Adolescent E-cigarette Use Increases Nicotine Exposure and Dependence Scores Over Time

E-cigarettes were introduced as a harm reduction product targeted to people who use cigarettes to reduce their exposure to toxins in smoke. Over the last few years, rates of adolescent e-cigarette use have risen exponentially and health consequences are poorly understood. This longitudinal study followed a cohort of 173 adolescents aged 13–18 with past-year e-cigarette use and documented trajectories of frequency of use, levels of nicotine exposure (measured via salivary cotinine), nicotine dependence scores (measured via the 10-item Penn State Electronic Cigarette Dependence Index), and preferred brands and flavors.

• 80% of participants were still using e-cigarettes at 12 month follow-up; the rate of daily use doubled from 15% to 30%.
• The mean frequency of use, nicotine exposure, and dependence scores all increased over time.
• Preference for the Juul device increased over time; fruit flavors were most popular at all time points.

Comments: For many adolescents, e-cigarette use is a first exposure to nicotine. While these products may represent “harm reduction” for some adult smokers, they appear to be more aptly named “harm introduction” for youth. The documented preference for one single product and high interest in flavored liquids may point the way to rational policy-making to protect youth.

Sharon Levy, MD, MPH

Reference: Vogel EA, Prochaska JJ, Ramo DE, et al. Adolescents’ e-cigarette use: increases in frequency, dependence, and nicotine exposure over 12 months. J Adolesc Health. 2019;64:770–775.