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Nicotine Addiction in Youth: Role of E-cigarettes and Vape Devices

Key Points:

  • E-cigarettes have evolved to deliver high nicotine concentrations that may further create and sustain addiction.

  • Nicotine has harmful effects, especially on youth.

  • Nicotine exposure through e-cigarettes may lead to other drug use.

E-cigarettes have long been marketed as a safer alternative to smoking regular cigarettes. But this is increasingly becoming unlikely due to persistent usage trends – especially among youth – and higher nicotine yields.


Nicotine Sources

A person walking on an e-cigarette with a cloud of smoke over their head.

Nicotine, found within the tobacco plant, is an addictive chemical compound. When it comes to e-cigarettes and vapes, common nicotine sources are:

  • Tobacco: The e-liquid in e-cigarettes is usually derived from tobacco plants.

  • Non-Tobacco: Referred to as synthetic nicotine, non-tobacco is made in a laboratory using chemicals rather than tobacco leaves.

  • Nicotine Salts: Created when combining a nicotine base with one or more acids, nicotine salts allow high levels of nicotine to be inhaled more easily and with less irritation, according to the Centers for Disease Control and Prevention (CDC).

How Does Nicotine Affect the Brain?

Nicotine use can disrupt and negatively influence brain function that controls attention level, learning, memory, mood, and impulse control. In the brain, nicotine attaches to acetylcholine receptors and releases dopamine, a pleasure-producing chemical. This increase in dopamine can lead to more receptors and alter brain wiring involved in these essential functions.

Adolescents and young adults are especially vulnerable to nicotine receptor increase and addiction, as the brain does not finish maturing and developing until the mid-to-late 20s. It is optimal for younger people to avoid nicotine in any form.

Nicotine Addiction and Intensity Increasing

One study involving 151,537 participants explored nicotine addiction and intensity of e-cigarette use by U.S. adolescents over seven years (2014-2021). Findings were:

An individual holding up e-cigarettes.
  • Intensity of use increased. The average number of days used rose from 3 to 5 days per month in 2014 to 10 to 19 days per month in 2021.

  • Level of addiction increased. This was measured as the odds of using a tobacco product within 5 minutes of waking. From 2014 to 2017, the percentage of sole e-cigarette users who used e-cigarettes in this time range was less than 1%, but 10.3% were using within 5 minutes of waking by 2021.

  • Use persists. Adolescents whose first tobacco product used was e-cigarettes increased from 27.2% in 2014 to 78.3% in 2019 and remained at 77% in 2021.

Gateway to Other Drugs?

Various studies have reported that e-cigarette use among youth is associated with a higher prevalence or increased odds of subsequent use of other drugs – marijuana being the most common – as well as cocaine and amphetamines.

One study explored the cocaine risk link in particular. In this U.K. study, 5,207 youth who had used e-cigarettes by the age of 14 years were matched to “nicotine naïve” youth by comparing common childhood factors and social demographics. After matching, 7.6% of those 14-year-old e-cigarette users had subsequently used cocaine by the age of 17 versus 3.1% of non-e-cigarette users. The researchers admit the rationale for this finding is unclear; social and environmental factors could be triggers, or nicotine and cocaine could share a similar biological vulnerability pattern.

The Bottom Line

Avoiding nicotine exposure, especially among youth, is crucial for keeping harmful health effects and addictions at bay. More research on the impact of e-cigarettes on health is urgently needed. By Linda Antinoro Reviewed by Cindy Bistany, DHSc References

1. Centers for Disease Control and Prevention (2022, November 10). Quick Facts on the Risks of E-Cigarettes for Kids, Teens and Young Adults. Centers for Disease Control and Prevention. Retrieved  from

2. Glantz S, Jeffers A, Winickoff JP. Nicotine Addiction and Intensity of e-Cigarette Use by Adolescents in the U.S., 2014 to 2021. JAMA Netw Open. 2022;5(11):e2240671. doi:10.1001/jamanetworkopen.2022.40671

3. Marques, P., Piqueras, L. & Sanz, MJ. An updated overview of e-cigarette impact on human health. Respir Res 22, 151 (2021).

4. Silva CP, Maggs JL, Kelly BC, Vuolo M, Staff J. Associations Between E-cigarettes and Subsequent Cocaine Use in Adolescence: An Analysis of the U.K. Millennium Cohort Study. Nicotine Tob Res. 2023 Feb 9;25(3):514-523. doi: 10.1093/ntr/ntac219. PMID: 36125041.

5. Temple JR, Shorey RC, Lu Y, Torres E, Stuart GL, Le VD. E-cigarette use of young adults motivations and associations with combustible cigarette alcohol, marijuana, and other illicit drugs. Am J Addict.2017;26(4):343–348.

6. Tiwari RK, Sharma V, Pandey RK, Shukla SS. Nicotine Addiction: Neurobiology and Mechanism. J Pharmacopuncture. 2020 Mar 31;23(1):1-7. doi: 10.3831/KPI.2020.23.001. PMID: 32322429; PMCID: PMC7163392.

7. U.S. Food and Drug Administration (2022, June 29). Nicotine is Why Tobacco Products Are Addictive. U.S. Food and Drug Administration. Retrieved from


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