E-Cigarette Nicotine Levels and Smoking Trends in Adolescents

smoking vaping teenager
smoking vaping teenager
Adolescents who use electronic cigarettes with higher levels of nicotine may progressively increase the frequency and intensity of smoking.

Adolescents who use electronic cigarettes (e-cigarettes) with higher concentrations of nicotine may be at risk for progressively increasing the frequency and intensity of smoking and vaping, according to a study published in JAMA Pediatrics.

Researchers performed a prospective cohort study of 181 students (85 girls and 96 boys; mean age, 16.1 years) at 10 high schools in the Los Angeles metropolitan area. Students were given a survey during the 10th grade in the spring (baseline), and then again in the 11th grade (6-month follow up), self-reporting their use of e-cigarettes within the last 30 days. Nicotine concentrations were divided into the following categories: none (0 mg/mL), low (1-5 mg/mL), medium (6-17 mg/mL), or high (≥18 mg/mL).

Study results showed an increase of 2.26 in the odds of frequent (vs no) smoking with each successive increase in nicotine concentration (none, low, medium, and high), reported by students at baseline (95% CI, 1.28-3.98). An increase in the odds of frequent (vs no) vaping was found to be 1.65 higher (95% CI, 1.09-2.51).

Further, it was found that the higher the nicotine concentration in e-cigarettes, the greater number of e-cigarettes smoked per day at the 6-month follow up (adjusted rate ratio [RR], 7.03; 95% CI, 6.11-7.95). In addition, a significantly greater number of vaping episodes was associated with low, medium, and high nicotine concentrations (adjusted RR, 3.32; 95% CI, 2.61-4.03; adjusted RR, 3.32; 95% CI, 2.54-4.10; and adjusted RR, 2.44; 95% CI, 1.63-3.24, respectively).   

Related Articles

Investigators concluded that the use of e-cigarettes with higher nicotine concentrations was associated with a progressive increase in smoking and vaping frequency and intensity.


Goldenson NI, Leventhal A, Stone MD, McConnell RS, Barrington-Trimis JL. Associations of electronic cigarette nicotine concentration with subsequent cigarette smoking and vaping levels in adolescents [published online October 23, 2017]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2017.3209