RESEARCH PAPER
A cross-sectional study of predictors of perceptions of
addiction among college students using Electronic Nicotine
Delivery System users
1
Psychology Department, Dickinson College, Carlisle, United States
These authors had equal contribution to this work
Submission date: 2026-01-21
Final revision date: 2026-03-06
Acceptance date: 2026-03-10
Publication date: 2026-07-16
Corresponding author
Sharon Kingston
Psychology Department, Dickinson College, 28 North College Street, P.O. Box 1773, PA 17013-2896, Carlisle, United States
Psychology Department, Dickinson College, 28 North College Street, P.O. Box 1773, PA 17013-2896, Carlisle, United States
Tob. Prev. Cessation 2026;12(July):43
KEYWORDS
Electronic Nicotine Delivery Systems (ENDS)nicotine dependenceperception of addictionquit attemptsinitiation regret
TOPICS
ABSTRACT
Introduction:
It is estimated that almost one quarter of young adults use electronic nicotine delivery systems (ENDS) despite health risks. Perceptions of addiction to nicotine has been linked with motivation to quit, highlighting the importance of understanding contributors to addiction perceptions among young adults.
Methods:
The current study used cross-sectional survey data to examine how perceptions of addiction were impacted by physical dependence, risk perception, intention to quit, number of quit attempts, and initiation regret among a sample of undergraduate students (n=99) who had used ENDS within the past 30 days. Participants were aged 18–23 years with a mean age of 19.64 years (SD=1.156). The majority (64.6%) identified as women, and 61.6% identified as White.
Results:
Only symptoms of nicotine dependence were significantly related to perception of addiction (β=−0.636; 95% CI: −0.829–−0.474, t=−7.415, p<0.001) indicating that experiencing more symptoms of nicotine dependence predicted stronger perceptions of nicotine addiction. The number of lifetime quit attempts moderated the relationship between symptoms of addiction and perception of addiction (β=0.129; 95% CI: 0.069–0.190, p<0.000) such that symptoms of nicotine dependence have a stronger relationship with perceptions of addiction when an individual has engaged in fewer quit attempts. The number of quit attempts did not moderate the relationship between initiation regret and perceptions of addiction or the relationship between perceptions of the risk of becoming addicted to vaping and perceptions of addiction.
Conclusions:
The results highlight the role of symptoms of physical dependence on perceptions of addiction among young adults attending college. Surprisingly, this relationship was stronger for individuals with fewer quit attempts. Perhaps more failed quit attempts lead young adults to adopt self-exemption beliefs and disconnect their symptoms of nicotine dependence from their perception that they are addicted to ENDS.
It is estimated that almost one quarter of young adults use electronic nicotine delivery systems (ENDS) despite health risks. Perceptions of addiction to nicotine has been linked with motivation to quit, highlighting the importance of understanding contributors to addiction perceptions among young adults.
Methods:
The current study used cross-sectional survey data to examine how perceptions of addiction were impacted by physical dependence, risk perception, intention to quit, number of quit attempts, and initiation regret among a sample of undergraduate students (n=99) who had used ENDS within the past 30 days. Participants were aged 18–23 years with a mean age of 19.64 years (SD=1.156). The majority (64.6%) identified as women, and 61.6% identified as White.
Results:
Only symptoms of nicotine dependence were significantly related to perception of addiction (β=−0.636; 95% CI: −0.829–−0.474, t=−7.415, p<0.001) indicating that experiencing more symptoms of nicotine dependence predicted stronger perceptions of nicotine addiction. The number of lifetime quit attempts moderated the relationship between symptoms of addiction and perception of addiction (β=0.129; 95% CI: 0.069–0.190, p<0.000) such that symptoms of nicotine dependence have a stronger relationship with perceptions of addiction when an individual has engaged in fewer quit attempts. The number of quit attempts did not moderate the relationship between initiation regret and perceptions of addiction or the relationship between perceptions of the risk of becoming addicted to vaping and perceptions of addiction.
Conclusions:
The results highlight the role of symptoms of physical dependence on perceptions of addiction among young adults attending college. Surprisingly, this relationship was stronger for individuals with fewer quit attempts. Perhaps more failed quit attempts lead young adults to adopt self-exemption beliefs and disconnect their symptoms of nicotine dependence from their perception that they are addicted to ENDS.
CONFLICTS OF INTEREST
The authors have each completed and submitted an ICMJE form for
disclosure of potential conflicts of interest. The authors declare that they
have no competing interests, financial or otherwise, related to the current
work. E. Coull, M. Fanus and O. LiCausi report that since the initial planning
of the work no grant funding was provided by Dickinson College for the
research used in the present manuscript. Dickinson College Library paid for
the article processing charges. E. Coull, M. Fanus and O. LiCausi report
that in the past 36 months received support from Dickinson College for
attending the 2025 Eastern Psychological Association annual meeting. S.
Kingston reports that since the initial planning of the work, is a full-time
employee of Dickinson College and receives salary and benefits. No grant
funding or other funding was provided by Dickinson College for the research
used in the present manuscript. Dickinson College Library paid for the
article processing charges. S. Kingston reports that in the past 36 months
received support from Dickinson College for attending the 2024 American
Psychological Association Annual Meeting, the 2025 Society for Prevention
Research annual meeting and the 2025 Eastern Psychological Association
annual meeting, has a leadership or fiduciary role as secretary of the
National Prevention Science Coalition to Improve Lives, and has holdings in
mutual funds that are not directly related to her work as part of a retirement
plan and personal investments.
FUNDING
There was no source of funding for this research.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval was obtained from the Dickinson College IRB (Aproval
number: 1113; Date: 2 May 2024). Participants provide informed consent.
DATA AVAILABILITY
The data supporting this research are available from the authors on
reasonable request.
AUTHORS' CONTRIBUTIONS
EC, MF, OL and SK: research concept and design. SK data analysis and
interpretation. EC, MF, OL and SK: writing of the manuscript, revision of
the manuscript. All authors read and approved the final version of the
manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer-reviewed.
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