BOSTON — E-cigarettes are getting young children hooked on nicotine. According to new research, some adolescents who vape are as young as 11.
Researchers from the Massachusetts General Hospital for Children say these devices are more addictive than real cigarettes, with some school-age users vaping within five minutes of getting up in the morning.
The phenomenon has been blamed on a smoother, more palatable form of the addictive substance, known as “nicotine salts” or “protonated nicotine.”
“The changes detected in this survey study may reflect the higher levels of nicotine delivery and addiction liability,” writes corresponding author Professor Jonathan Winickoff and the team in the journal JAMA Network Open.
A recent government report revealed that at least 2.6 million U.S. children are hooked on e-cigarettes.
“Modern e-cigarettes that use protonated nicotine to make nicotine easier to inhale,” the team adds.
The findings are based on more than 151,000 sixth to 12th graders tracked between 2014 and 2021.
“Age at initiation of e-cigarette use decreased and intensity of use and addiction increased between 2014 and 2021,” the team reports. “By 2019, more e-cigarette users were using their first tobacco product within 5 minutes of waking than users of cigarettes and all other tobacco products combined.”
“These findings suggest that clinicians need to be ready to address youth addiction to these new highly addictive nicotine products during many clinical encounters, and stronger regulation is needed, including comprehensive bans on the sale of flavored tobacco products.”
E-cigarettes continue to market to younger users
In October 2022, the Centers for Disease Control and Prevention found use among middle or high school students rose by 500,000 (24%) since 2021. Super-strength disposable devices — like Elf bars — are the most popular (55%). Moreover, most children in the study (85%) have used flavored e-cigs at some point.
They are often sold in glossy displays and come in a variety of colors, with child-friendly names and flavors such as bubble-gum, jellybeans, and strawberry milkshake.
“Early e-cigarettes did not deliver nicotine as efficiently as cigarettes because they delivered freebase nicotine that was hard to inhale,” study authors write. “This situation changed with the 2015 introduction of Juul products (Juul Labs Inc.), which added benzoic acid to the nicotine e-liquid to lower the pH level and form protonated nicotine.”
The San Francisco start-up that invented the trendy devices found the adjustment was more efficient at captivating users with the first use. They have reversed the long-term decline in U.S. youth tobacco use, attracting many adolescents at low risk of initiating nicotine use with cigarettes.
The pandemic increased youth e-cigarette use
“Despite the COVID-19 pandemic leading to people being socially isolated, students being out of school, and the increased risk of adolescents and young adults contracting COVID-19 with e-cigarette use, intensity of use among adolescents continued to increase,” researchers explain.
“This increase in intensity may reflect increasing use of nicotine for self-medication in response to increases in adolescent depression, anxiety, tic disorders, and suicidality that occurred during the COVID-19 pandemic. The pandemic has also been a lost year for school-based prevention and treatment efforts, meaning that abatement plans will need to be intensified to address the nicotine addiction in those adolescents who missed a year of contact with adults who might have otherwise helped them get treatment,” the team concludes.
Study authors recommend that clinicians question all their patients about nicotine and tobacco product use, including e-cigarettes and other new nicotine products. Studies show that vaping has become a gateway to nicotine addiction for teens, as many who take it up have never smoked before.
South West News Service writer Mark Waghorn contributed to this report.