Elsevier

Addictive Behaviors

Volume 82, July 2018, Pages 109-113
Addictive Behaviors

Short Communication
Adolescents' understanding and use of nicotine in e-cigarettes

https://doi.org/10.1016/j.addbeh.2018.02.015Get rights and content

Highlights

  • Adolescents may not know whether their e-cigarettes contain nicotine.

  • We recruited a sample of e-cigarette–using adolescents through social media.

  • Youth who used without nicotine (29%) had worse knowledge of e-cigarette chemicals.

  • Most youth mistakenly believed the nicotine was artificial, not made from tobacco.

  • Educational efforts could help youth understand e-cigarette chemicals and risks.

Abstract

Introduction

Nicotine harms adolescent brain development and contributes to addiction. Some adolescents report using nicotine-free e-cigarettes, but the accuracy of their reporting is unclear. We explored adolescents' use of nicotine-free e-cigarettes and understanding of chemicals in e-cigarettes, including nicotine.

Methods

Using social media, we recruited 1589 US adolescents (aged 15–17) who reported past 30-day use of e-cigarettes in 2016. We assessed perceptions of the nicotine source in e-liquid and whether e-cigarette aerosol is just “water vapor.” We explored differences among adolescents who usually used e-cigarettes with nicotine (n = 473) and without nicotine (n = 452). We used weights to calibrate our sample to the Youth Risk Behavior Survey.

Results

Twenty-nine percent usually used e-cigarettes without nicotine, 28% with nicotine, 39% with “both,” and 5% were “not sure.” Few participants (17% of non-nicotine users vs. 34% of nicotine users, p < .001) understood the nicotine was derived from tobacco. Youth who thought e-cigarette aerosol was just water vapor were more likely to usually use without nicotine. Older adolescents and current tobacco users were less likely to usually use without nicotine.

Conclusions

The adolescents who reported usually using e-cigarettes without nicotine had poorer knowledge of e-cigarettes. This lack of understanding could contribute to inaccurate reporting of nicotine use. Most youth thought the nicotine in e-cigarettes was artificial, potentially indicating a belief that this nicotine is “safer.” The US Food & Drug Administration will require nicotine warnings on e-cigarettes in 2018; a complementary educational campaign could address youths' misperceptions about nicotine and other chemicals in e-cigarette aerosol.

Introduction

Rates of use of electronic cigarettes (e-cigarettes) and other electronic vaping products among adolescents increased dramatically from 2011 to 2015 (Singh et al., 2016), although the trend may have leveled off in 2016 (Miech, Johnston, O'Malley, Bachman, & Schulenberg, 2017). E-cigarette use can be detrimental to adolescents because it exposes them to harmful constituents in aerosol such as formaldehyde (Goniewicz, Hajek, & McRobbie, 2014) and nicotine, a chemical that contributes to addiction and harms adolescent brain development (US Department of Health and Human Services, 2012). Using e-cigarettes may or may not serve as a “gateway” to other tobacco use (Etter, 2017; Barrington-Trimis, Urman, Berhane, et al., 2016).

Adolescents' reports of using nicotine-containing versus nicotine-free e-cigarettes are inconsistent. A 2014 study found that, among Connecticut youth who used e-cigarettes, 29% typically used e-liquid without nicotine, 37% used e-liquid with nicotine, and 34% did not know if the e-liquid they used contained nicotine (Morean, Kong, Camenga, Cavallo, & Krishnan-Sarin, 2015). In contrast, in the 2015 Monitoring the Future (MTF) study, two-thirds of middle and high school students stated that the “mist” from the last e-cigarette they used contained “just flavoring” rather than nicotine, marijuana or hash oil, other substances, or unknown substances (“don't know”) (Miech, Patrick, O'Malley, & Johnston, 2017). Given that adolescents have difficulty differentiating types of vaping products and their characteristics (Wagoner et al., 2016), and even adults are often unsure of the amount of nicotine in the e-cigarettes they use (Hinds III, Loukas, Chow, et al., 2016; Kim, Davis, Dohack, & Clark, 2017), the accuracy of adolescents' self reports of nicotine use is unclear.

Given the potential for nicotine to cause long-lasting developmental effects on adolescents (US Department of Health and Human Services, 2012), it is important to understand whether adolescents can appropriately self-report use of non-nicotine e-cigarettes as well as determine their general understanding of nicotine and other chemicals in e-cigarettes. This study explored these issues among adolescents in a convenience sample of current e-cigarette users.

Section snippets

Procedures

We recruited adolescents through advertisements on Facebook and Instagram. Eligible participants were aged 15–17, were currently living in the United States, provided a valid email address, and reported use of an e-cigarette at least once in the past 30 days. We screened out fraud and poor response quality based on similarities in email addresses and responses to an attention check. The study was approved by RTI International's Institutional Review Board. Pepper et al. provide additional

Results

Of all qualified respondents (n = 1589), 29.1% stated that they usually used non-nicotine e-liquid, while 27.6% reported they usually used e-liquids with nicotine, 38.7% reported ‘both,’ and 4.5% reported ‘not sure’ or preferred not to answer. Most respondents were male (51.8%), aged 15 or 16 (63.8%), and non-Hispanic white (52.6%). Just over half (52.7%) had smoked cigarettes in the past 30 days, and fewer reported using little cigars/cigarillos (20.2%) or OTPs (24.3%). Most respondents used

Discussion

Two-thirds (66.3%) of respondents usually used e-cigarettes with nicotine or as often with nicotine as without. This rate of nicotine use is similar to that reported in a survey of Connecticut adolescents (Morean et al., 2015) and higher than the rate reported in the MTF study (Miech et al., 2017). This contrast might result from a difference in question wording: the survey of Connecticut adolescents asked about typical use, as this study did, while the MTF study asked about most recent use.

Role of funding sources

This work was supported by Strategic Investment Funds from RTI International. RTI International employs the authors but had no other role in study design, reporting, the interpretation of findings, or the decision to submit the manuscript.

Contributors

Dr. Farrelly designed the study. Drs. Farrelly and Pepper conceptualized the manuscript. Ms. Watson conducted the statistical analysis. Dr. Pepper and Ms. Watson wrote the first draft of the manuscript, and all authors contributed to and have approved the final manuscript.

Conflicts of interest

All authors declare that they have no conflicts of interest.

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