Between 2017 and 2022, high-nicotine vape use surged by 80% among United States 18-24 year olds, associated with large increases in daily vaping and nicotine dependence, News-Medical reported. Researchers analyzing national data published in the journal Tobacco Control called on the Food and Drug Administration (FDA) to urgently review marketing approvals for these products.
Young Vapers Show High Nicotine Dependence Levels
- Nicotine Dependence Surge: Young people who used only electronic cigarettes in 2022 had dependence levels equivalent to those of young people who smoked only cigarettes in 2017.
- Age-Based Targeting: Vapers aged 18 to 24 selected high-nicotine (4%+) e-cigarettes at rates up to 15 times higher than adults aged 55 and older.
- Regulatory Pressure: Scientists emphasize that these findings raise questions about whether high-nicotine e-cigarettes continue to meet the public health standard required for Food and Drug Administration (FDA) marketing authorization.
The Shift in US E-Cigarette Sales and High-Nicotine Choices
E-cigarette sales in the US held relatively steady at 6 to 7 million units per month between 2014 and late 2017. Technological advances and the introduction of flavors shifted that trajectory, as palatable high-nicotine (5%) e-cigarettes entered the market. By 2021, monthly sales tripled to over 20 million units, boosted by young people, many of whom didn’t smoke conventional cigarettes.
Data from the US Population Assessment of Tobacco and Health (PATH) Study tracked this trajectory across large nationally representative samples. In 2017, 1% of respondents reported using nicotine strength of 4% or greater. That figure climbed to just over 15% in 2019, reached over 24% in 2021, and hit nearly 25% by 2022.
Young Adults and Daily Vapers Choose High Nicotine
By 2022, age heavily dictated high-nicotine selection. Overall, young adults aged 18 to 24 faced odds of choosing high-nicotine products that were 15 times higher than the oldest demographic group.
Among those who vaped daily, there was a more than 70% higher likelihood of using high-nicotine concentrations compared to those who didn’t.
| Year | 18–24 Daily Vapers Using 4%+ Nicotine | Overall US Monthly E-Cigarette Sales |
|---|---|---|
| 2017 | 3.1% | 6–7 million units |
| 2019 | 40.1% | — |
| 2021 | — | Over 20 million units |
| 2022 | 49.2% | — |
Nicotine Dependence and Cessation Challenges
Scientists at the University of California San Diego’s Herbert Wertheim School of Public Health and Human Longevity Science observed that greater utilization of high-nicotine gadgets tracked alongside escalating nicotine dependence metrics within young people who used exclusively electronic cigarettes. Back in 2017, their addiction severity stood markedly lower relative to counterparts relying solely on traditional combustible cigarettes. Fast forward to 2022, this measurement climbed upward, reaching parity with the severity observed among conventional cigarette smokers in 2017.
Vapers utilizing high-nicotine products in 2019 demonstrated 31% lower odds of successfully abstaining from vaping by 2022. Nicotine delivery systems combine sweet flavors with fine particles and chemical irritants, engaging a developing brain where systems involved in learning, attention, mood and impulse control continue maturing into approximately the mid-20s.
Contrasting Brand Preferences and Marketing Influences
When examining specific brands such as Vuse and JUUL, researchers observed that 18- to 24-year-olds selected high-nicotine options more than twice as often as those aged 25 and older using the exact same brands. Two brands with particularly large differences have been marketed through paid social media influencers, though the observational study could not definitively prove a direct causal link between marketing campaigns and product selection.
Withdrawal Symptoms Require Professional Cessation Support
Young users experiencing withdrawal symptoms—such as irritability, restlessness, anxiety, sleep problems, and difficulty concentrating—should consult a healthcare professional for cessation support.
Future Research and Regulatory Reassessment
Because the study was observational, researchers acknowledged it could not establish a direct causal link between high-nicotine content and increased dependence. However, the findings raise questions regarding whether high-nicotine e-cigarettes continue to meet the public health standard required for FDA marketing authorization.
References
- Pierce, J. P., et al. (2026). High-nicotine e-cigarettes and nicotine dependence among United States young and older adults, 2017–2022. Tobacco Control. DOI: 10.1136/tc-2025-060044
