- Teens with symptoms of e-cigarette dependence are more likely to continue vaping and more often.
- Dependence symptoms for tobacco products include strong cravings to use, difficulty quitting, feeling addicted, and withdrawal symptoms, such as irritability or difficulty concentrating.
- Teens who reported at least one e-cigarette dependence symptom during the first survey in 12th grade were more likely to still be vaping 6 months later.
Nicotine is a highly addictive chemical. It’s what keeps most cigarette smokers smoking.
It may also drive young people to continue vaping and increase how often they use e-cigarettes, suggests a new
This is backed by earlier
But the authors of the new study say their research provides the “most detailed evidence to date” on e-cigarette dependence symptoms among teens, and shows how that dependence is connected to continued vaping.
In the new
Students took the surveys twice a year from 9th through 12th grades, answering questions about their use of tobacco and other substances as well as their mental health.
The fall survey in 12th grade also asked students whether they had experienced symptoms of dependence for either e-cigarettes or combustible cigarettes. Six months later students completed a follow-up survey.
Dependence symptoms for tobacco products include strong cravings to use, difficulty quitting, feeling addicted, and withdrawal symptoms, such as irritability or difficulty concentrating.
Researchers had full data on 444 students in 12th grade who reported using e-cigarettes in the past year, with or without nicotine. Slightly more than half of these past-year e-cigarette users were male.
Overall, a small number of vapers reported e-cigarette dependence symptoms: 11.7 percent of past-year e-cigarette users and 17.6 percent of past-month e-cigarette users.
Dependence symptoms, though, were around twofold higher in teens who smoked combustible cigarettes. The most common symptoms were similar for both types of tobacco products, such as cravings and urges.
Some teens in the new study had higher rates of dependence symptoms: those who had recently vaped, used e-cigarettes with nicotine, or were dual users of e-cigarettes and combustible cigarettes.
In addition, teens who reported at least one e-cigarette dependence symptom during the first survey in 12th grade were more likely to still be vaping 6 months later.
They also vaped more often and intensely compared with their peers who didn’t have any dependence symptoms.
This fits with an earlier study that found continued vaping is common among youth.
In that study, more than 80 percent of teens surveyed were still vaping 1 year later. During that time, the number of students who vaped daily had increased from 14.5 percent to 29.8 percent.
“Our study further suggests that youth with dependence symptoms are at elevated risk for continuation and escalation [of vaping],” write the authors of the new study.
One of the strengths of the study is that researchers followed students over several months, so they were able to see how vaping habits changed.
But the researchers relied on students to report how often they used e-cigarettes, which may not be entirely accurate.
They also surveyed students about e-cigarette dependence symptoms rather than using a clinical diagnosis.
While the researchers looked at e-cigarette dependence symptoms, “the dependency is for the nicotine, of which the e-cigarettes are packed with,” said Moe Gelbart, PhD, executive director of the Thelma McMillen Center at Torrance Memorial Medical Center in California, who wasn’t involved in the study.
Nicotine also drives continued use of combustible cigarettes for most smokers. But it’s not something that can’t be overcome.
Cigarette smoking rates have been falling for decades in both American adults and youth.
“Over long years of hard work, cigarette use by teenagers has decreased,” Gelbart said, “in part due to the health concerns and in part because smoking was deemed as ‘not cool.’”
Gelbart says this is partially due to marketing aimed at youth; flavors like mint, menthol, and fruit that make vaping more pleasurable; and the ability to easily conceal vaping devices from adults.
These factors may make it more likely that youth start vaping. And once they’ve started, nicotine keeps them coming back.
Like alcohol, heroin, and other addictive substances, nicotine “hijacks” the brain’s reward system.
Because the brain isn’t fully developed until around age 25, youth are especially vulnerable to nicotine addiction because their brains are more sensitive to reward.
“The developing brain will cause stronger and more lasting [nicotine] dependence in many youth,” Gelbart said. “Teens have and will become highly addicted to nicotine, and many eventually will turn to cigarette use.”
The new study didn’t look at how long it takes for teen vapers to develop dependence. That depends on many factors, including how often they vape, their genetics, and the amount of nicotine they’re getting.
The authors of the new study point out the study ended before JUUL and other pod mod–style e-cigarettes were widely used. These products deliver higher amounts of nicotine, which can increase dependence symptoms.
“I suspect that a fairly large chunk of daily [e-cigarette] users today are actually dependent or addicted. That’s because most of them use a JUUL, which delivers a very high dose of nicotine,” said Steven H. Kelder, PhD, MPH, Beth Toby Grossman distinguished professor in spirituality and healing at UTHealth School of Public Health in Austin, who wasn’t involved in the study.