Nicotine Addiction and Intensity of e-Cigarette Use by Adolescents in the US, 2014 to 2021

Abstract

ImportanceAs e-cigarettes have become more effective at delivering the addictive drug nicotine, they have become the dominant form of tobacco use by US adolescents.ObjectiveTo measure intensity of use of e-cigarettes, cigarettes, and other tobacco products among US adolescents and their dependence level over time.Design, Setting, and ParticipantsThis survey study analyzed the cross-sectional National Youth Tobacco Surveys from 2014 to 2021. Confirmatory analysis was conducted using Youth Behavioral Risk Factor Surveillance System from 2015 to 2019. The surveys were administered to national probability samples of US students in grades 6 to 12.ExposuresUse of e-cigarettes and other tobacco products before and after the introduction of e-cigarettes delivering high levels of nicotine.Main Outcomes and MeasuresFirst tobacco product used, age at initiation of use, intensity of use (days per month), and nicotine addiction (measured as time after waking to first use of any tobacco product).ResultsA total of 151 573 respondents were included in the analysis (51.1% male and 48.9% female; mean [SEM] age, 14.57 [0.03] years). Prevalence of e-cigarette use peaked in 2019 and then declined. Between 2014 and 2021, the age at initiation of e-cigarette use decreased, and intensity of use and addiction increased. By 2017, e-cigarettes became the most common first product used (77.0%). Age at initiation of use did not change for cigarettes or other tobacco products, and changes in intensity of use were minimal. By 2019, more e-cigarette users were using their first tobacco product within 5 minutes of waking than for cigarettes and all other products combined. Median e-cigarette use also increased from 3 to 5 d/mo in 2014 to 2018 to 6 to 9 d/mo in 2019 to 2020 and 10 to 19 d/mo in 2021.Conclusions and RelevanceThe changes detected in this survey study may reflect the higher levels of nicotine delivery and addiction liability of modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale. The increasing intensity of use of modern e-cigarettes highlights the clinical need to address youth addiction to these new high-nicotine products over the course of many clinical encounters. In addition, stronger regulation, including comprehensive bans on the sale of flavored tobacco products, should be implemented.

E-cigarettes and asthma in adolescents

“…The authors of this study postulate that high concentrations of nicotine increased tolerability of e-cigarettes and nicotine addiction over time [23]. Glantz et al [24] analysed NYTS trends and found e-cigarettes adolescent use intensity increased from 2014 to 2021, from 3 to 5 days/month in 2014 to 10 to 19 days/month in 2021, accompanied by reduced time between morning waking and first e-cigarettes use.…”

Elevated rates of systemic inflammation among adolescents pervade geography and time: A systematic review and meta-analysis of global mean C-reactive protein levels

“…Another explanation could be the general improvement of the world economy between 2011-2019; the majority of countries worldwide either saw no changes or a decline in the proportion of their population living below the poverty line. (153) While neither body size nor the intake of western UPF has declined, these may be mitigated by reductions in other economically driven risk factors for inflammation, such as smoking (154) and psychosocial stressors.…”

Quick nic: novel smokeless nicotine products and pediatric trends

“…From 2014 to 2021, the proportion of users who used their first e-cigarette within 5 min of waking rapidly increased more than 10-fold. The results also tested the intensity of nicotine use and found that the median use of e-cigarettes has grown astonishingly from 3 to 5 days per month in 2014-2018 to 10 to 19 days per month in 2021 [61]. Despite all efforts to combat addiction, the prevalence of nicotine appears to be growing as addiction remains a clear threat for adolescents.…”