Abstract
INTRODUCTION: Before granting marketing authorization for electronic nicotine delivery systems (ENDS), the US Food and Drug Administration (FDA) must consider population risks and benefits associated with ENDS use. This study describes characteristics and usage patterns of individuals who use Juul or Vuse Alto to assess differences in product use. METHODS: A national, cross-sectional, online survey with US adults who use ENDS was conducted in 2022-2023 as the baseline component of a longitudinal study. Data from 503 people who regularly used either Juul (n=224) or Alto (n=279) were analyzed, including sociodemographic characteristics, cigarette smoking and quitting behaviors, ENDS use patterns, reasons for use, and risk perceptions. Chi-squared tests, ANOVA, and binary, ordinal, and multinomial logistic regression compared people who use each product. RESULTS: Those using Juul were less likely to have formerly smoked cigarettes than those using Alto (OR=0.50; 95% CI: 0.25-0.99), and those using Alto and currently smoking reported greater readiness to quit smoking cigarettes compared to those using Juul. People who used Juul and smoked cigarettes more often used Juul in places where they could not smoke compared with people using Alto. Those using Juul regularly were less likely to be over the age of 29 years (OR=0.47; 95% CI: 0.31-0.70) and more likely to come from racial/ethnic minoritized groups (34.1% vs 21.8%). People using Alto regularly consumed more e-liquid (6.6 mL vs 3.7 mL ) and those using Juul regularly used pods with higher nicotine content (OR=1.98; 95% CI: 1.25-3.14) than did those using Alto. CONCLUSIONS: We noted differences between people using Juul and Alto in sociodemographic characteristics and usage patterns of both cigarettes and ENDS. These data provide information about the potential impact of authorizing marketing of a new product on tobacco use behaviors.