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Teens Report E-Cigarette Use Accurately But Are Not Aware of Nicotine Levels in Products


Adolescents accurately self-report use of tobacco, e-cigarettes and marijuana, but many do not know how much nicotine is in the products they use. A study in the May 2019 issue of Pediatrics, “Self-Reported Use of Tobacco, E-Cigarettes, and Marijuana versus Urinary Biomarkers,” (published online April 22) compared what teens self-reported regarding usage of tobacco, e-cigarettes and marijuana with biomarkers for cotinine (a nicotine by-product) and THC (a marijuana by-product) in the urine. Researchers found that 27% of those who reported using nicotine-free products had cotinine levels of more than 10 ng/mL, the cut-off level identifying non-users in this study. Researchers say this points to many teens not knowing the products they used contained nicotine. In addition, those who used e-cigarette pod systems, such as Juul, had significantly higher cotinine levels than non-pod users. In this study, e-cigarette users reported more marijuana use than non-e-cigarette users and had higher urinary THC and cotinine levels. The authors conclude that more study needs be done on teens’ knowledge of nicotine in products and that pediatricians should ask about e-cigarette and marijuana use as these products can be associated with significant nicotine exposure and risk for addiction.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit and follow us on Twitter @AmerAcadPeds