High-nicotine e-cigarettes lead to more smoking and vaping

Compared with adolescents who use e-cigarettes with relatively low or no nicotine concentrations, those who use e-cigarettes with higher nicotine concentrations are more likely to progress to more frequent and intense combustible cigarette smoking and vaping.

This was the major finding of surveys of 181 10th-grade students from 10 California high schools who were followed for 6 months after reporting vaping in the previous 30 days. At the study’s start, 35% of participants had used cigarettes within the past 30 days in addition to vaping, and 59.7% had vaped a solution with nicotine. Of the latter, 52 used a low-nicotine concentration, 35 a medium concentration, and 21 a high-nicotine concentration.

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Six months later, survey responses showed that each 1-level increase in baseline nicotine concentration increased by 2.43 times the odds of participants’ reporting frequent smoking in the past 30 days and the odds of frequent vaping by 1.73 times. This association remained after adjusting for demographic factors and risk factors for vaping and smoking.

Investigators found little difference in how many cigarettes teenagers who did not vape nicotine smoked each day and those who vaped low- or medium-nicotine concentrations at baseline. Those who vaped high-nicotine concentrations, however, smoked 14.2 times as many cigarettes per day as peers who did not vape nicotine (Goldenson NI, et al. JAMA Pediatr. 2017;171[12]:1192-1199).

Thoughts from Dr. Burke

As vaping rates rise, rates of adolescent use of combustible cigarettes have continued to fall. My fear is that a generation of vaping adolescents, once they cement in place their nicotine addiction, will become a new wave of conventional cigarette-using adults. Do your patients know the nicotine concentration of the liquids they use to vape? Continue to ask your patients about smoking and vaping, and continue to make strong, clear recommendations against both.