Frequent, Dual and Nighttime Nicotine Use Among Dutch Adolescents: Findings From a School-Based Survey

Purpose

Adolescent nicotine use has increased recently. Detailed insights on usage patterns 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.

Methods

A cross-sectional survey was conducted among students from five Dutch secondary schools between March and May 2025. Data were collected using a self-report questionnaire administered both as a school-wide survey and during sessions with students specifically identified as nicotine users. Measures included demographics, nicotine use patterns (age at initiation, product type, frequency), perceived parental awareness, perceived addiction, quit attempts, and self-reported health complaints.

Results

Of 978 respondents (mean age 14.5 years), 457 reported ever using nicotine, with 90% of these reporting 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%). Past year use was dominated by e-cigarettes (83%) and tobacco cigarettes (74%). Nearly half (47%) of past-year users reported daily use, over half (53%) 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, most unsuccessful, and 61% reported health complaints attributed to nicotine use.

Conclusion

Adolescent nicotine use is characterized by frequent daily use, including use during school hours and nighttime awakenings, limited parental awareness, perceived addiction, largely unsuccessful quit attempts, and notable health complaints. These findings emphasize the urgent need for school-based cessation programmes involving parents, combined with policies to limit tobacco industry influence and reduce youth nicotine access.

WHAT IS KNOWN

• Adolescent nicotine use has increased recently.

• National surveys provide prevalence estimates but lack detailed data on usage patterns.

WHAT IS NEW

• Frequent daily use (47%) and nicotine use during nighttime awakenings (35%), perceived addiction (41%), and quit attempts (60%), with high rates of self-reported health complaints (61%), indicate substantial nicotine dependence.

• E-cigarettes are the predominant initiation product (80%) compared to cigarettes (18%), while past-year use involves both e-cigarettes (83%) and cigarettes (74%), supporting the gateway effect.

• High school-hour use and limited perceived parental awareness stress the need for school-based cessation interventions.

• Most adolescents begin 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.