Trends in Incidence of Nicotine Use Disorder Among Adolescents in the Pediatric Hospital, 2012–2019

OBJECTIVES: To assess trends in the incidence of nicotine use disorder (NUD) and describe associated factors among adolescents in the pediatric emergency department (ED) and inpatient settings.

METHODS: We conducted a retrospective cohort study of all adolescents (11–18 years) with a hospital encounter (inpatient, observation, or ED) in the Pediatric Health Information System between January 1, 2012, and September 30, 2019. After excluding adolescents with a previous International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, NUD diagnosis in the past 2 years, adolescents with new NUD diagnosis (ie, NUD incidence) were identified. A multivariable generalized liner mixed model was used to assess adjusted NUD incidence and investigate the relationship of NUD with patient characteristics and any interactions between characteristics and time. Spearman’s correlation coefficient was used to assess the correlation between NUD incidence and e-cigarette use reported among youth.

RESULTS: Of 3 963 754 adolescents, 15 376 (0.4%) had a new diagnosis of NUD. Between 2012 and 2019, NUD incidence increased from 0.3% to 0.4% (P < .001). Findings from the time interaction effect analysis revealed increasing NUD incidence among certain subpopulations, including boys, those with a commercial or other insurance type, adolescents seen in the ED, those from the lowest and highest median household income quartile, and those in the South and West US Census regions. The correlation between NUD incidence and e-cigarette use among high school students was ρ = 0.884 (P = .006).

CONCLUSIONS: The incidence of NUD among adolescents is increasing. Efforts to increase the screening and treatment of NUD among adolescents in the hospital, particularly among the at-risk populations identified, are needed.