Don't Know What They're Smoking: 41% of Teens Have No Idea About Vape Strength

According to a 2024 national survey of U.S. schoolchildren, most teens who vape reported that they typically use devices with very high (5%) or even ultra-high (≥6%) nicotine concentrations. The higher the percentage, the “stronger” the consumption profile: more often daily vaping, early debut, and parallel use of other nicotine products. 41% of teens do not even know what percentage they have — often because they get devices from third parties, without packaging and labeling. The study is published in the journal JAMA Network Open.

What was discovered

• Don't know the concentration: 41.4% of teens who vaped in the last 30 days.
• Among those who know:
  • 5% - 52.6%
  • ≥6% - 13.0%
  • 3-4% - 13.5%
  • 1–2% — 20.9%

Reminder: 5% is about 50 mg/ml of salt nicotine, a level that can quickly become addictive to a beginner.

"Dose is the answer": the stronger, the harder the pattern

After adjusting for demographics, guys vaping ≥5% vs ≤4% had significantly higher odds of having a "problematic" pattern:

• Frequent vaping (≥20 days out of 30): relative risk 4.46
• Failed Quit Attempts: 2.71
• Expects to be vaping in 5 years: 3.12
• Early debut (before 7th grade): 4.08
• Concurrent use of other nicotine forms (at least one): 2.54; two or more - 4.41; three or more - 5.25

Comparing ≥6% versus 5% shows an additional “step” of risk:

• Frequent Vaping: 2.56
• Use of multiple nicotine products (2 or more): 2.25; (3 or more): 3.75

At the same time, no differences were found in alcohol and marijuana use between 6%+ and 5% - the connection appears to be nicotine-specific, and not just a “general tendency towards all substances.”

Who doesn't know what's hovering

Teenagers who answered “I don’t know” were 2.3 times more likely to receive devices through third parties (friends, resellers, relatives) rather than retail. Their profile generally looked less “heavy” (lower frequency of frequent vaping and polytobacco use) — there are probably more newbies here who don’t keep track of the percentage and don’t buy packaged devices with a label.

Where does this data come from?

The study is based on a representative school panel from Monitoring the Future (US; grades 8–12), in-person surveys February–June 2024. The analysis included 2,318 adolescents who reported “usual” nicotine levels over the past 30 days (or “don’t know”). Statistics take into account the complex sample design and correction for multiple testing.

Why is this important?

• Regulatory vacuum. In the US, there is no federal ceiling on nicotine concentration for e-cigs and no mandatory labeling on the device/cartridge itself. Meanwhile, the FDA has already approved products with 6%.
• Access routes: 41% of teens don't know their percentage; many devices reach them without packaging or labels.
• Biology of addiction. High concentrations of salt nicotine provide fast, “soft” inhalation and a rapid increase in dose – ideal ground for fixing the habit and moving on to other nicotine products.

What does this change for policy and practice?

Policy and control:

• Introduce mandatory marking of the concentration directly on the device/cartridge (similar to the strength on a bottle of alcohol).
• Consider concentration limits for devices popular with young people (a number of US and EU states already have restrictions).
• Squeeze third supply channels: control over the circulation of disposables without packaging, responsibility for “gray” reselling to teenagers.

Schools and parents:

• In prevention, shift the focus from the abstract “don’t vape” to the specifics of the dose: 5–6% is “strong.”
• Pay attention to the first signs of addiction: frequent use, unsuccessful attempts to quit, early debut.
• Talking about sources of devices and signs of unpackaged devices without reliable information.

Doctors:

• Include a couple of clear questions in your screening: “What percentage of nicotine is in your device?” and “Where do you get it?”
• In case of “strong” concentrations, offer migration to less strong forms and programs of refusal, and not just moral lectures.

Limitations of the study

• Cross-sectional design: associations, not rigid causality.
• Self-reporting on percentages and frequency; the actual dose also depends on the volume of liquid, the power of the device and the style of puffing.
• Chemical analyses of the devices themselves were not taken into account - this is the next logical step.

Conclusion

Teen vaping in 2024 is no longer “light steam”: most users know and choose very high nicotine concentrations, and each additional step (from 5% to 6%+) is associated with a more frequent and “stronger” pattern of nicotine behavior. When 4 out of 10 do not even know “what’s inside them,” simple measures — concentration limits and labeling on the device — cease to be bureaucracy and become a matter of protecting young brains from rapid addiction.