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E-cigarettes are getting children as young as eleven hooked on nicotine, according to new research.
They are more addictive than traditional cigarettes, say scientists in a new study, which found some school age users are now vaping within five minutes of waking up.
This is a greater level of addiction than peers who smoke traditional cigarettes or other tobacco products.
The phenomenon has been blamed on a smoother, more palatable form of nicotine known as “nicotine salts” or “protonated nicotine”.
Corresponding author Professor Jonathan Winickoff said: “The changes detected in this survey may reflect the higher levels of nicotine delivery and addiction liability.
“Modern e-cigarettes that use protonated nicotine make nicotine easier to inhale.”
The findings published in the journal JAMA Network Open are based on more than 151,000 American children in grades six to 12, tracked between 2014 and 2021.
Prof Winickoff, of Massachusetts General Hospital for Children in Boston, said: “Age at initiation of e-cigarette use decreased and intensity of use and addiction increased.
“By 2019, more e-cigarette users were using their first tobacco product within five minutes of waking than users of cigarettes and all other tobacco products combined.
“Clinicians need to be ready to address youth addiction to these new highly addictive nicotine products during many clinical encounters, and stronger regulation is needed, including comprehensive bans on the sale of flavoured tobacco products.”
In October the US Centres for Disease Control and Prevention found use among middle or high school students had risen by 24 per cent since 2021. Super-strength disposable devices were the most popular and most child users surveyed had used flavoured e-cigarettes.
Prof Winickoff said: “Early e-cigarettes did not deliver nicotine as efficiently as cigarettes because they delivered freebase nicotine that was hard to inhale.”
This changed in the last decade when products were introduced which “added benzoic acid to the nicotine e-liquid to lower the acidity and form protonated nicotin,” he said.
Prof Winickoff said: “Despite the pandemic leading to people being socially isolated, students being out of school, and the increased risk of adolescents and young adults contracting Covid with e-cigarette use, intensity continued to increase.
“This may reflect increasing use of nicotine for self-medication in response to adolescent depression, anxiety, tic disorders and suicidality.
“The pandemic has also been a lost year for school-based prevention and treatment efforts, meaning abatement plans will need to be intensified to address the nicotine addiction in those adolescents who missed a year of contact with adults who might have otherwise helped them get treatment.”
Clinicians should question all their patients about nicotine and tobacco product use, including e-cigarettes and other new nicotine products, researchers said.
Vaping has become a gateway to nicotine addiction for teens as most who take it up have never smoked before. Tobacco addiction is a chronic disease, said Prof Winickoff.
A US government report last month revealed at least 2.6 million American children are hooked on e-cigarettes.