Adolescents' E-Cigarette Use: Increases in Frequency, Dependence, and Nicotine Exposure Over 12 Months

J Adolesc Health. 2019 Jun;64(6):770-775. doi: 10.1016/j.jadohealth.2019.02.019.


Purpose: This study examined changes in e-cigarette and dual-use frequency, levels of nicotine exposure and e-cigarette dependence, and device and e-liquid preferences over 12 months.

Methods: Adolescents (N = 173, aged 13-18 years) who reported past-month e-cigarette use and at least 10 lifetime uses were recruited from the San Francisco Bay Area. The sample was 75.1% male, 54.9% non-Hispanic White, mean age 16.6 years (standard deviation = 1.2); 26.6% reported past-month cigarette smoking at baseline (i.e., dual use). At baseline, 6-month, and 12-month follow-up, participants provided saliva samples for cotinine testing and self-reported e-cigarette use frequency, dependence, past-month smoking, product preference, and flavor preference.

Results: Most (80.3%) were still using e-cigarettes at 12 months, and daily use increased from 14.5% to 29.8%. Model testing indicated an overall increase from baseline to 12 months in frequency of e-cigarette use (F(2, 166) = 5.69, p = .004), dependence (F(2, 164) = 5.49, p = .005), and cotinine levels (F(2, 103) = 4.40, p = .038). Among those reporting only e-cigarette use at baseline, 28.8% reported combustible cigarette use during follow-up. Among those reporting dual use at baseline, 57.1% were still dual using at 12 months, 31.4% reported e-cigarette use only, and none abstained from both products. Higher nicotine delivering e-cigarette devices (i.e., Juul, mods) became more popular over time, whereas flavor preferences (i.e., fruit, mint/menthol, and candy) remained stable.

Conclusions: Adolescents' e-cigarette use persisted over a 12-month period with significant increases in frequency of use, nicotine exposure, and e-cigarette dependence. Transitions from single to dual and dual to single nicotine product use were observed in approximately one in three users over the study period.

Keywords: Addiction; Adolescent; Cigarettes; Dependence; E-cigarette; ENDS; Nicotine.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cigarette Smoking / epidemiology*
  • Cotinine / analysis
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Female
  • Flavoring Agents
  • Humans
  • Male
  • Nicotine*
  • Saliva
  • San Francisco / epidemiology
  • Self Report
  • Vaping / epidemiology*


  • Flavoring Agents
  • Nicotine
  • Cotinine