Background United States (US) e-cigarette sales surged from 2017 to 2022, following the introduction and marketing of high-nicotine e-cigarettes.

Methods The US Population Assessment of Tobacco and Health (PATH) Study re-interviewed a large nationally representative sample at regular intervals. Those who vaped (3000–4000 per survey) were queried on the nicotine strength of their usual e-cigarette. Study outcomes included nicotine dependence and vaping abstinence in 2022.

Results In 2022, those who vaped high-nicotine (4+%) e-cigarettes were more likely to vape daily (AOR=1.78, 95% CI: 1.30 to 2.43). Vaping high-nicotine e-cigarettes increased from minimal levels in each age group in 2017 to significant differences across age in 2022: 18–24 years=49.2%, 25–34 years=32.8%, 35–54 years=17.6% and 55+years=4.5%. In 2017, nicotine dependence among 18–24-year-olds who vaped exclusively was much lower than among those who smoked exclusively; however, this difference had disappeared by 2022. Vaping high- (vs lower-) nicotine e-cigarettes in 2019 was associated with (1) an increase of 0.3 SD units of nicotine dependence within each age group by 2022 and (2) significantly lower odds of vaping abstinence in 2022 (AOR=0.69, 95% CI: 0.48 to 0.99, p=0.043). Among those who used the same e-cigarette brands, particularly Vuse and JUUL, 18–24-year-olds chose a high-nicotine option 2.2 times as often as 25+-year-old adults, suggesting a potential marketing effect.

Conclusions Vaping high-nicotine e-cigarettes surged between 2017 and 2022, particularly in 18–24-year-olds. Among 18–24-year-olds this was associated with increased daily vaping and a large increase in nicotine dependence. The US Food and Drug Administration’s assessment of benefits versus harms of vaping high-nicotine e-cigarettes needs to be reassessed.