This study addressed growing concerns about the abuse potential of modern electronic cigarettes, particularly those using nicotine salts. These salts are formed by the addition of acidic additives, making nicotine inhalation milder than nicotine in free base form.
The main objective of the study was to determine how variations in nicotine form (salts vs. free base), nicotine concentration (5% vs. 1%), and e-liquid flavours (menthol vs. tobacco) influence subjective perceptions, vaping behaviours, and nicotine absorption levels in young adults.
To do this, a randomised crossover clinical trial was conducted with a cohort of young adults aged 21 to 25, all regular users of electronic cigarettes. Recruitment took place between December 2021 and August 2023 in Columbus, Ohio. Participants took part in up to nine vaping sessions in the laboratory. The first session used the participant's usual brand of electronic cigarette, while subsequent sessions used e-liquids prepared in the laboratory, which varied according to nicotine form, concentration, and flavour. Each session consisted of a standardised 5-minute vaping period (10 puffs), followed by 30 minutes of ad libitum vaping. The final sample comprised 72 participants, with an average age of 22.4, 58.3% of whom were women.
To do this, a randomised crossover clinical trial was conducted with a cohort of young adults aged 21 to 25, all regular users of electronic cigarettes. Recruitment took place between December 2021 and August 2023 in Columbus, Ohio. Participants took part in up to nine vaping sessions in the laboratory. The first session used the participant's usual brand of electronic cigarette, while subsequent sessions used e-liquids prepared in the laboratory, which varied according to nicotine form, concentration, and flavour. Each session consisted of a standardised 5-minute vaping period (10 puffs), followed by 30 minutes of ad libitum vaping. The final sample comprised 72 participants, with an average age of 22.4, 58.3% of whom were women.
The analysis revealed that e-liquids containing nicotine salts resulted in a higher absorption of nicotine than those containing free base nicotine. E-liquids with 5% nicotine salts delivered the highest average plasma levels, irrespective of the flavour used. Vaping behaviour was also influenced by the form of nicotine and the concentration. E-liquids based on nicotine salts provoked more intense vaping, with a 25% increase in the total number of puffs compared with freebase nicotine. However, this intensification of vaping was not observed for menthol e-liquids. Finally, all the e-liquids tested reduced nicotine cravings and urges, but those containing 5% nicotine proved more effective than those containing 1%. This study shows that e-liquids containing nicotine salts increase nicotine absorption, generate more positive subjective effects and lead to more intense vaping behaviour in young adults.
These results suggest a higher abuse potential for e-liquids containing nicotine salts compared with those using free-base nicotine. The authors suggest that limiting acidic additives and menthol flavours could reduce the addictive nature of electronic cigarettes.
These results have important implications for the regulation of vaping products, particularly in the context of preventing addiction among young users. The study's recommendations could help to guide public health policies aimed at reducing the risks associated with the use of electronic cigarettes, particularly among vulnerable populations such as young adults.
These results have important implications for the regulation of vaping products, particularly in the context of preventing addiction among young users. The study's recommendations could help to guide public health policies aimed at reducing the risks associated with the use of electronic cigarettes, particularly among vulnerable populations such as young adults.
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