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Diagnoses were recorded using the International Classification of Diseases-9 (ICD-9) and ICD-10 coding system (eTable 3 in Supplement)

This is consistent with the epidemiological profile of larynx cancer in Reunion Island, France 35 and Brazil 19

A quarter of young people surveyed who ever used JUUL or e-cigarettes cited the perception that it is less harmful than other forms of tobacco, and slightly less 21 percent said they use JUUL because it gives them a buzz. Despite many using JUUL to feel the effects of nicotine, it is uncertain whether young people are aware of the nicotine content of the product