These findings may reflect the increasing use of nicotine for self-medication in response to adolescent depression, anxiety, tic disorders, and suicidality that rose during the COVID-19 pandemic, the researchers wrote. “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,” said the senior author, Jonathan P. Winickoff, MD, MPH, a pediatrician at Massachusetts General Hospital and a professor of pediatrics at Harvard Medical School in Boston, in a press release.
Young People Who Use E-Cigarettes and Vaping Pens May Be More Likely to Become Daily Cigarette Smokers
Electronic cigarettes (e-cigarettes) and vape pens allow the user to inhale a vapor that may contain nicotine as well as flavorings, solvents, and other chemicals. They come in many forms, including cigarettes, pens, USB sticks, cartridges, and refillable tanks, pods, and mods. E-cigarettes and vape pens have not been approved by the U.S. Food and Drug Administration (FDA) as a smoking cessation method, but some people use them that way. It’s important to note that e-cigarettes have not been shown to be a safe or effective way to quit smoking, according to MedlinePlus. The use of e-cigarettes by young people may actually increase the likelihood of later cigarette smoking. A study published in February 2021 in Pediatrics found that adolescents and young adults ages 12 to 24 who used e-cigarettes were three times more likely to eventually become daily cigarette smokers.
Adolescents Start Using E-Cigarettes at a Younger Age
To explore the trends of e-cigarette use in adolescents, investigators used data from 151,573 individuals from the annual National Youth Tobacco Survey, a nationally representative survey of middle and high school students in grades 6–12. Researchers found that e-cigarette prevalence among youth peaked in 2019 then declined, but e-cigarette initiation age dropped between 2014 and 2021, and the intensity of use (how many e-cigarettes are used a day) and addiction increased (as measured by vaping or e-cigarette use within five minutes of waking) after the introduction of protonated nicotine products. Protonated nicotine is created by adding acid to the e-cigarette liquid, which makes the nicotine easier to inhale. According to a paper published in the journal Tobacco Control in October 2020, protonated nicotine has “likely made e-cigarette products vastly more addictive for never-smokers.” Age at first use of e-cigarettes has fallen by 1.9 months per year, while age at first use of cigarettes, cigars, and smokeless tobacco did not change significantly. By 2017, e-cigarettes had become the most common first tobacco product used.
More Youth E-Cigarette Users Are Using Within 5 Minutes of Waking, an Indicator of Addiction
By 2019 more young people were using e-cigarettes as their first tobacco product of the day within five minutes of waking than cigarettes and all other products combined. The percent of sole e-cigarette users who used e-cigarettes within five minutes of waking was only around 1 percent through 2017, but it has increased every year — by 2021, 10.3 percent of youth were using their first e-cigarette within five minutes of waking. The median amount of time spent in e-cigarette use also increased, rising from 3 to 5 days per month in 2014–2018 to 10 to 19 days per month in 2021.
New Data Indicates That the Number of Adolescents Using E-Cigarettes Has Gone Down
A bit of good news: The just released 2022 National Youth Tobacco Survey (those numbers weren’t included in this study) indicates that the percentage of adolescents using e-cigarettes daily continues to drop. In 2022, 2.55 million adolescents (27.6 percent) used e-cigarettes, compared with 2.1 million (24.7 percent) in 2021.
E-Cigarettes Expose Users to Toxic Chemicals
“We have known for many years now that vaping is likely safer than combustible tobacco, at least in laboratory studies, but it is not safe, and vaping exposes users to many toxic chemicals,” said Adam Goldstein, MD, MPH, a professor at UNC Family Medicine and the director of the tobacco intervention programs at the University of North Carolina School of Medicine in Chapel Hill; Dr. Goldstein was not involved in the new research. A few things to keep in mind when considering e-cigarettes, according to MedlinePlus:
There’s no evidence that e-cigarettes are safe to use over the long term.E-cigarettes may contain harmful substances such as heavy metals and cancer-causing chemicals.The ingredients in e-cigarettes are not labeled, so it is not clear exactly what’s in them, and it’s not known how much nicotine is in each cartridge.
