Frequent, dual and nighttime nicotine use among Dutch adolescents: findings from a school-based survey

Adolescent nicotine use has increased recently. Detailed insights on nicotine use remain limited but are essential for effective prevention and intervention strategies. This study provides recent school-based data to enhance understanding of nicotine use among Dutch secondary school students. A cross-sectional survey was conducted among students from five Dutch secondary schools participating in a prevention programme (Vaping #yourchoice). Self-reported data were collected via a school-wide survey and a targeted survey among students identified by school staff as likely nicotine users. Results presented here combine data from both recruitment strategies. Measures included demographics, nicotine use patterns (e.g. age at first use, product type and frequency), perceived parental awareness, perceived addiction, quit attempts, and self-reported health complaints. Of all 978 respondents (mean age 14.5 years), 457 reported ever using nicotine of whom 90% reported past-year use. Median initiation age was 13 years. E-cigarettes were the predominant initial product (80%), followed by tobacco cigarettes (18%) and nicotine pouches (2%). Ever use was dominated by e-cigarettes (93%) and tobacco cigarettes (78%), while one-third (32%) reported ever using nicotine pouches. Nearly half (47%) of past-year users reported daily use, 70% reported dual use of e-cigarettes and tobacco cigarettes, the majority (77%) used nicotine during school hours, and over one-third (35%) used nicotine upon waking at night. Among these past-year users, 32% perceived parental unawareness, 41% perceived themselves as addicted, 60% reported quit attempts, of which approximately three quarters (77%) were unsuccessful, and 61% reported health complaints attributed to nicotine use.

This school-based study provides detailed, real-world insights into adolescent nicotine behaviour and dependence within Dutch secondary schools. Adolescent nicotine use is characterised by frequent daily use, including dual use, use during school hours and nighttime awakenings, limited parental awareness, perceived addiction, largely unsuccessful quit attempts, and notable health complaints. These findings emphasise the urgent need for school-based cessation programmes involving parents, combined with policies to limit tobacco industry influence and reduce youth nicotine access.

• Adolescent nicotine use has increased recently. • National surveys provide prevalence estimates but lack detailed data on usage patterns.

• Frequent daily use (47%), dual use of e-cigarettes and tobacco cigarettes (70%), and nicotine use during nighttime awakenings (35%), together with perceived addiction (41%), quit attempts (60%), and self-reported health complaints (61%), indicate substantial nicotine dependence among adolescents. • E-cigarettes were the predominant initiation product (80%), while past-year use involved both e-cigarettes (83%) and tobacco cigarettes (74%), consistent with the gateway effect. • High school-hour use and limited perceived parental awareness highlight the need for school-based cessation interventions. • Most adolescents initiate nicotine use around age 13, often progressing to regular use, underscoring policymakers' responsibility to limit the tobacco industry's influence and reduce youth access to nicotine products.