Adolescents' understanding and use of nicotine in e-cigarettes

Addict Behav. 2018 Jul;82:109-113. doi: 10.1016/j.addbeh.2018.02.015. Epub 2018 Feb 10.


Introduction: Nicotine harms adolescent brain development and contributes to addiction. Some adolescents report using nicotine-free e-cigarettes, but the accuracy of their reporting is unclear. We explored adolescents' use of nicotine-free e-cigarettes and understanding of chemicals in e-cigarettes, including nicotine.

Methods: Using social media, we recruited 1589 US adolescents (aged 15-17) who reported past 30-day use of e-cigarettes in 2016. We assessed perceptions of the nicotine source in e-liquid and whether e-cigarette aerosol is just "water vapor." We explored differences among adolescents who usually used e-cigarettes with nicotine (n = 473) and without nicotine (n = 452). We used weights to calibrate our sample to the Youth Risk Behavior Survey.

Results: Twenty-nine percent usually used e-cigarettes without nicotine, 28% with nicotine, 39% with "both," and 5% were "not sure." Few participants (17% of non-nicotine users vs. 34% of nicotine users, p < .001) understood the nicotine was derived from tobacco. Youth who thought e-cigarette aerosol was just water vapor were more likely to usually use without nicotine. Older adolescents and current tobacco users were less likely to usually use without nicotine.

Conclusions: The adolescents who reported usually using e-cigarettes without nicotine had poorer knowledge of e-cigarettes. This lack of understanding could contribute to inaccurate reporting of nicotine use. Most youth thought the nicotine in e-cigarettes was artificial, potentially indicating a belief that this nicotine is "safer." The US Food & Drug Administration will require nicotine warnings on e-cigarettes in 2018; a complementary educational campaign could address youths' misperceptions about nicotine and other chemicals in e-cigarette aerosol.

Keywords: Adolescent; E-cigarette; Nicotine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Comprehension*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Nicotine / administration & dosage*
  • Nicotine / adverse effects
  • Psychology, Adolescent*
  • Risk Factors
  • United States
  • Vaping / adverse effects*
  • Vaping / psychology


  • Nicotine