Date of Award


Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Ralitza Gueorguieva


Background: E-cigarette use among youth is concerning due to the risk of exposure to hazardous chemicals and future combustible cigarette use. Alternative e-cigarette use behaviors, or dripping (i.e., applying drops of e-liquids directly onto heated coils) and vape tricks (i.e., blowing shapes or large clouds of visible exhaled aerosol), may also increase this risk. However, little is known about the risk of nicotine dependence among adolescents who engage in these behaviors. Therefore, the aim of this study was to determine the association between these alternative e-cigarette use behaviors and nicotine dependence among adolescents.

Research Design: Cross-sectional data were collected from four Connecticut high schools. Students reported use of tobacco products, including e-cigarettes, dripping and vape trick behaviors, nicotine dependence, sex, race, grade, socioeconomic status, age of e-cigarette onset, and past 30 day e-cigarette frequency. Two general linear models were generated with and without covariates to evaluate the association between alternative e-cigarette use behaviors and nicotine dependence.

Results: Based on the unadjusted model, individuals who engaged in both vape tricks and dripping displayed greater nicotine dependence than individuals who engaged in either (Mean difference = 0.27, 95% CI = [0.13, 0.42]) or neither behaviors (Mean difference = 0.31, 95% CI = [0.10, 0.52]). However, after adjusting for demographic and other tobacco use characteristics, the association was no longer significant. Rather, age of e-cigarette onset (β = -0.07 [SE = 0.02], p = 0.002) and e-cigarette frequency (β = 0.01 [SE = 0.005], p = 0.01) significantly predicted nicotine dependence.

Conclusions: Future research should further evaluate levels of nicotine concentration used for alternative use behaviors and potential pathways in which nicotine dependence can develop among adolescents who engage in vape tricks and/or dripping as they are at risk for engaging in more frequent use of e-cigarettes.


This thesis is restricted to Yale network users only. It will be made publicly available on 08/28/2021