More e-cigarette users report vaping within five minutes of waking up, the study found


Although the prevalence of e-cigarette use among teenagers has fallen in recent years, vapers are younger and using e-cigarettes more intensively, a new study suggests.

Among teens who only use e-cigarettes, the percentage who used the product within the first five minutes of waking up was less than 1% between 2014 and 2017, but that changed to 10.3% from 2017 to 2021, according to the study published Monday in the medical journal JAMA Network Open.

“This increase in intensity may reflect the increasing use of nicotine for self-medication, adolescent depression, anxiety, tic disorders, and suicidality in response to the increase that occurred during the COVID-19 pandemic,” researchers from San Francisco and Massachusetts General Hospital. – he wrote in the exam.

“The pandemic has also been a lost year for school-based prevention and treatment efforts, meaning that reduction plans will need to be stepped up to address nicotine addiction among adolescents who lost a year of contact with adults who might otherwise have helped them. Treatment.”

The researchers analyzed self-report data from the US Centers for Disease Control and Prevention’s National Youth Tobacco Surveys and the Youth Risk Behavior Surveillance System. The data included a total of 151,573 survey respondents, all from middle or high schools in the United States.

The data showed that between 2014 and 2021, the age at which teenagers started using e-cigarettes decreased and the intensity of their use increased, from using e-cigarettes nine or fewer days per month to 10 or more days per month. .

The researchers found that the average age at first use got younger over time, about 1.9 months per calendar year, for e-cigarettes, but remained stable for other tobacco products. The average age of those who answered the survey was 14.5 years.

Among adolescents who currently use any type of tobacco product, the proportion who used an e-cigarette for the first time as a youth increased from 27.2% in 2014 to 78.3% in 2019, and remained at 77% in 2021. according to the data

The overall prevalence of e-cigarette use peaked in 2019 and then declined. But by 2019, more e-cigarette users were using them within the first five minutes of waking each day compared to traditional cigarette users.

“The changes detected in this survey study may reflect greater nicotine delivery and addiction liability in modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale,” the researchers wrote.

“The increasing use of modern electronic cigarettes highlights the clinical need to address youth addiction to these new high-nicotine products across multiple clinical encounters. In addition, stronger regulations should be implemented, including comprehensive bans on the sale of flavored tobacco products.”

The findings of this study suggest that e-cigarettes may put a new generation of teenagers at risk for nicotine addiction, and research has shown that many teens are unaware that most e-cigarettes contain nicotine, said Ashley Merianos, a research associate at Cincinnati Children’s. Hospital Medical Center and the Thirdhand Smoke Research Consortium, which were not involved in the new study.

“It is encouraging that the prevalence of e-cigarette use among US adolescents decreased from 2019 to 2021. However, the addiction and use trends reported in this study are concerning, especially since tobacco is commonly established during adolescence,” Merianos. he said in an email.

“Unfortunately, early nicotine addiction can reverse important tobacco control progress made over many decades,” he said. “Currently, cigarette smoking is at a low level among US teens, but the initiation and use of e-cigarettes among teens may halt this progress.”

In 2020, the US Food and Drug Administration banned e-cigarettes based on flavored cartridges other than tobacco or menthol from the market. But the researchers noted in their study that after the ban, disposable flavored e-cigarettes quickly gained popularity among teenagers, and they are urging doctors to be on the lookout for cases of nicotine addiction among young people.

“Because tobacco dependence is a chronic disease, clinicians should be prepared to address addiction to these new high-nicotine products during many clinical encounters,” the researchers wrote in their study. “The increasing intensity of use of modern electronic cigarettes highlights the need for comprehensive local, state and federal bans on the sale of flavored tobacco products and to consider ending the sale of these products on the open retail market, as has been done in 47 countries from 2021.

The new study is among the first to examine nicotine use among adolescents during the Covid-19 pandemic, said Dr. Scott Hadland, chief of adolescent and youth medicine at Mass General for Children and Harvard Medical School, who was not involved in the new study. research

“Most of us pediatricians don’t know what to expect in terms of adolescent nicotine use amid these fluctuations, but we were concerned. This study fills a huge knowledge gap,” Hadland said in an email.

“National data suggests that teen vaping has declined during the Covid pandemic, we suspect that substance use occurs more often when teens are among their peers, and that Covid isolates many teens socially,” he said. “But in my clinic, I’m seeing that teenagers who vape show more severe nicotine addiction than in all my years of practice.”

Hadland added that the study’s new findings are consistent with what he has seen on the front lines of his practice, including younger people starting to use e-cigarettes at an earlier age, greater frequency of use, and greater symptoms of addiction, such as the first vape. thing in the morning

“Teenagers who vape often receive high levels of nicotine throughout the day, which leads to greater nicotine dependence and the risk of addiction. As a result, I commonly see teens experiencing uncomfortable nicotine withdrawal if they try to stop vaping, as well as strong urges to use,” he said. Hadland in email.

“I have increasingly had to use medications (such as vareline tablets, nicotine patches and nicotine gum or lozenges, and often a combination of these) to manage withdrawal symptoms and cravings in teenagers to help them quit,” she said. “All this is a phenomenon of recent years.”