A new analysis published in Open JAMA Network by Massachusetts General Hospital (MGH) investigators in conjunction with a retired UCSF professor reveals continued and worsening e-cigarette addiction among adolescents in the United States.

In analyzing data from the Annual National Youth Smoking Survey, a nationally representative survey of middle and high school students in grades 6 through 12, researchers found that the prevalence of e-cigarette among youth had peaked in 2019 and then declined, but initiation to e-cigarette age declined between 2014 and 2021, and intensity of use and addiction increased after product introduction based on protonated nicotine

Protonated nicotine is created by adding acid to the e-cigarette liquid, which makes it easier to inhale the nicotine. Since Juul pioneered protonated nicotine, it has been widely adopted by other e-cigarette manufacturers.

Age at first use of e-cigarettes decreased by 1.9 months per year, while age at first use of cigarettes, cigars, and smokeless tobacco did not change significantly. In 2017, e-cigarettes became the most commonly used tobacco product.

E-cigarette nicotine addiction, measured as the likelihood of use within 5 minutes of waking up, an indicator of addiction, increased over time. In 2019, more young e-cigarette users used their first tobacco product within 5 minutes of waking up than cigarettes and all other products combined. The percentage of unique e-cigarette users who used e-cigarettes within 5 minutes of waking up was around 1% until 2017, but has since increased each year, reaching 10.3% of young people using their first e-cigarette within 5 minutes of waking up by 2021.

Median e-cigarette use also increased from 3-5 days per month in 2014-2018 to 6-9 days per month in 2019-2020 and 10-19 days per month in 2021.

Data from the recently released 2022 National Youth Tobacco Survey shows that 2.55 million teens use e-cigarettes and 27.6% of teens use e-cigarettes daily. The comparable figures reported in this document for 2021 were 2.1 million and 24.7%.

“The increasing intensity of use of modern e-cigarettes highlights the clinical need to treat youth addiction to these new high nicotine products in many clinical encounters,” says lead author Jonathan P Winickoff, MD, MPH, MGH pediatrician. and professor of pediatrics at Harvard Medical School.

In addition, stricter regulations, including comprehensive state and local bans on the sale of flavored tobacco products, such as voting YES to Proposition 31 in the November ballot in California, should be implemented. »

Stanton A. Glantz, study first author and retired professor, medicine, University of California, San Francisco


Massachusetts General Hospital

Journal reference:

Glantz, S. et al. (2022) Nicotine addiction and intensity of e-cigarette use among adolescents in the United States, 2014 to 2021. Open JAMA Network. doi.org/10.1001/jamanetworkopen.2022.40671.