Mental health disparities persist for LGBTQ+ college students nationwide

One in 10 LGBTQ+ college students reported discrimination in the past year, increasing depression, anxiety, suicidal thoughts, and avoidance of health care

 LGBTQ+ college students who experience discrimination are significantly more likely to experience depression, anxiety, suicidal thoughts, and avoid needed health care, according to a new national study by Columbia University Mailman School of Public Health, Boston University School of Public Health and Harvard Pilgrim Health Care Institute. The findings underscore the profound impact of discrimination on student mental health during a critical stage of life. The results are published in the journal Behavior Medicine.

The study, based on nearly 18,000 LGBTQ+ students at 119 colleges and universities across 34 states, is the largest to examine how discrimination affects the mental health and health care experiences of LGBTQ+ college students. It is also the first to assess these associations during and immediately following a national election year, a period marked by heightened political debate over LGBTQ+ rights.

"Addressing discrimination among college students is essential to support student well-being, reduce mental health disparities, and ensure all students have equitable access to care," said Sarah McKetta, MD, PhD, assistant professor of Epidemiology at Columbia Mailman, and co-first author.

Researchers found that one in 10 LGBTQ+ students experienced discrimination on campus during the previous year. Those students were: 84 percent more likely to meet criteria for depression; 87 percent more likely to meet criteria for anxiety; and 78 percent more likely to report suicidal thoughts in the past year.

Students who experienced discrimination in the form of health care or service denial faced even greater risks. Among LGBTQ+ students, denial of health care was associated with a more than 200 percent higher likelihood of suicidal ideation.

"In addition to an increasingly hostile federal climate, many states have enacted legislation aiming to curtail LGBTQ+ rights," said McKetta. "In 2025 alone, more than 1,000 bills were introduced that would limit transgender people's access to health care, education, or legal recognition."

Emerging adulthood is a pivotal period for lifelong health. It is also when many young adults transition from pediatric to adult health care, often losing established providers and facing new barriers to care.

"Behavioral health during emerging adulthood is a strong predictor of health later in life," said McKetta. "Improving access to affirming health care and reducing discrimination during this transition can have lasting benefits."

Overall, mental health needs among LGBTQ+ students were striking. More than half of participants met criteria for depression. Nearly half of LGBQ+ students and more than half of transgender and nonbinary students met criteria for anxiety. Nearly one in five LGBQ+ students and more than one in four transgender and nonbinary students reported suicidal thoughts during the previous year.

Although more than half of participants sought mental health counseling, many continued to avoid health care because of concerns about discrimination. Nearly 5 percent of LGBQ+ students and 13 percent of transgender and nonbinary students reported avoiding needed medical care.

Researchers found that counseling services may represent an important point of intervention. LGBTQ+ students reported utilizing therapy and counseling services from mental health professionals at high rates, suggesting that counseling settings offer an opportunity to identify psychological distress, provide affirming care, and connect students with broader health services.

The researchers analyzed responses from 17,942 LGBTQ+ students ages 18 to 24 who participated in the 2024–2025 Healthy Minds Study, an annual national survey of college student mental health to examine three types of discriminatory experiences: interpersonal discrimination on campus, past denials of healthcare, or past denials of other services on the basis of sexual orientation and/or gender identity. They also assessed how these discriminatory experiences were associated with mental health outcomes: flourishing, depression, anxiety, suicidal ideation; and healthcare utilization.

"Particularly troubling were our findings on suicidal ideation," noted McKetta. "Across every subgroup of students and every type of discrimination we examined, experiencing discrimination increased the likelihood of suicidal thoughts. These findings highlight the urgent need for colleges to address discrimination as part of comprehensive suicide prevention efforts."

The researchers note that transgender and nonbinary students were more than twice as likely as LGBQ+ students to report being denied health care. Because many transgender people rely on medical services for gender-affirming care, such barriers may have especially serious consequences for both physical and mental health.

"Improving training in LGBTQ+ health for clinicians and campus providers can reduce discriminatory experiences, strengthen trust in health care systems, and improve outcomes for students during this pivotal stage of life," said McKetta.

The authors also emphasize the importance of continuing to support large-scale, high-quality research on LGBTQ+ health.

"Understanding how discrimination affects health depends on rigorous data collection and sustained investment in research," said McKetta. "Without these resources, it becomes much more difficult to identify disparities and develop effective solutions." 

Access to ASL from birth supports childhood math proficiency in deaf children

 

One fish.

Two fish.

Three fish.

The concept of counting a small number of objects is so simple, so fundamental, that we often take for granted what one, two, and three really mean when applied to the world.

Not just reading the words, or recognizing the numeric characters – 1, 2, and 3 – but understanding how those numbers apply to sets of things around us. How they answer the question, “How many?”

Understanding that the final number word said when counting a group of objects represents the total quantity of items in that set is a mathematical concept known as the cardinal principle, and it’s something that typically developing children usually grasp between the ages of 3½ and 5½.

“Kids learn to count, then they start understanding what the words mean, and then they understand this cardinal principle – that the last number word that you say, if you’ve followed all of the counting principles, is a property of the set,” says Marie Coppola, a professor of psychological sciences and linguistics in UConn’s College of Liberal Arts and Sciences who studies language acquisition and language creation as well as the relationship between language and cognition.

“It’s not like there’s something special about that last one that makes it seven,” Coppola says. “No, it’s the whole set that’s seven. It’s an abstraction, and it marks a real milestone in children’s number development.”

Achieving that milestone is a critical component in later mathematics proficiency.

But what if a child doesn’t know the word “one” to begin with, or doesn’t understand what “two” means when applied to a set?

That can be the case for children who are deaf and hard-of-hearing, where language acquisition that otherwise would begin in infancy oftentimes doesn’t begin until later in development.

Cascading Impact

Fewer than 10% of deaf and hard-of-hearing children are born in the United States to deaf parents who use American Sign Language, or ASL, meaning that very few acquire language at home starting at birth like most hearing children do.

Many parents are instead encouraged to pursue spoken language, assistive technologies, and speech therapies for their children, and Coppola notes that while some deaf children do acquire those spoken-language skills, a large number do not.

“Even though we know ASL is a natural language, there is this very, very strong idea – it’s millennia old – that speech is associated with intelligence and ability to learn,” says Coppola. “And that really persists even in the face of so much counterevidence.”

Researchers have reported that significant gaps exist between hearing and deaf and hard-of-hearing children in language development in early childhood. Even in high-income nations with strong infrastructure in special education, deaf and hard-of-hearing children lag about one year behind their hearing peers in mathematics.

The impact cascades through later educational experiences as well. Deaf and hard-of-hearing students score lower on standardized mathematics assessments conducted between ages 8 and 16, researchers have found. In 2017, 15.2% fewer deaf and hard-of hearing individuals earned bachelor’s degrees compared with hearing individuals.

But there isn’t any fundamental reason why deaf children can’t achieve proficiency at the same rate as hearing children, Coppola maintains, and researchers have been working to increase our understanding of why these differences exist and about the approaches that make greater proficiency possible.

“I’ve been very passionate about building an evidence base for the benefits of early access to language for deaf and hard-of-hearing children for a very long time,” Coppola says. “There has been more than 30 years of research showing that later access to language leads to less proficient language development. But that didn’t seem to be getting anyone’s attention.”

Hoping to capitalize on the growing popularity of STEM education and careers, Coppola wants that attention now, with novel research that focuses on the early access to language’s impact not on literacy – but on math.

How High Can They Count?

In 2016, Coppola received a National Science Foundation CAREER Program award to explore the hypothesis that access to language from birth, be it spoken English or ASL, would impact a child’s development of numeracy skills.

The findings from her team’s study were recently published in the Sept.1 issue of the journal Child Development.

To begin investigating the links between language and math proficiency, Coppola worked with specialized schools around the United States to recruit deaf and hard-of-hearing students between the ages of 3 and 7 years old, including those identified as having been exposed to ASL by at least one signing parent since birth, those exposed to spoken English since birth, and those who began acquiring either spoken English or ASL later in childhood.

“Honestly, that was the most difficult part of the study, because only one to two kids per thousand has a significant hearing loss around the time of birth,” Coppola says. “Of this small population, only 5% of them have deaf parents, so we focused on the schools that had a lot of native signing kids.”

She notes that the study would not have been possible without the collaboration of the participating programs.

Once participants were identified and agreed to participate, Coppola’s team began flying around the country to conduct assessments, focused mostly on how well the children had grasped the cardinal principle.

“The easiest thing is the counting – how high can they count?” Coppola explains. “We had two ways of getting them to count. One was just counting, without any objects. For the second condition, we gave them a board that had these very colorful fish and had them count the fish. If they could count up to 10, then we gave them another 10, and they’d count up to 20.”

The data collection process took years and was led by a team comprised of deaf and hearing research assistants who interacted with each of the 178 children included in the study.

“If you’re going to say that deaf kids are struggling with something, you want to give that kid the best opportunity to communicate what they know,” Coppola says. “And that means having a deaf person who’s a proficient signer and who is really good at interacting with deaf kids who may not have had all the language access that they should have had.”

Each child participant was evaluated on their grasp of number concepts, with researchers noting the highest number each child correctly counted without any mistakes, like skipping a number, saying number words out of order, or repeating numbers.

The children were also asked to create sets of specific quantities to assess how well they understood the meanings of the number words they knew, and whether they understood the cardinal principle.

Indistinguishable

What they found, Coppola says, was clear.

“If you compare hearing kids learning spoken English from their parents at home – the way that all hearing kids are – to deaf kids learning ASL from their parents at home, those kids are indistinguishable,” Coppola says. “They have totally comparable performance.”

The study also found that the children who had early access to spoken English or ASL at home performed better at the numbers tasks than children who were exposed at later points in their development, even when controlling for external factors, including socioeconomic status, or SES.

“If you pick any math development paper out of the literature, SES is a significant factor,” says Coppola, but it had no impact in this study.

The findings, Coppola notes, dovetail with research from Boston University that found deaf children of hearing parents demonstrated age-level vocabulary development when exposed to ASL by the time they were 6 months old.

“It turns out that, regardless of how old kids were when they started having good access to language, knowing how to count is really important for understanding the cardinal principle,” Coppola says. “This is not surprising, but it is the first really hard evidence that this is the case for both hearing kids and deaf kids.”

A Language of Academics

This study represents the first to systematically assess how the timing of access to language, the modality of language learned, and hearing status affect children’s acquisition of the cardinal principle and the ability to create sets larger than six.

The study demonstrated, the researchers note, that deafness itself does not impede numeracy development – underscoring the equivalence of early sign and spoken language in supporting number cognition.

The implications, according to Coppola, are broad, though her primary focus is on the people who would impact deaf and hard-of-hearing early learners the most: their parents.

“I designed this whole study and the whole proposal, the whole grant project, to be aimed at parents,” Coppola says. “If hearing parents have a deaf child, and they don’t know what to do, and they want their kid to succeed like a typically hearing child, well, here you go. Now you can see that kids who are exposed to ASL from early in life look like typically hearing children.”

Hearing parents can even be learning to sign right alongside their deaf children, Coppola notes, and research has shown that hearing parents can support age-appropriate development.

More broadly, Coppola hopes that the study will contribute to broader conversations and efforts to impact best-practice recommendations and early intervention methodologies for deaf and hard-of-hearing children – something she acknowledges will take time.

But as evidence-based literature like her study gain attention, and as Deaf culture becomes increasingly more visible through social media and popular culture, Coppola is hopeful that the work of members of the Deaf Community to shift the ways service providers and clinicians approach the needs of deaf and hard-of-hearing children will ultimately change.

And she’s energized to tackle the task herself.

“I want people to see that ASL is a language of academics, Coppola says. “This is why I sign my talks if there’s some percentage of deaf people in the audience. It’s why I try to amplify the perspectives of deaf people whenever I can.

“Kids experience so many conditions and circumstances where the best intervention or approach is not obvious. It’s so clear in this case, and yet it’s still not happening after decades. So, I’m really very motivated to try and change this.”

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Journal

Child Development

DOI

10.1093/chidev/aacag159

Student motivation and responsibility key to tackling bullying in physical education

 Physical education has traditionally been one of the most eagerly awaited classes of the school day, since it lets students get out of the classroom, move around, and interact with their classmates in a different way — conditions that are conducive to learning values such as camaraderie and cooperation. However, the physical exposure and the dynamics of interaction, comparison, and competition that the class can entail still make some students uneasy, and, in settings where bullying occurs, turn it into a potentially unsafe space. In this context, the responses of those who witness bullying are crucial to either stopping or enabling it, and motivation and responsibility are key factorsdetermining whether they adopt active roles.

This is the conclusion of a study of more than 1,300 students ages 10 to 18 conducted by Rafael Clavero Prados, Javier Murillo Moraño, Rafael Zapata Lamana, and Juan De Dios Benítez Sillero, with the Sport and Physical Education for Personal and Social Development research group (GIDEPSO) in the Department of Specific Didactics at the University of Córdoba. To find out how bullying relates to motivation in physical education, they asked students "about their experience with bullying they had suffered or witnessed," while also assessing their motivation toward physical education and their levels of personal and social responsibility, explains researcher Rafael Clavero Prados. The results of the study, published in the journal Physical Education and Sport Pedagogy, focus on the role of bystanders and link their responses, whether active or passive, to their interest in sports: students who are more motivated to participate in physical education also show greater personal responsibility, which leads them to step in actively when faced with situations they consider unfair. At the other end of the spectrum, students who have been bullied show lower levels of motivation toward the subject.

Actively defending victims, however, takes more than a willingness to step in. For this to happen, "students must perceive themselves as capable of acting and feel a personal responsibility to do so," the authors argue, pointing to the importance of working at both the individual and social levels to help students recognize how their behavior either perpetuates unfair situations or helps stop them. Researcher Javier Murillo Moraño thus underscores the importance of "developing teaching models that increase social responsibility, which is associated with students more actively standing up for victims." For this reason, the GIDEPSO group maintains that teaching responsibility should be part of a broad bullying prevention strategy that also addresses student motivation, peer relationships, and the responses of those who witness these situations.

Learning to get along

The study is part of a series of research projects that GIDEPSO is carrying out to give teachers tools to combat bullying and to turn both physical education classes and youth sports into safe spaces where young people learn to get along. "The findings are important because they provide new evidence and help us complement the intervention programs we design for this purpose," explains Juan De Dios Benítez Sillero, the group's principal investigator. One example is the PrebullPE program, a hands-on model that the research group has already brought into classrooms and that addresses identifying bullying, managing emotions, and fostering social skills for a better school climate. In this way physical education can become a space for learning not only to cooperate and compete, but also to respect others, take on responsibilities, and stand up to injustice.

 

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Journal

Physical Education and Sport Pedagogy

DOI

10.1080/17408989.2026.2716877

Is all screen time bad for children? Maybe not

The effects of screen time on young children may depend on more than just how long they spend in front of a device, according to a new publication from the University of Georgia.

What children watch, how old they are and whether a parent watches with them can all shape the experience, the review of 30 studies found. Led by UGA researcher Minal Manisha, the paper points to co-viewing — parents watching and talking about media with their children — as one way to help young viewers make sense of what they see.

A common belief, especially among parents, is that all screen time is bad, but the researchers found that it wasn’t that simple.

Some shows appeared to have a positive impact. For example, programs such as “Daniel Tiger” supported social skills, while “Sesame Street,” “Between the Lions” and “SuperWhy!” were linked with stronger letter and sound recognition among some preschoolers.

“If they are watching prosocial content, they will have values like empathy or compassion,” Manisha said. “If children are watching violent content, they may exhibit physical aggression.”

Heavy screen use may come at expense of physical activity, reading

How much time children spend with screens matters, too. Heavy use can push out other activities like reading, outdoor play and time with family. Evening media use was also linked with sleep problems, the review found.

Very young children learn heavily through play, exploration and face-to-face interaction. Among infants and toddlers, the review linked heavier screen use with poorer language development, smaller vocabularies and other learning concerns.

So what works for a 5-year-old may not work for a toddler. Younger children need more help understanding what they see while older preschoolers may be better able to learn from programs designed for their age group.

Previous research suggests children in lower-income households often spend more time with media, likely due to work schedules, childcare or lack thereof, access to recreation and other pressures. The review focused on children from low-income families for this reason.

Watch programs with your child and answer questions about content

That challenge looks different today than it did in much of the research Manisha reviewed, which focused heavily on television. Modern devices are portable, personalized and often shaped by algorithms, allowing children to move from room to room with an endless stream of recommended content.

That is where watching together can help.

Co-viewing does not mean turning every cartoon into a lesson. It can be as simple as watching programs together, answering questions or talking afterward about what a child saw, the researchers said.

“We need to be aware of what our children are actually watching,” Manisha said. “It’s a big thing to be able to talk to them about the content they are absorbing.”

We need to be aware of what our children are actually watching … (and) the content they are absorbing.

Minal Manisha, Office of Research

The goal is not necessarily to remove media from children’s lives altogether but to help them build healthier habits around it.

Still, Manisha cautions against one-size-fits-all rules. Families have different schedules, resources and needs, which can all shape how realistic certain screen-time limits are.

And those recommendations may keep changing as technology does.

“It’s an evolving landscape,” Manisha said.

The study, co-authored by Minal Manisha and William Schneider, was published in the Journal of Evidence-Based Social Work.

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Journal

Journal of Evidence-Based Social Work

DOI

10.1080/26408066.2026.2725613

Nearly one in five young adults in the United States reported feeling anxious every day

 

Nearly one in five young adults in the United States reported feeling anxious every day in 2024, up from 15% in 2020. Over the same period, the odds of receiving an anxiety diagnosis as well as use of prescription anxiety medication each rose by roughly a third. 

The overall increase in anxiety varied by race and ethnicity, sex, and sexual orientation, according to a new study by George Mason University researcher Melissa Villodas. The research found higher rates of anxiety among women and lesbian, gay, and bisexual (LGB) young adults than among their peers. Racial and ethnic differences were less clear-cut, varying by whether researchers looked at anxiety symptoms, diagnoses, or medication use and by sex and sexual orientation. 

Published in the American Journal of Public Health, the study explored anxiety among nearly 11,000 U.S. adults ages 18 to 25. While most research considers demographic characteristics separately, Villodas and her colleagues studied them in combination to reveal differences that might be overlooked. 

“Rather than assuming that all young adults experience anxiety in the same way, these findings underscore the importance of considering the multiple social identities and contexts that shape experiences with anxiety,” said Villodas, an assistant professor in the Department of Social Work at the College of Public Health. 

Why it matters 

Young adulthood is a vulnerable phase for the onset of mental health problems, and anxiety was already rising in this age group before the COVID-19 pandemic. The study can’t establish what caused the increases after 2020, but the researchers say its findings warrant attention to possible lasting impacts from the pandemic. 

The research also offers a more specific picture of which young adults need support and raises questions about whether groups with fewer diagnoses are facing obstacles to get help. 

Key findings 

The researchers analyzed National Health Interview Survey responses between 2020 and 2024. Key findings included: 

• Daily anxiety, diagnoses, and medication increased. Daily anxiety rose from 15% to 19.5%, reported anxiety diagnoses increased from 17.9% to 23.4%, and prescription anxiety medication use rose from 9.8% to 13.3%. Despite the increase in daily anxiety, the intensity of anxiety respondents reported didn’t change significantly overall.
• Nearly half of LGB young adults reported an anxiety diagnosis. In 2024, 44.6% reported having received a diagnosis, compared with 18.5% of straight young adults. Prescription anxiety medication use among LGB respondents doubled  from 12.9% in 2020 to 26% in 2024. Among straight respondents, it increased from 9.3% to 10.4%.
• Women consistently reported higher rates than men. In 2024, 32.1% of women reported having received an anxiety diagnosis, compared with 14.7% of men. About one in four women reported daily anxiety, and one in five took prescription anxiety medication.
• Differences also emerged within racial and ethnic groups. Hispanic LGB young adults had about 4.7 times the odds of taking anxiety medication as their straight Hispanic peers. Black women had higher odds of an anxiety diagnosis and medication use than Black men.
• Fewer diagnoses didn’t necessarily mean milder anxiety. In 2024, 31.3% of non-Hispanic White respondents reported an anxiety diagnosis, compared with 12.7% of non-Hispanic Black respondents, and 15.3% of Hispanic respondents. But across the study period, Black and White young adults did not differ significantly in reported anxiety intensity. The researchers noted that access to care, stigma, and differences in how symptoms are recognized might help explain the disparities.

Villodas’ coauthors were Alexandria B. Forte of the University of Connecticut, Hayden C. Dawes of Bryn Mawr College, Michelle R. Munson of New York University, and Mansoo Yu of the University of Missouri. 

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Journal

American Journal of Public Health

DOI

Preschoolers aren’t more creative than adults — they’re just more confident

 

Children also “practice” creativity more frequently and enjoy it more, study shows

Peer-Reviewed Publication

PLOS

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Are children really more creative than adults? Adults perform better, but children engage with more confidence and joy.

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Credit: M. Benedek, PLOS One, CC-BY 4.0 (https://creativecommons.org/licenses/by/4.0/)

Adults are more objectively creative than preschoolers, but are inhibited by anxiety and low self-confidence, according to a study published October 21, 2026, in the open access journal PLOS One by Janika Saretzki from the University of Graz, Austria, and colleagues.

Do we lose our creativity with age? When asked whether children or adults are more creative, most people assume the former. To explore this tension between public opinion and scientific evidence, Saretzki and colleagues gathered 92 preschool-aged children and 70 adults, mostly in their 20s. Everyone completed three creative tasks. First, participants had 3 minutes to come up with as many creative uses as possible for a simple tin can. Second, everyone had about 8 minutes to freely draw with colored pens on blank paper. Third, they received 8 additional minutes to invent and draw a unique fantasy animal. Afterwards, participants reflected on their confidence, anxiety, and enjoyment of the activities.

Trained raters evaluated the creative products without knowing who created them. Across all tasks, the adults’ performances were objectively rated as more novel, effective, and creative than the preschoolers’. Subjectively, though, the preschoolers excelled: they enjoyed the tasks more and felt more motivation and less anxiety than their older counterparts.

Paradoxically, more than three-fourths of the adults in this study believed preschoolers to be their creative superiors. The researchers posit this may stem from adults perceiving children’s enthusiasm and confidence for creativity — similarly to how “a ‘sporty’ person is often someone who regularly engages in sports rather than wins competitions.” It follows that children reported engaging in creative activity more frequently than adults (about once per day vs. once per week).

The researchers said future studies will focus on discovering why adults generally rate themselves as less creative than children.

The authors add: “The popular idea that children are more creative than adults turns out to be overly simplistic. Adults came up with more original and effective ideas, but preschoolers were more confident, more motivated and enjoyed the creative tasks more.”

  The freely available article in PLOS One: https://plos.io/4hC51wV

High-nicotine e-cigarettes linked to rising nicotine dependence among young adults

 

Researchers from University of California San Diego Herbert Wertheim School of Public Health and Human Longevity Science have found that high-nicotine e-cigarette use rose sharply among young adults between 2017 and 2022 and was associated with increased nicotine dependence and more persistent vaping. The study, published on Oct. 20, 2026 in the Tobacco Control journal, found that by 2022, nearly half (49.2%) of young adults who vaped daily were using e-cigarettes containing at least 4% nicotine – considered a high-nicotine product. Among daily vapers ages 55 and older, just 4.5% were using products with that level of nicotine. Overall, among people who vaped in 2022, the odds of using a high-nicotine e-cigarette were 12 times higher for 18- to 24-year-olds than for adults ages 55 and older.

“The Food and Drug Administration’s (FDA) authorization of these products was based in part on the expectation that the benefits to adults who smoke would outweigh the risks of creating new nicotine dependence among young people,” said John P. Pierce, PhD, senior author and professor at the Herbert Wertheim School of Public Health. “Our findings suggest that this balance needs to be reassessed. Young adults are disproportionately choosing high-nicotine products, including within the same brands used by older adults, and that use is associated with substantially greater nicotine dependence.”

The researchers analyzed data from the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative study that follows tobacco and nicotine use in the U.S. The analysis included surveys conducted in 2017, 2019, 2021 and 2022, as well as longitudinal data from 2,356 adults who vaped in 2019 and whose behaviors were tracked through 2022.

In 2017, fewer than 4% of people who vaped reported using an e-cigarette with at least 4% nicotine. Among 18- to 24-year-olds who vaped daily, that figure rose from 3.1% in 2017 to 40.1% in 2019 and 49.2% in 2022. By comparison, 32.8% of daily vapers ages 25 to 34, 17.6% of those ages 35 to 54 and 4.5% of those 55 and older used high-nicotine products in 2022.

The rise in high-nicotine vaping coincided with a substantial increase in nicotine dependence among young adults who exclusively vaped. In 2017, 18- to 24-year-olds who exclusively vaped had substantially lower nicotine dependence scores than those who exclusively smoked cigarettes. By 2022, their dependence scores had risen to a level equivalent to that of 18- to 24-year-olds who exclusively smoked in 2017.

The study also found that nicotine strength was associated with dependence across age groups. People who used high-nicotine e-cigarettes showed higher levels of nicotine dependence than those who used lower-nicotine products. Among people who vaped in 2019, those using high-nicotine e-cigarettes had 31% lower odds of being abstinent from vaping four years later. Overall, 40.9% of those who vaped in 2019 – including those who did not vape daily – were abstinent by 2022.

The researchers say the strong age difference in nicotine strength used raises questions about the role of marketing. Among people who used the same brands, 18- to 24-year-olds were more likely than adults ages 25 and older to choose high-nicotine versions. Two brands with particularly large differences have been marketed through paid social media influencers, although the study was not designed to establish that marketing caused young adults to choose higher-nicotine products.

The authors note that the study cannot establish that high-nicotine e-cigarettes directly caused the increase in nicotine dependence because it was observational rather than a randomized clinical trial. The researchers also note that many participants, particularly in the first two years, did not know the nicotine strength of their e-cigarette, which would tend to make the study’s estimates more conservative.

The findings also raise questions about whether high-nicotine e-cigarettes continue to meet the public health standard required for FDA marketing authorization. The researchers argue that the evidence warrants an urgent reassessment of whether the benefits of these products for adults who smoke continue to outweigh the risk of creating nicotine dependence among people who do not smoke.

“We need to understand not only who is using these products, but how the nicotine content, product design and marketing environment are influencing long-term patterns of use,” said Pierce. “Previous research has questioned the effectiveness of e-cigarettes in helping smokers quit. In this study, we have documented that high-nicotine products have created a new generation of people who are dependent on nicotine.”

Read the full study: “High-nicotine e-cigarettes and nicotine dependence among US young and older adults, 2017-2022.”