Taking the measure of youth addiction to nicotine in the USA

The starting point for US policy towards e-cigarettes has been and continues to be the notion of an emerging epidemic of youth addiction to nicotine.  This epidemic is taken to be a matter of fact, and is evidenced by the recent rapid increase in past 30 day e-cigarette use in high school students, peaking at 27% in 2019. However, youth tobacco use in the USA is characterized by a diverse range of products, both combustible and non-combustible, traditional and novel,  with prevalence and patterns of use evolving rapidly over time.

The National Youth Tobacco Survey (NYTS) includes two well-established self-report indicators of nicotine dependence (craving for tobacco; time to first use of the day).  This paper reports NYTS data from high school students and examines self-reported dependence by product used and over time, and attempts to estimate the evolving overall burden of nicotine dependence in the whole population.  Dependence in otherwise tobacco-naïve e-cigarette users appears to be low, and there is little evidence for any substantial change in population burden of nicotine dependence over time as product preference has shifted from cigarettes towards e-cigarettes.

Click here to view powerpoint presentation