JAMA Psychiatry: Nicotine levels among teenagers who vape nearly tripled

A new study has found that modern e-cigarettes are delivering significantly higher amounts of nicotine to adolescents. Researchers discovered that by the end of 2024, the average level of cotinine—the primary metabolite of nicotine—in teenagers' urine had nearly tripled within just a few months.

The study, published in JAMA Psychiatry, involved more than 150 adolescents aged 13 to 19 who were receiving treatment for substance use disorders.

Researchers analyzed more than 1,900 urine samples collected between 2023 and 2025.

The highest average cotinine concentration increased from approximately 1,062 to 2,959 nanograms per milliliter after October 2024. E-cigarette use was confirmed in all adolescents with the highest cotinine levels.

According to the researchers, the increase is linked to the growing popularity of newer vaping devices. Modern e-cigarettes use nicotine salts with higher nicotine concentrations, while disposable vapes feature larger e-liquid reservoirs, allowing users to consume substantially greater amounts of nicotine during a single vaping session.

The researchers warn that such high levels of nicotine exposure could have serious consequences for the developing adolescent brain. They note that the harmful effects may not become apparent until years later, when the long-term impact of nicotine on memory, learning, emotional regulation, and decision-making becomes more evident.

The authors suggest that limiting the maximum nicotine concentration allowed in e-cigarettes, as well as banning cooling additives that mask nicotine's harsh taste and make vaping more appealing, could help reduce these risks.

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