Experts analyze the intensity of use and addiction to e-cigarettes

Experts analyze the intensity of use and addiction to e-cigarettes

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

Analyzing data from the annual National Youth Tobacco Survey, a nationally representative survey of middle and high school students in grades 6 through 12, researchers found that e-cigarette prevalence among youth peaked in 2019 and then declined, but e-cigarette initiation by age declined between 2014 and 2021, and intensity of use and use Addictions increased after the introduction of protonated nicotine products

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

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. Until 2017, e-cigarettes were the most commonly used first tobacco product.

E-cigarette nicotine addiction, measured as the likelihood of use within 5 minutes of waking, an indicator of addiction, increased over time. As of 2019, more youth e-cigarette users consumed their first tobacco product within 5 minutes of waking than cigarettes and all other products combined. The percentage of sole e-cigarette users who used e-cigarettes within 5 minutes of waking up was about 1% by 2017, but then increased each year, reaching 10.3% of youth using their first e-cigarette within 5 minutes of waking by 2021.

Average 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.

Recently released 2022 National Youth Tobacco Survey data shows that 2.55 million youth use e-cigarettes and 27.6% of youth use e-cigarettes daily. The comparable figures reported in this paper for 2021 were 2.1 million and 24.7%.

“The increasing intensity of modern e-cigarette use highlights the clinical need to address adolescent addiction to these new high-nicotine products over the course of many clinical encounters,” says senior author Jonathan P. Winickoff, MD, MPH, a pediatrician at MGH and professor of pediatrics at Harvard Medical School.

In addition, stricter regulations should be implemented, including comprehensive state and local bans on the sale of flavored tobacco products, such as the yes vote on Proposition 31 on California's November ballot.

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

Source:

Massachusetts General Hospital

Reference:

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

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