Health & Studies

Adolescents Ecig Addiction

The UK E-Cigarette Research Forum critically appraises a study that measured e-cigarette addiction among adolescents

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Researchers at the Stanford University and the University of California San Francisco looked at measuring addiction levels in teens who use vape devices. The researchers believe their work “will aid clinicians and researchers in documenting exposure and identifying those adolescents at greatest risk for becoming addicted.” The UK E-Cigarette Research Forum (UKECRF) critically appraised the paper and found it wanting.

The UKECRF is an initiative developed by Cancer Research UK in partnership with Public Health England and the UK Centre for Tobacco and Alcohol Studies. The UKECRF looks at new studies on electronic cigarettes and provides a critical overview of each of them. It brings together experts to discuss emerging evidence about e-cigarettes.

One hundred and seventy-three 13-18year olds, who reported vaping during the previous month, were recruited from the San Francisco Bay Area using advertisements posted on social media and in the community and by word-of-mouth.

Eligible participants were scheduled for an initial, in-person session during which they provided informed consent, completed self-report measures and provided saliva and urine samples for biomarker testing.

UKECRF reported:

Study aims

This U.S study aimed to determine the most accurate self-reported measures for estimating nicotine exposure among adolescents (ages 13-18). Participants (n = 173) that had used an e-cigarette in the past month and had at least 10 lifetime uses, were asked about their frequency of use. Nicotine exposure was measured using salivary cotinine levels. Researchers evaluated three measures of e-cigarette dependency: The E-cigarette Addiction Severity Index (EASI), Heaviness of Vaping Index (HVI) and Penn State Electronic Cigarette Dependence Index (ECDI). Correlations between frequency of use and dependency measures, and cotinine levels were calculated.

Key findings

  • Most (85.5%) respondents used their e-cigarettes less than daily, mean days per month = 15.4. When restricted to exclusive e-cigarette users, 89.6% used their e-cigarettes less than daily
  • 26.6% of participants reported smoking a cigarette in the past 30 days and 5.0% reported smoking a cigarette in the past 24 hours
  • 80.3% of participants reported that some or all their e-cigarette liquid contained nicotine (77.1% in exclusive e-cigarette users)
  • Sessions per month (SPM), days per month, sessions per day (SPD) all showed a moderate positive correlation with cotinine levels, r=0.59, r=0.58 and r=0.57, respectively. The three dependency measures, EASI (r=0.51), HVI (r=0.50) and ECDI (r=0.50) also showed moderate positive correlations
  • All measures remained moderately positively correlated with cotinine levels when restricting to e-cigarette only users

Study Limitations

  • The study did not test whether correlations were significantly different from one another or significantly different across dual users and exclusive vapers. Therefore, we cannot determine whether one measure of e-cigarette dependence is better than the other or whether one might be better used among certain groups
  • Biomarkers of nicotine and tobacco exposure were only taken once so do not give an indication of participants exposure levels over time
  • While cotinine levels are a good indicator of recent nicotine exposure they may not be appropriate to measure addiction. High cotinine levels may reflect combustible cigarette use rather than e-cigarette use, and the researchers could only validate 24h tobacco abstinence among self-reported exclusive vapers
  • The correlations may not be applicable outside the US setting because nicotine regulation of e-cigarettes differs across countries and therefore may affect nicotine exposure
  • This was a relatively small sample size and participants may not be representative of the wider adolescent vaping population


  • “Measuring e-cigarette addiction among adolescents” by Vogel, Prochaska, and Rubinstein – [link]
Dave Cross avatar

Dave Cross

Journalist at POTV
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Dave is a freelance writer; with articles on music, motorbikes, football, pop-science, vaping and tobacco harm reduction in Sounds, Melody Maker, UBG, AWoL, Bike, When Saturday Comes, Vape News Magazine, and syndicated across the Johnston Press group. He was published in an anthology of “Greatest Football Writing”, but still believes this was a mistake. Dave contributes sketches to comedy shows and used to co-host a radio sketch show. He’s worked with numerous vape companies to develop content for their websites.

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