Teens are becoming addicted to e-cigarettes younger; addictions are more intense: report

Story at a glance

• In 2021, more than 10 percent of adolescent e-cigarette users reported using the device within five minutes of waking up.

• That statistic, along with the drop in age when users are first introduced to the products, underscores the growing intensity of teen nicotine addiction in the United States.

• Findings are based on a survey of more than 150,000 adolescents.

New survey findings paint a harrowing picture of nicotine and e-cigarette addiction among American teenagers.

Between 2014 and 2021, the age at which adolescents first began using e-cigarettes dropped by nearly two months per calendar year while the age of initiation for other tobacco products remained the same.

At the same time, intensity of e-cigarette use and addiction increased so that by 2019, more e-cigarette users were using a tobacco product within five minutes of waking up compared with cigarette smokers and all other tobacco product users combined.

Between 2014 and 2017, less than 1 percent of e-cigarette users reported using the devices within five minutes of waking up, while by 2021 the total grew to 10.3 percent.

The results are based on a survey of 151,000 students in grades six to 12 with an average age of 15. Findings were published in the Journal of the American Medical Association.

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In 2021, 77 percent of adolescents who used any tobacco products reported their first product used was an e-cigarette — a steep increase from 27.2 percent of users who reported the same in 2014.

Furthermore, “for each year from 2019 to 2021, more current tobacco users were initiating use with e-cigarettes than all other products combined,” authors wrote. Frequency of e-cigarette use also increased over the study period, from nine or fewer days a month to 10 or more days a month.

Overall, between 2014 and 2021, adolescent e-cigarette addiction surpassed that for all other forms of tobacco products combined.

Researchers hypothesize the findings could be the result of more addictive products entering the market.

Early versions of e-cigarettes were less efficient at delivering nicotine compared with regular cigarettes. But the 2015 introduction of Juul products reversed that trend, as these products contained protonated nicotine — a substance that “increases addictive potential by making it easier to inhale quantities of nicotine that are difficult for naive users to achieve with cigarettes or earlier e-cigarettes.”

The many flavors of Juul products and other e-cigarette brands appealed to adolescents and teenagers. Although the FDA partially banned cartridge-based flavored products in 2020, disposable flavored protonated nicotine e-cigarettes soon took over the adolescent market, and the products continue to be popular among this demographic.

Survey findings prompted concern among researchers who say clinicians need to be prepared to address youth addiction. They also stress the need for stronger regulation of the industry, including “comprehensive bans on the sale of flavored tobacco products.”

Young adults’ and adolescents’ brains evolve and change as they age, meaning they are more susceptible to nicotine addiction.

However, despite the current findings, trends show fewer teens overall are using e-cigarettes. In 2019, it was estimated around 5.3 million middle and high-schoolers used the products; that total fell to 2.1 million in 2021 during the COVID-19 pandemic.

The decrease could have been due to the raising of the federal age to buy tobacco to 21, or increased campaigns targeting teens and highlighting the dangers of e-cigarettes.

While fewer social interactions during the COVID-19 pandemic may have led some teens to quit e-cigarettes, the increase in addiction intensity could be attributed to teens’ use of the products for anxiety or depression experienced throughout the crisis.

Notably, trends in teen use of e-cigarettes differ from those of adults, as data show fewer adults use the products altogether.

“These findings suggest that the primary effect of the modern e-cigarette has been to addict adolescents to nicotine,” authors wrote.

“Use of e-cigarettes reversed the long-term decline in US youth tobacco use and expanded the tobacco epidemic by attracting many adolescents at low risk of initiating nicotine use with cigarettes.”

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