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What do young people know about the nicotine in their e-cigarettes?
  1. Grace Balzer1,
  2. Anthony Landrus1,
  3. Ilona Ovestrud1,
  4. Jill M Singer1,
  5. Bo Lu2,
  6. Dylan D Wagner3,
  7. Elizabeth G Klein1,
  8. Loren E Wold4,
  9. Clark Wilson1,
  10. Alayna P Tackett5,
  11. Megan E Roberts1
  1. 1College of Public Health, The Ohio State University, Columbus, Ohio, USA
  2. 2College of Public Health Division of Biostatistics, The Ohio State University, Columbus, Ohio, USA
  3. 3Department of Psychology, The Ohio State University, Columbus, OH, USA
  4. 4Division of Cardiac Surgery, Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
  5. 5Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
  1. Correspondence to Dr Megan E Roberts, The Ohio State University, Columbus, Ohio 43210, USA; roberts.1558{at}


Introduction In recent years, the nicotine in e-cigarettes has been available in either a ‘free-base’ (unprotonated) or ‘nicotine salt’ (protonated) form. Additionally, e-cigarette nicotine can be either ‘synthetic’ or ‘tobacco-derived’. These dimensions of nicotine have implications for nicotine absorption, bioavailability and sensory experiences. However, it is unclear if the young people using e-cigarettes are aware of these nicotine dimensions.

Methods Data came from a cohort of Ohio youth (aged 15–24) who reported using an e-cigarette in the past 4 months (N=271). Participants were enrolled and provided background information in 2021; their 12-month follow-up survey asked about the presence, form and type of nicotine in their usual e-cigarette. Individuals who reported that they could distinguish between tobacco-derived and synthetic nicotine were additionally asked to describe the difference.

Results Of the 247 youth who reported that there was nicotine in their usual e-cigarette, 71.7% did not know whether it was free-base or nicotine salt and 75.7% did not know whether it was synthetic or tobacco-derived. Awareness was higher among youth who were using e-cigarettes at a greater frequency and quantity. The majority reported that they could not detect a difference between the experience of using synthetic vs tobacco-derived nicotine.

Conclusions These findings indicate the generally limited awareness about nicotine among youth who used e-cigarettes. Improvements in health communications and requirements for e-cigarette industry disclosures are necessary to ensure that consumers are better informed about the dimensions—and the risks—of the nicotine they are consuming.

  • Nicotine
  • Tobacco industry
  • Surveillance and monitoring

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  • Contributors GB, AL and IO share first authorship and contributed to the analyses, writing and editing of this paper. MER supervised the conceptualisation, analyses, manuscript development and editing. MER and APT contributed to the funding acquisition. MER, APT and JMS contributed to study methodology. All other authors contributed to the development of the draft, interpretation of the results and approved the final version for submission.

  • Funding This paper was supported by American Heart Association grant 20YVNR35490079 and by grant U54CA287392 from the NCI and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.