Nicotine addiction and Intensity of e-Cigarette Use by adolescents in the US, 2014 to 2021.

Introduction:
This text provides an analysis of the National Youth Tobacco Surveys from 2014 to 2021, focusing on the use of e-cigarettes, cigarettes, and other tobacco products among US adolescents. The study aims to measure the intensity of use and dependence level over time.

Key Points:

* The study analyzed cross-sectional data from the National Youth Tobacco Surveys and the YouthBehavioral Risk Factor Surveillance System.
* The exposure of interest was the use of e-cigarettes and other tobacco products before and after the introduction of e-cigarettes delivering high levels of nicotine.
* The main outcomes measured were the first tobacco product used, age at initiation of use, intensity of use (days per month), and nicotine addiction (measured as time after waking to first use of any tobacco product).
* Prevalence of e-cigarette use peaked in 2019 and then declined.
* Between 2014 and 2021, the age at initiation of e-cigarette use decreased, and intensity of use and addiction increased.
* By 2017, e-cigarettes became the most common first product used (77.0%).
* age at initiation of use did not change for cigarettes or other tobacco products, and changes in intensity of use were minimal.
* By 2019, more e-cigarette users were using their first tobacco product within 5 minutes of waking than users of cigarettes and all other products combined.

Main Message:
The study's findings suggest that the changes in e-cigarette use patterns among US adolescents over time may reflect the higher levels of nicotine delivery and addiction liability of modern e-cigarettes that use protonated nicotine. 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. Stronger regulation, including comprehensive bans on the sale of flavored tobacco products, should be implemented to protect adolescents from the addictive potential of e-cigarettes.

Glantz S, Jeffers a, Winickoff JP. Nicotine addiction and Intensity of e-Cigarette Use by adolescents in the US, 2014 to 2021. JaMa network open. 2022;5(11):1. doi:10.1001/jamanetworkopen.2022.40671