Nicotine Dependence Can Be Measured in Adolescent E-Cigarette Users

Adolescents are more likely to use e-cigarettes (“vape”) than to smoke cigarettes, yet there are no data on whether e-cigarette users demonstrate nicotine dependence. To investigate this issue, investigators administered an anonymous survey about tobacco product use to almost 3000 high school students that included a four-item measure of nicotine dependence validated in adult vapers. The items were (paraphrased here): craving gets intolerable if I haven't vaped for a few hours, I drop everything to get e-cigarettes, I vape more before going into a situation where vaping isn't allowed, and I reach for e-cigarettes without thinking about it. Response options ranged from “never” to “almost always.”

Among 520 students reporting past-month vaping (50% female; mean age, 16 years; 85% white), the mean age at first e-cigarette use was 14.5 years, and 22% also smoked cigarettes. On average, students vaped on 13 of the past 30 days, and three fourths reported use of nicotine e-liquid. The mean e-cigarette dependence score (range, 0–4) was 2.3, and older current age, younger age at initiation of vaping, vaping more frequently, using nicotine e-liquid, and concomitant cigarette smoking were each associated with a higher score.