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Tob Control. 2019 May 11. pii: tobaccocontrol-2018-054900. doi: 10.1136/tobaccocontrol-2018-054900. [Epub ahead of print]

Measuring e-cigarette addiction among adolescents.

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Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA.
Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, USA.
Division of Adolescent Medicine, University of California, San Francisco, San Francisco, California, USA



With high rates of use and uncertain consequences, valid electronic cigarette (e-cigarette) use frequency and addiction measures for adolescents are needed. This cross-sectional study examined correlations for multiple measures of adolescent e-cigarette use with nicotine exposure quantified with salivary cotinine levels.


Adolescents (N=173, age 13-18) who reported past-month e-cigarette use were recruited from the San Francisco Bay Area. Participants self-reported: (1) days of e-cigarette use in a typical month, (2) number of e-cigarette sessions in a typical day (sessions per day; SPD) and the (3) E-Cigarette Addiction Severity Index (EASI). Participants also completed the 10-item Penn State Electronic Cigarette Dependence Index (ECDI), which we examined in full and as a 2-item Heaviness of Vaping Index (HVI; the sum of the ECDI items on use frequency and time to first vaping on wakening). Sessions per month (SPM) were calculated using days per month and SPD. Cotinine levels, SPD and SPM were log-transformed.


Among frequency measures, SPM correlated most strongly with cotinine (r=0.59), followed closely by days per month (r=0.58) and SPD (r=0.57), p<0.001. Among dependence measures, the EASI correlated most strongly with cotinine (r=0.51), closely followed by the ECDI and HVI (r's=0.50), all p's<0.001.


Adolescents' reports of frequency of e-cigarette use and degree of addiction correlated significantly with cotinine as a biomarker of nicotine exposure. We recommend the EASI and days per month as brief general measures. SPM and the ECDI are more extensive measures that may yield a more nuanced understanding of use.


ENDS; addiction; adolescent; dependence; e-cigarette; frequency

Conflict of interest statement

Competing interests: JJP has provided consultation to pharmaceutical and technology companies that make medications and other treatments for quitting smoking and has served as an expert witness in lawsuits against the tobacco companies. MLR has consulted for Pfizer on research involving smoking cessation medication and for Carrot, Inc., which makes a tobacco cessation device.

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