More teenage e-cigarette users report vaping within five minutes of waking up, study finds


Although the prevalence of e-cigarette use among teens has declined in recent years, those who vape are starting younger and using e-cigarettes more intensely, according to a new study.

Among teens who only use e-cigarettes, the percentage who used the products within the first five minutes of waking up was less than 1% between the years 2014 and 2017, but increased to 10.3% in 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 in response to the increase in adolescent depression, anxiety, tics, and suicidality that occurred during the COVID-19 pandemic,” the researchers – from San Francisco and Massachusetts General Hospital – wrote in the study.

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

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

Data showed that between 2014 and 2021, the age at which adolescents first started using e-cigarettes decreased and the intensity of their use increased – from nine days or less per month to 10 days or more per month. .

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

Among adolescents who currently use any type of tobacco product, the proportion whose first use of a product at a young age was an e-cigarette 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 in 2019, more e-cigarette users used within the first five minutes of waking up each day compared to traditional cigarette users.

“The changes detected in this study may reflect the higher levels of nicotine intake and addiction risk from modern e-cigarettes that use protonated nicotine to make the nicotine easier to inhale,” the researchers wrote.

“The increasing intensity of use of modern e-cigarettes highlights the clinical need to address youth addiction to these new high nicotine products in many clinical encounters. In addition, stricter regulations, including complete bans on the sale of flavored tobacco products, should be implemented. »

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

“It is encouraging to see that the prevalence of e-cigarette use has declined among American adolescents from 2019 to 2021. However, the patterns of addiction and intensity of use reported in this study are concerning, to especially since tobacco use is usually established during adolescence,” Merianos, who is also a researcher at the University of Cincinnati, said in an email.

“Unfortunately, early nicotine addiction could undo the significant progress in tobacco control made over many decades,” she said. “Currently, smoking is at an all-time high among American teens, but the continued initiation and use of e-cigarettes among teens could halt this progress.”

In 2020, the United States Food and Drug Administration banned electronic cigarettes made with 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 teens, and they urge clinicians to be on the alert for possible cases of nicotine addiction in teens. young people.

“Because tobacco addiction is a chronic condition, clinicians should be prepared to treat youth addiction to these new high-nicotine products over multiple clinical encounters,” the researchers wrote in their study. “The increasing intensity of modern e-cigarette use highlights the need for comprehensive local, state and federal bans on the sale of flavored tobacco products and consideration of 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 look at nicotine use in adolescents during the Covid-19 pandemic, said Dr. Scott Hadland, chief of adolescent and young adult medicine at the Mass General for Children and the Harvard Medical School, which was not involved in the new research.

“Most of us pediatricians didn’t know what to expect when it came to teenage nicotine use amidst this upheaval – but we were worried. This study fills a large knowledge gap,” Hadland said in an email.

“National data suggests teen vaping may have declined during the Covid pandemic – we suspect substance use often occurs when teens are among peers, and Covid has socially isolated many teens,” said he declared. “But in my clinic, I found that teenagers who ‘vaped’ showed more severe nicotine addiction now than in all my years of practice. »

Hadland added that the new study results are consistent with what he has seen first-hand in his own practice, including the earlier age at which young people start using e-cigarettes, higher frequency of use and more significant addictive symptoms, such as vaping first. morning thing.

“Teenagers who vape often receive high levels of nicotine throughout the day, leading to greater nicotine dependence and risk of addiction. As a result, I regularly see teens who experience uncomfortable withdrawal from nicotine if they try to quit vaping, as well as strong cravings for use,” Hadland said in the email.

“I increasingly need to use medications (eg varenicline pills, nicotine patches and nicotine gum or lozenges – and often a combination of these) to manage withdrawal symptoms and cravings in teens to help them quit,” he said. “This is all a phenomenon of recent years.”


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