Half of young daily vapers now reach for the strongest nicotine, UC San Diego study finds
By 2022, 49.2 percent of Americans ages 18 to 24 who vaped daily were using e-cigarettes at 4 percent nicotine or higher, up from about 3 percent in 2017. The UC San Diego led analysis, published Tuesday in Tobacco Control, ties the high-strength products to deeper dependence and lower odds of quitting.
SAN DIEGO: The strongest vapes on the American market have become the default choice of the youngest people who use them every day. An analysis led by UC San Diego researchers and published Tuesday in the journal Tobacco Control found that by 2022, just under half of daily vapers ages 18 to 24 were using e-cigarettes with nicotine concentrations of 4 percent or more, the study's definition of high nicotine. Five years earlier, that share was about one in thirty.
The team, led by John P. Pierce of the university's Herbert Wertheim School of Public Health and Human Longevity Science and its Moores Cancer Center, worked from the Population Assessment of Tobacco and Health Study, a nationally representative federal survey. They compared four waves of the study, in 2017, 2019, 2021 and 2022, each drawing samples above 30,000 people and capturing between 3,000 and 4,000 who vaped, and then followed 2,356 adults who vaped in 2019 through to 2022 to see how their dependence changed.
The climb, by age
Among daily vapers ages 18 to 24, high-nicotine use ran at just over 3 percent in 2017, passed 40 percent in 2019 and reached 49.2 percent in 2022. The comparable figure for daily vapers ages 55 and older in 2022 was 4.5 percent. Across everyone who vaped in 2022, the odds of using a high-nicotine product were 15 times higher for the youngest adults than for the oldest group. The shift sits inside a broader rise: the share of 18 to 24 year olds who vaped at all grew 80 percent over the study period, from just over 10 percent to nearly 19 percent, and the share of those users vaping daily roughly doubled, to 55.5 percent. When the researchers compared people using the same brands, Vuse and JUUL among them, the youngest adults still chose the high-nicotine versions more than twice as often as adults 25 and older.
Dependence caught up with smoking
The follow-up is where the study turns from preference to consequence. In 2017, dependence scores among young adults who only vaped sat well below those of peers who only smoked. By 2022, the authors report, that difference had disappeared. People who used high-nicotine products in 2019 showed a measurable rise in dependence by 2022 and had 31 percent lower odds of vaping abstinence. High-nicotine users were also more likely to vape daily in the first place. The context is a market that changed shape mid-study: monthly U.S. e-cigarette sales held near six to seven million units from 2014 to late 2017, then tripled past 20 million a month by 2021 as smoother, stronger 5 percent products took over.
The authors are explicit about the limits. The work is observational and cannot by itself establish cause and effect, and a substantial share of users, between about a fifth and a third depending on the year, did not know the strength of what they were vaping. The study was funded by the Tobacco-Related Disease Research Program of the University of California. Their conclusion is aimed at federal regulators: the paper closes by saying the Food and Drug Administration's balancing of the benefits of these products against their harms "needs to be reassessed."
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