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

• 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.