Person using Vape

New study shows that vaping is more common among adolescents who use e-cigarettes within the first five minutes of waking up.

A new study shows that teens are using e-cigarettes less frequently than ever in recent years. However, they are vaping more often and starting earlier.

According to a study published Monday in JAMA Network Open, less than 1% of adolescents used e-cigarettes within the first five minutes after waking up. However, that percentage has risen to 10.3% between 2017 and 2017.

The study’s authors, who hail from San Francisco and Massachusetts General Hospital, wrote that the increase in intensity could be due to increased use of nicotine for self-medication.

“The pandemic was also a lost year in school-based prevention and treatment efforts. Therefore, abatement plans must be intensified to treat nicotine addiction in adolescents who have not had a year of contact with adults who could have helped them get treatment.

Researchers analyzed self-reported data taken from the US Centers for Disease Control and Prevention’s National Youth Tobacco Surveys and Youth Risk Behavior Surveillance Systems. There were 151,573 respondents to the survey, all middle and high school students in the United States.

Data showed that between 2014 and 2021, adolescents started to use e-cigarettes at a younger age and their intensity increased. They now use e-cigarettes on a greater number of days per month, ranging from nine days or less each month to ten or more.

Researchers found that the average age of first use for e-cigarettes decreased over time by approximately 1.9 months per year. However, it remained stable for other tobacco products. The survey respondents were 14.5 years of age.

According to data, among adolescents who use tobacco products, the proportion of those who first tried e-cigarettes at young age rose from 27.2% to 78.3% in 2014 and then remained at 77% for 2021.

“Concerning” trends in the intensity and frequency of use

In 2019, e-cigarette usage reached its peak and has since declined. However, e-cigarette use was higher than traditional cigarettes in 2019, with more users using e-cigarettes within five minutes of waking up.

Researchers wrote that the changes they observed in the survey study could be due to the increased nicotine delivery and addiction risk of modern e-cigarettes, which use protonated nicotine to make it easier to inhale.

“The growing use of modern electronic cigarettes highlights the need to treat youth addiction over many clinical encounters.” Additionally, stronger regulation should be implemented, including complete bans on the sale of flavored tobacco products.

The findings of this study suggest that e-cigarettes could be making a new generation of teenagers more susceptible to nicotine addiction. Research has also shown that adolescents may not know that most e-cigarettes contain nicotine. Ashley Merianos is a research affiliate member at Cincinnati Children’s Hospital Medical Center. She was not part of the new study.

“It is encouraging to see that the U.S. teens have decreased their use of e-cigarettes between 2019 and 2021,” Merianos stated in an email that the study’s findings on addiction and intensities of use are troubling, particularly since smoking is most commonly established in adolescence.

She said that early nicotine addiction could reverse the substantial tobacco control gains made over many years. “Currently, U.S. teens are smoking at an all-time low, but continued use of e-cigarettes could stop this progress,” she said.

The US Food and Drug Administration has banned all flavors of flavored cartridge-based electronic cigarettes, other than tobacco and menthol, from being sold in 2020. The researchers found that disposable flavored e-cigarettes gained popularity quickly after the ban. They are now urging clinicians to be alert for cases of nicotine addiction in young people.

The researchers concluded that tobacco addiction is a chronic condition and clinicians should be prepared to treat youths addicted to high-nicotine products in the course of many clinical encounters. “The growing use of modern electronic cigarettes highlights the need to have comprehensive bans at the local, state, and federal levels on the sale and distribution of flavored tobacco products. This should also be considered in the context of the possible end of the sale of these products on the open market.

Concern about more severe nicotine dependence

According to Dr. Scott Hadland (chief of adolescent medicine at Mass General for Children, Harvard Medical School), the new study is the first to look at nicotine use among adolescents during Covid-19. He was not part of the research.

“Most pediatricians aren’t sure what to expect in terms of teen nicotine use during these upheavals. But they were worried. Hadland stated in an email that this study “fills a large knowledge gap.”

He said that national data suggests that adolescents’ vaping may have decreased during the Covid pandemic. This is likely because teens often use substances with their peers and Covid socially isolated many teens. But in my clinic, I’ve noticed that teens who ‘do’ vape have a greater nicotine addiction than at any time in my practice.

Hadland said that the findings of the new study match his own experience, which includes the earlier age when youth begin to vape, the higher frequency of vaping, and the greater symptoms of addiction such as vaping in the early morning.

Teens who use vaping often consume high levels of nicotine throughout the day. This leads to increased nicotine dependence and a higher risk for addiction. Hadland explained in an email that teens often experience discomfort from nicotine withdrawal when they stop vaping.

He said, “I have found myself increasingly needing to take medications (e.g. varenicline pills or nicotine patches and nicotine gum or nicotine lozenges–and sometimes a combination thereof) to manage withdrawal symptoms in teens and help them quit.” This is a recent phenomenon.

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