Use of E-cigarettes With Nicotine Salts and Nicotine Dependence Symptoms in Youth: The National Youth Tobacco Survey, 2024

PURPOSE: Understanding the relationship between youth use of e-cigarettes containing nicotine salts and nicotine dependence is important, as e-cigarette manufacturers commonly use nicotine salts in their products, and their formulation results in higher blood level nicotine concentrations. METHODS: The National Youth Tobacco Survey is a cross-sectional, national survey of middle and high school students. Using 2024 data, we described sociodemographic characteristics and tobacco use behaviors among students who currently used e-cigarettes (n = 1,830) by nicotine salt status. We estimated prevalence ratios (PRs) of frequent e-cigarette use (≥20 of the past 30 days) and nicotine dependence symptoms (craving, use within 30 minutes of waking) associated with nicotine salt use utilizing survey-weighted robust Poisson regression, controlling for relevant covariates. RESULTS: Youth use of e-cigarettes with nicotine salts varied by sex, age at tobacco product initiation, use of most individual e-cigarette flavors, number of non-tobacco e-cigarette flavors, use of ice flavor, device type, and other tobacco product use. After adjusting for relevant covariates, youth who used e-cigarettes with nicotine salts were more likely to report frequent e-cigarette use (adjusted PR [aPR]: 1.47; 95% confidence interval [CI]: 1.24, 1.75), craving tobacco products (aPR: 1.69; 95% CI: 1.31, 2.16), wanting to use tobacco products within 30 minutes of waking (aPR: 1.60; 95% CI: 1.22, 2.11), and experiencing either symptom of nicotine dependence (aPR: 1.54; 95% CI: 1.26, 1.88) than those who reported not using nicotine salts. DISCUSSION: Use of e-cigarettes with nicotine salts was associated with frequent e-cigarette use and symptoms of nicotine dependence, underscoring the importance of continued surveillance and prevention efforts.