Symptoms of nicotine dependence by e-cigarette and cigarette use behavior and brand: A population-based, nationally representative cross-sectional study

Abstract

BackgroundMany modern e-cigarette brands contain equivalent or higher nicotine levels than traditional cigarettes. ObjectiveTo examine differences in four nicotine dependence indicators (i.e., use within 30minutes of waking, cravings, needing to use, and frequent use) among adolescents (aged 12–17 years) with past 30-day (P30D) exclusive use of e-cigarettes, cigarettes, or dual use of both. MethodsData were from Wave 5 (2018–2019) of the Population Assessment of Tobacco and Health (PATH) study (n=1060; N=2053,659). Multivariable logistic regression was performed to determine differences in indicators by P30D e-cigarette and cigarette use behavior (exclusive vs. dual use) and brand (e-cigarette use: JUUL vs. non-JUUL vs. Unknown). ResultsThe odds of frequent use among adolescents with JUUL (AOR: 2.11; 95% CI=1.02–4.37) and non-JUUL (AOR: 2.12; 95% CI=0.95–4.77) use were similar and paralleled that for dual use (AOR: 3.50; 95% CI=1.46–8.43) but were stronger (JUUL only) than exclusive cigarette use. The odds of using within 30minutes of waking for adolescents with JUUL (AOR: 2.23; 95% CI=0.80–6.25) and non-JUUL (AOR:1.42; 95% CI=0.47–4.32) use were similar and paralleled that for both dual (AOR=3.00; 95% CI=1.01–8.88) and exclusive cigarette use. For adolescents who used unknown brands, the odds of all indicators paralleled exclusive cigarette use but were lower than JUUL, non-JUUL, and dual use. ConclusionCompared to exclusive cigarette use, symptoms of nicotine dependence are similar for adolescents with exclusive e-cigarette use, irrespective of brand. Symptoms of nicotine dependence for JUUL and non-JUUL use parallel dual use. Tobacco regulation should consider these findings when assessing the abuse liability of e-cigarettes.