{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T22:24:35Z","timestamp":1775255075983,"version":"3.50.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T00:00:00Z","timestamp":1705363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"University of Rochester Research Innovation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Increasing electronic cigarette use among youth has led to a need for a novel intensity measure of e-cigarette use and its association with nicotine addiction variables.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aims and Methods<\/jats:title>\n                  <jats:p>Using a cross-sectional study of the 2018\u20132019 PATH Wave 5 Youth survey, a new intensity metric of e-cigarette use, the average number of puffs per month as a function of frequency (days of use per month), number of uses per day and number of puffs per use, was developed for adolescent e-cigarette users. Using logistic regression, standard addiction measures were tested for association with higher quartile (Q) of e-cigarette intensity: Q1 (1\u20135 puffs), Q2 (6\u201350 puffs), Q3 (51\u2013528 puffs), and Q4 (529\u2005+\u2005puffs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 1051 current youth e-cigarette users, cravings were associated with greater intensity of use (Q2: aOR\u2005=\u20051.90, 95% CI: 0.94\u20133.87; Q3: aOR\u2005=\u20056.91, 95% CI: 3.25\u201314.69; and Q4: aOR\u2005=\u200521.48, 95% CI: 10.03\u201345.97). Craving associations exceeded the corresponding aORs for the identical regression using the frequency of use. Higher intensity was significantly associated with being an older adolescent (aOR\u2005=\u20051.85), best friend use (aOR: 3.35), not thinking about quitting (aOR: 2.51), and lower perceived addiction (aOR: 1.95).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study found that an intensity metric (puffs per month) was strongly associated with cravings, best friend use, harm perception, and lack of intention to quit. This metric provides a more accurate picture of the intensity of youth e-cigarette use than other commonly used measures and may be important for understanding the current and future impact of the youth e-cigarette epidemic.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>Adolescent addiction to e-cigarettes affects learning, memory, and attention. However, it is unknown whether the intensity of use, puffs per month, differs from frequency, days of use per month, and in relation to addiction measures. This study provides evidence that high-intensity use characterized by puffs per month has a stronger association with cravings compared to frequency, which suggests puffs per month may be a better measure of nicotine exposure. This new intensity metric may give insights into youth e-cigarette use patterns, addiction, and appropriate treatment of intense but intermittent users.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntae003","type":"journal-article","created":{"date-parts":[[2024,1,16]],"date-time":"2024-01-16T19:22:08Z","timestamp":1705432928000},"page":"984-990","source":"Crossref","is-referenced-by-count":5,"title":["Categorizing Vaping Intensity Among Youth"],"prefix":"10.1093","volume":"26","author":[{"given":"Catherine","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Biology, University of Rochester , Rochester, NY , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abra M","family":"Jeffers","sequence":"additional","affiliation":[{"name":"Division of General Academic Pediatrics, Massachusetts General for Children , Boston, MA , USA"},{"name":"Health Policy Research Center, Mongan Institute, Massachusetts General Hospital , Boston, MA , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6126-9095","authenticated-orcid":false,"given":"Jonathan P","family":"Winickoff","sequence":"additional","affiliation":[{"name":"Division of General Academic Pediatrics, Massachusetts General for Children , Boston, MA , USA"},{"name":"Department of Pediatrics, Harvard Medical School , Boston, MA , USA"},{"name":"Tobacco Consortium, American Academy of Pediatrics , Itasca, IL , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,1,16]]},"reference":[{"key":"2024072205520787100_CIT0001","volume-title":"Surgeon General\u2019s Advisory on E-cigarette Use Among Youth.","author":"U.S. Department of Health and Human Services, Office of the Surgeon General","year":"2018"},{"issue":"44","key":"2024072205520787100_CIT0002","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.15585\/mmwr.mm7244a1","article-title":"Tobacco product use among US middle and high school students\u2014National youth tobacco survey, 2023","volume":"72","author":"Birdsey","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"3","key":"2024072205520787100_CIT0003","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/MOP.0000000000000896","article-title":"Vaping in adolescents: epidemiology and respiratory harm","volume":"32","author":"Hamberger","year":"2020","journal-title":"Curr Opin Pediatr."},{"issue":"6","key":"2024072205520787100_CIT0004","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1080\/10408444.2020.1794443","article-title":"A review of toxic effects of electronic cigarettes\/vaping in adolescents and young adults","volume":"50","author":"Overbeek","year":"2020","journal-title":"Crit Rev Toxicol."},{"issue":"12","key":"2024072205520787100_CIT0005","doi-asserted-by":"crossref","first-page":"789","DOI":"10.3949\/ccjm.86a.19118","article-title":"Vaping: the new wave of nicotine addiction","volume":"86","author":"Dinardo","year":"2019","journal-title":"Cleve Clin J Med."},{"issue":"7","key":"2024072205520787100_CIT0006","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jama.2015.8950","article-title":"Association of electronic cigarette use with initiation of combustible tobacco product smoking in early adolescence","volume":"314","author":"Leventhal","year":"2015","journal-title":"JAMA."},{"issue":"1","key":"2024072205520787100_CIT0007","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1136\/tobaccocontrol-2021-056483","article-title":"Electronic cigarette use intensity measurement challenges and regulatory implications","volume":"32","author":"Soule","year":"2021","journal-title":"Tob Control."},{"key":"2024072205520787100_CIT0008","doi-asserted-by":"crossref","first-page":"105769","DOI":"10.1016\/j.ypmed.2019.105769","article-title":"Frequency of E-cigarette use and cigarette smoking among Canadian students","volume":"126","author":"Azagba","year":"2019","journal-title":"Prev Med."},{"key":"2024072205520787100_CIT0009","volume-title":"National Institute on Drug Abuse. 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