RT’s Three Key Takeaways:

  1. Surging Youth Uptake: Nearly half of daily vapers aged 18 to 24 reported using e-cigarettes containing at least 4% nicotine by 2022, compared to just 4.5% of daily vapers aged 55 and older.
  2. Rising Dependence Levels: Young adults who exclusively vaped reached nicotine dependence levels by 2022 that were equivalent to those of exclusive cigarette smokers in 2017.
  3. Reduced Likelihood of Quitting: Individuals who used high-nicotine e-cigarettes had 31% lower odds of achieving abstinence four years later, challenging assumptions that these devices facilitate cessation.


The use of high-nicotine e-cigarettes increased substantially among young adults between 2017 and 2022 and is linked to heightened nicotine dependence and lower rates of quitting, according to a study published in Tobacco Control.

According to researchers from the UC San Diego’s Herbert Wertheim School of Public Health and Human Longevity Science, by 2022, 49.2% of daily vapers aged 18 to 24 used devices containing at least 4% nicotine—a concentration classified as high nicotine. In contrast, 4.5% of daily vapers aged 55 and older used products with that nicotine strength. Among all individuals who vaped in 2022, the odds of choosing a high-nicotine product were 12 times higher for young adults aged 18 to 24 than for older adults aged 55 and older.

“The FDA authorization of these products was based in part on the expectation that the benefits to adults who smoke would outweigh the risks of creating new nicotine dependence among young people,” said John P Pierce, PhD, senior author and professor at the Herbert Wertheim School of Public Health. “Our findings suggest that this balance needs to be reassessed. Young adults are disproportionately choosing high-nicotine products, including within the same brands used by older adults, and that use is associated with substantially greater nicotine dependence.”

Surging Rates of High-Nicotine Device Use

To evaluate trends, the investigators analyzed findings from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative US dataset tracking tobacco and nicotine behaviors. The analysis evaluated survey rounds from 2017, 2019, 2021, and 2022, along with longitudinal data following 2,356 adult vapers from 2019 through 2022.

The data revealed that in 2017, fewer than 4% of individuals who vaped reported using products with 4% or higher nicotine concentrations. Among daily vapers aged 18 to 24, high-nicotine use rose from 3.1% in 2017 to 40.1% in 2019, and reached 49.2% in 2022. Among daily vapers in other age brackets in 2022, high-nicotine use was reported by 32.8% of individuals aged 25 to 34, 17.6% of those aged 35 to 54, and 4.5% of those aged 55 and older.

Dependence and Barriers to Quitting

The rise in high-nicotine product adoption paralleled a measurable increase in dependence among exclusive vapers, according to the study. In 2017, young adults aged 18 to 24 who exclusively vaped had lower nicotine dependence scores than their peers who smoked traditional combustible cigarettes. However, by 2022, dependence scores among exclusive vapers in that age group climbed to match the levels observed among exclusive cigarette smokers in 2017.

The study also demonstrated that higher nicotine strength correlated with greater difficulty quitting across all age brackets. Among individuals who reported vaping in 2019, those using high-nicotine formulations had 31% lower odds of being abstinent from vaping four years later. Across the overall cohort followed from 2019, 40.9% had achieved abstinence by 2022.

The investigators pointed out that 18- to 24-year-olds selected higher-nicotine varieties more frequently than older adults even within identical brands, raising questions regarding the impact of marketing tactics, including influencer campaigns on social media.

The authors noted limitations in the research, observing that because the analysis was observational, it cannot definitively prove direct causation. Additionally, many respondents, particularly during the initial two survey years, were unaware of the nicotine percentage in their products, which researchers indicated likely made their statistical estimates more conservative.

The study concludes that these trends call into question whether high-nicotine e-cigarettes meet the public health standard established for marketing authorizations by the FDA, as respiratory healthcare teams and public health authorities continue to manage adolescent and adult nicotine addiction.

“We need to understand not only who is using these products, but how the nicotine content, product design and marketing environment are influencing long-term patterns of use,” said Pierce. “Previous research has questioned the effectiveness of e-cigarettes in helping smokers quit. In this study, we have documented that high-nicotine products have created a new generation of people who are dependent on nicotine.”