Do Adolescents Understand What They’re Vaping?

In the last 3 years, there has been a drastic shift in how U.S. adolescents use tobacco and nicotine. More adolescents now “vape” (that is, use e-cigarettes and similar devices) than smoke cigarettes. Many, but not all, of the liquids that can be used to fill vaping devices, contain nicotine. Although all vaping is harmful to adolescents, there may be additional harm posed by vaping with nicotine.

Nicotine harms adolescent brain development and, if youth become addicted nicotine through vaping, they might be more likely to use cigarettes and other tobacco products in the future. The current study provides some evidence that youth may not understand whether they are vaping with or without nicotine.

How was this study conducted?

In 2016, we used Facebook to recruit 1,589 US adolescents aged 15-17 who reported using e-cigarettes in the past 30 days. These adolescents completed an online survey assessing a variety of tobacco use behaviors, including items asking whether they usually vape with nicotine, without nicotine, or both. The survey also asked about their understanding of nicotine and other chemicals in the liquids in vaping devices.

What did the study find?

Most adolescents vaped with nicotine at least some of the time (28% said they usually vaped with nicotine and 39% vaped with both with and without nicotine). Older adolescents and adolescents who smoked cigarettes or used other tobacco products were more likely to vape with nicotine.

Misinformation about nicotine was common. Only about one-quarter of respondents knew that the nicotine in e-cigarette liquids is derived from tobacco plants. Most incorrectly believed the nicotine was made artificially in a lab or weren’t sure where the nicotine came from. Adolescents who claimed that they usually vaped without nicotine were especially like to answer the question about nicotine source incorrectly. Most adolescents understood that the aerosol produced by vaping is not “just water vapor”; however, adolescents who usually vaped without nicotine were slightly less likely than those who usually vaped with nicotine to understand this key fact.

When asked how they knew if a vaping liquid contained nicotine, adolescents who usually vaped without nicotine had greater difficulty responding. They were less likely than adolescents who usually vaped with nicotine to understand the connection between using nicotine and feeling a buzz and more likely to say that they were not sure how to tell if a liquid had nicotine.

Why do these findings matter?

Any kind of vaping among adolescents is a major public health problem, but the behavior poses additional concerns when it involves nicotine. These study results suggest that most adolescents lack basic information about the nicotine in e-cigarettes and often believe it is made artificially in laboratories, rather than coming from tobacco plants.

Although synthetic nicotine is commercially available in the United States, it is expensive and rare. The preponderance of youth who believe that the nicotine in vaping liquid is synthetic is concerning because these adolescents may believe that this nicotine is “safer” than the nicotine in other tobacco products. Adolescents who claim to usually vape without nicotine are less likely to answer questions about nicotine correctly, calling into question their ability to accurately report their behavior. These adolescents might be vaping with nicotine without realizing it.

These findings are described in the article Adolescents’ understanding and use of nicotine in e-cigarettes, recently published in the journal Addictive Behaviors. This work was conducted by Jessica Pepper, Matthew Farrelly, and Kimberly Watson at RTI International.