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A spokesperson for Juul dismissed the Yale team's lab research, writing in a statement, "The researchers' hypothetical exposure analysis failed to take into account real world conditions, including realistic human exposure to vapor products like Juul." One of the chemicals that the FDA is considering adding to the list is diacetyl, which gives products a butter-like flavor

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It is worth noting that 37.5% of participant students started smoking cigarettes before the age of 12, as reported by other authors,12,25 but differently from the late initiation age (13 years) provided by the WHO report data and by other authors.2,28,29 The early initiation of tobacco use verified in our study constitutes an important prognostic factor for smoking-related diseases and as such it should be prevented at a very early stage.3 It is very concerning that 54% of the surveyed adolescents believe they will continue smoking in the next year, thus exposing themselves to the risks of becoming adult smokers.5 Moreover, the fact that 60.9% of the students reported finding very easy to get cigarettes when they wanted to smoke sends a clear warning that authorities have the responsibility to continue imposing limitations to tobacco use, raising tobacco-related taxes as recommended by the MPOWER program,7 and not ignoring the possibility of illegal selling of cigarettes to minors, as pointed out by other studies.30,31 Even though 88% of the youths were aware of the health consequences of smoking 1 to 5 cigarettes per day, we found out that more than half of them (56.2%) believe that it is safe to smoke for one or two years, and then quit smoking after this time