Understanding signs of nicotine dependence requires separating what is known about vaping from assumptions that are often made about these products. Nicotine is central to understanding vaping in the United States because it is the addictive substance found in most e-cigarettes. Repeated nicotine exposure can lead to dependence, cravings, tolerance, and withdrawal symptoms. Adolescents are particularly important in this discussion because the brain continues developing during youth, and nicotine exposure can affect areas involved in attention, learning, mood, and impulse control. Modern products can also use nicotine salts, which allow relatively high nicotine concentrations to be inhaled with less harshness than some traditional freebase nicotine formulations. These characteristics have influenced both product design and public-health concerns. A careful discussion should distinguish federal rules from state and local requirements and should distinguish established findings from questions that remain under study.
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