e-Cigs' 'Cool Factor' a Major Draw for Teens

Nancy A. Melville

July 25, 2016

Although electronic cigarettes (e-cigarettes) are touted mainly as a tool for smoking cessation, the devices are gaining favor among adolescents for some of the reasons that have long made tobacco smoking attractive ― they're perceived as "cool," new research shows.

"Our most concerning result was that almost three quarters of the students surveyed reported trying e-cigarettes primarily because it was something cool, fun, or new," first author Michael Khoury, MD, of Stollery Children's Hospital, University of Alberta, in Edmonton, Canada, told Medscape Medical News.

"This is in stark contrast to the motivations of adults, which is to use e-cigarettes for their advertised smoking cessation purpose.

"Further, this suggests, though doesn't conclude, that e-cigarettes may be drawing in teens into a new, smokinglike behavior."

The findings were published online July 18 in the CMAJ.

Public Health Concern

e-Cigarettes are electronic devices designed to mimic cigarettes. They vaporize a liquid that the user inhales, hence the nickname, "vaping."

Although advertised as tools for quitting smoking, research suggests that e-cigarettes may have the opposite effect in youth.

"There have been numerous recent studies in the pediatric population that have suggested that e-cigarettes may be associated with future cigarette use, thus playing the opposite role they may play in adults," Dr Khoury said.

The cross-sectional study included students enrolled in grade 9 in the Niagara region of Ontario as part of the Heart Niagara Inc Healthy Heart Schools Program for the 2013-2014 school year.

Among 2367 students who responded to questions on smoking, 238 (10.4%) reported use of e-cigarettes, with the vast majority (171, 71.9%) of those students indicating that the reason for use was that it was considered "cool/fun/new."

Only 14 students (5.8%) reported using the e-cigarettes for smoking reduction or cessation.

Factors that were strongly associated in a multivariate analysis with e-cigarette use included male sex (P = .002), current tobacco smoking (P < .001), and other smokers among family (P = .003) or friends (P < .001).

Although the rate of use, about 10%, is lower than previously reported rates of 15% to 20% among adolescents, the authors speculate that the lower rate may be due to the study’s inclusion of younger adolescents, aged 14 to 15 years.

The popularity of e-cigarettes among youth is on the rise. A recent report indicates that use of e-cigarettes among adolescents in Canada is now more common than use of conventional cigarettes.

Dr Khoury noted that similar rates of use among teens have been reported in the United States, possibly for the same reasons.

"We hypothesize that motivations would very well be similar across borders," he said.

The authors cited one survey involving adolescents in the United States that found that reasons for for e-cigarette use included curiosity and exploration. Conversely, two other studies indicated that only 10% of adults reported being motivated by curiosity.

Although the new study does not conclude that e-cigarettes are attracting teens to smokinglike behaviors, the similarities in associations are significant, Dr Khoury said.

"We found e-cigarettes were associated with many of the factors traditional cigarettes are associated with: friends who use tobacco, tobacco in the home, higher perceived stress levels, lower perceived health levels, and lower mean and median household income," he said.

Despite the strong association with current smoking, as many as 82.5% of respondents who reported e-cigarette use had not smoked cigarettes in the past 30 days.

"The majority of students who tried e-cigarettes had done so only once or a few times," Dr Khoury noted. "Of students who had smoked in the last 30 days, there was quite a wide distribution.

"This is a significant public health concern and needs to be addressed. Regulations are required that will allow adults to continue to use e-cigarettes but reduce exposure to children and teenagers and prevent the sale and marketing of these devices to youth."

Harm Creation?

In an accompanying editorial, Matthew B Stanbrook MD, PhD, deputy editor of the CMAJ, agreed that more regulation is needed to curb the use of e-cigarettes in youth.

"While we debate the question of whether e-cigarettes may enable harm reduction for smokers, we cannot ignore the simultaneous potential for harm creation, especially for youth," he writes.

"Mitigating this will require expansion of existing public health anti-tobacco programs to explicitly encompass e-cigarettes, including more active participation on social media."

Dr Stanbrook further called for the prohibition of flavorings in e-cigarettes, which entice youth, and for the extension of advertising restrictions for tobacco products to include e- cigarettes.

"At an individual level, we all have an important role to play in engaging our youth in a conversation about the harms of e-cigarettes, lest we lose the progress against tobacco that we have worked so hard for decades to achieve," Dr Stanbrook asserted.

Study coauthor Brian McCrindle, MD, MPH, has receiving consultant fees from Janssen Pharmaceuticals, Aergerion Pharmaceuticals, Merck, and Bristol-Myers Squibb, and grants from Janssen Pharmaceuticals, Amgen, and Daiichi Sankyo. The other authors have disclosed no relevant financial relationships.

CMAJ. Published online July 18, 2016. Full text, Editorial

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