Factors Associated With Stronger Nicotine Dependence in Adolescent E-Cigarette Users

e-cigarette teenager
In adolescent e-cigarette users, stronger nicotine dependence was associated with being in a higher grade in school, vaping at an earlier age, vaping more frequently, and the use of higher nicotine concentrations.

Adolescent e-cigarette users reported experiencing nicotine dependence, which could be reliably evaluated with the 4-item Patient-Reported Outcomes Measurement Information System Nicotine Dependence Item Bank for E-cigarettes (PROMIS-E), according to the results of a school-based survey conducted in Connecticut high schools and published by Drug and Alcohol Dependence.

The researchers sought to assess the psychometric properties of the PROMIS-E tool for evaluating adolescent e-cigarette dependence and to investigate risk factors for stronger symptoms of dependence.

A total of 520 adolescent past-month e-cigarette users completed the PROMIS-E in 2017, during a school-based survey. Overall, 50.5% of the participants were young women and 84.8% were white. The mean patient age was 16.22±1.19 years. In addition, the youth reported on the following factors: sex, current grade in school, race, age at onset of e-cigarette use, frequency of vaping, use of nicotine e-liquid, and cigarette smoking during the previous month.

Age at vaping onset was evaluated with the following question: “How old were you when you first tried an e-cigarette, even just one or two puffs?” Nicotine e-liquid use was assessed via the following question: “Did you vape e-cigarettes with nicotine in the past 30 days?” Response options on the 4-item PROMIS-E included the following: 0 (never), 1 (rarely), 2 (sometimes), 3 (often), and 4 (almost always).

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Stronger nicotine dependence, which translated to higher PROMIS-E scores, was significantly associated with being in a higher grade in school (r, 0.13), vaping at an earlier age (r, −0.31), vaping more frequently (r, 0.47), and the use of higher nicotine concentrations (r, 0.46; P <.01 for all). Dependency on e-cigarettes was also significantly associated with the use of liquid e-nicotine and past-month cigarette smoking (P <.001 for both).

The investigators concluded that the findings of this study highlight the need for adolescent-focused e-cigarette prevention and regulatory efforts. Future research should evaluate the link between self-reported e-cigarette nicotine dependence with biochemical indicators of use, explore relationships with other indices of addiction, and replicate the findings of this study in a nationally representative sample.


Morean ME, Krishnan-Sarin S, S O’Malley S. Assessing nicotine dependence in adolescent e-cigarette users: the 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Nicotine Dependence Item Bank for electronic cigarettes. Drug Alcohol Depend. 2018;188:60-63.