e-Cigs No Deterrent, Likely Contributor, to Teen Smoking

Caroline Cassels

March 06, 2014

Far from claims that electronic cigarettes (e-cigarettes) may help curb conventional cigarette use in youth, new research suggests that these increasingly popular products may actually contribute to nicotine addiction.

A large, cross-sectional study of US middle school and high school students showed that current e-cigarette smokers were more than 7 times more likely to be current cigarette smokers than their counterparts who had not used e-cigarettes.

"The debate over e-cigarettes has centered on whether e-cigarettes could be useful as a harm-reduction strategy in established adult cigarette smokers. The results of our study…suggest that e-cigarettes may contribute to nicotine addiction and are unlikely to discourage conventional cigarette smoking among youths," authors Lauren M. Dutra, ScD, and Stanton A. Glantz, PhD, both from the Center for Tobacco Research and Education, University of California, San Francisco, write.

The study was published online March 6 in JAMA Pediatrics.

Use Doubles

Battery-operated products, e-cigarettes vaporize nicotine, flavor, and other chemicals that are then inhaled by the user. Currently unregulated, these products are aggressively marketed as a "safe" alternative to conventional tobacco products and as smoking cessation aids.

However, previous research showing high rates of dual use of e-cigarettes and conventional cigarettes brings into question the products' efficacy as cigarette substitutes and/or smoking cessation aids.

To gain a better understanding of the relationship between e-cigarette use and conventional cigarette use and smoking cessation, the investigators examined survey data from middle school and high school students in 2011 (n = 17,353) and 2012 (n = 22,529) who completed the National Youth Tobacco Survey.

The investigators found that in 2011, 3.1% of adolescents had ever tried e-cigarettes at least once (1.7% use with cigarettes, 1.5% with only e-cigarettes). Results also showed that 1.1% were current e-cigarette users (0.5% use with cigarettes, 0.6% with only e-cigarettes).

By 2012, 6.5% of adolescents had tried e-cigarettes (1% use with cigarettes, 1.1% with only e-cigarettes).

The investigators report that among cigarette experimenters (≥1 puff), ever using e-cigarettes was associated with higher odds of ever smoking cigarettes (≥100 cigarettes; odds ratio [OR] = 6.31; 95% confidence interval [CI], 5.39 - 7.39) and currently using e-cigarettes (OR, 5.96; 95% CI, 5.67 - 6.27).

They also report that current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63 - 9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01 - 10.32).

The results also showed that in 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year. However, e-cigarettes were associated with lower abstinence rates from conventional cigarettes.

"Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents," the investigators conclude.

Need for Quick Action

In an accompanying editorial, Frank J. Chaloupka, PhD, University of Illinois in Chicago, notes that the use of e-cigarettes, which are also known as electronic nicotine delivery systems (ENDS), is projected by some analysts to surpass sales of traditional cigarettes in the not-too-distant future.

The current study, he writes, "highlights some of the concerns about the potential public health harms" from these products, including the doubling of ever use among teenagers between 2011 and 2012 and the link between the use of these products and reduced likelihood of abstinence from conventional cigarettes.

"While much remains to be learned about the public health benefits and/or consequences of ENDS use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly. Adopting the right mix of policies will be critical to minimizing potential risks to public health while maximizing the potential benefits," Dr. Chaloupka writes.

The authors and Dr. Chaloupka report no relevant financial relationships.

JAMA Pediatr. Published online March 6, 2014. Abstract, Editorial

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