Assortative mixing in networks.
        Phys Rev Lett. 2002; 89208701
        • Csardi G
        • Nepusz T
        The igraph software package for complex network research.
        InterJ, Complex Syst. 2006; 1695: 1-9
        • Soneji S
        • Yang J
        • Knutzen KE
        • et al.
        Online tobacco marketing and subsequent tobacco use.
        Pediatrics. 2018; 141e20172927
        • Cruz TB
        • McConnell R
        • Low BW
        • et al.
        Tobacco marketing and subsequent use of cigarettes, e-cigarettes, and hookah in adolescents.
        Nicotine Tob Res. 2018;
      6. Jenders M, Kasneci G, Naumann F. Analyzing and predicting viral tweets. In: WWW ’13 Companion Proc. 22nd Int. Conf. World Wide Web, Rio de Janeiro, Brazil 2013, 657–64.

      7. Twitter. About age screening on Twitter. 2018. Available at:

      8. Twitter. Tobacco and Tobacco Accessories. 2018. Available at:

        • Davis GF
        • Yoo M
        • Baker WE
        The small world of the American corporate elite, 1982-2001.
        Strateg Organ. 2003; 1: 301-326