Study Shows Teen E-Cigarette Use Increasing in Intensity and Addiction

According to a new study published in JAMA Network Open, conducted by researchers from Massachusetts General Hospital (MGH) in collaboration with retired professor Stanton A. Glantz from the University of California, San Francisco, while the prevalence of teenage smoking has decreased in recent years, those who do smoke are starting at a younger age and using e-cigarettes more frequently.

According to an analysis of data from the National Youth Tobacco Survey (a nationally representative survey of middle and high school students in grades 6-12), researchers have found that the popularity of e-cigarettes among adolescents peaked in 2019 and then declined. However, the age of initiation for e-cigarettes has decreased between 2014 and 2021, and usage intensity and addiction have increased with the introduction of protonated nicotine products.

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

The age at which people first try electronic cigarettes is decreasing by 1.9 months each year, while the age at which people try traditional cigarettes, cigars, and smokeless tobacco has remained stable. By 2017, electronic cigarettes had become the most commonly tried tobacco product for the first time.

Nicotine addiction associated with e-cigarettes is measured by the likelihood of use within the first five minutes of waking up, which is an indicator of addiction that increases over time. In 2019, more young e-cigarette users were using their first tobacco product within the first five minutes of waking up than cigarettes and all other products combined. In 2017, the percentage of e-cigarette users who used it within the first five minutes after waking up was about 1%, but increased annually and by 2021, 10.3% of young people were using their first e-cigarette within the first five minutes of waking up.

The median usage of electronic cigarettes has increased from 3 to 5 days per month between 2014 and 2018 to 6 to 9 days per month between 2019 and 2020, and further to 10 to 19 days per month in 2021.

The recently released 2022 National Youth Tobacco Survey data has revealed that 2.55 million teenagers are using e-cigarettes, with 27.6% of them using it every day. Comparable figures for 2021, as reported in this article, are 2.1 million and 24.7%.

The increasing intensity of use of modern e-cigarettes highlights the clinical need to address adolescent addiction to these new high-nicotine products in many clinical settings," said senior author, pediatrician at MGH and professor of pediatrics at Harvard Medical School, Jonathan P. Winickoff, in a news statement.

Stanton A. Glantz, a retired medical professor from the University of California, San Francisco and first author, stated, "In addition, stronger regulations should be implemented, including statewide and local bans on the sale of flavored tobacco products, such as voting in favor of Proposition 31 in California in November.

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