Nicotine's Highly Addictive Impact on Youth Underestimated

Nancy A. Melville

January 03, 2017

Although smoking trends among youth have shifted in recent years from tobacco cigarettes to e-cigarettes, the highly addictive culprit nicotine remains constant, a fact that should be underscored in discussion of risk with youth and their parents.

"I think most people realize nicotine is addictive, but I don't know if there's an understanding of just how addictive it is – particularly for youths," said Lorena M. Siqueira, MD, MSPH, lead author of a new report on nicotine, addiction, and youth that was released by the American Academy of Pediatrics (AAP).

"People think, for instance, only having a few cigarettes a week may be fine and they can quit any time, but they don't realize that they are already well on their way to dependency," Dr Siqueira, a member of the AAP Committee on Substance Use and Prevention, told Medscape Medical News.

The report was published in the January issue of Pediatrics.

Evidence shows that the earlier in life a person is exposed to nicotine, the less likely they will be able to quit using tobacco and the more likely they will consume increasingly greater quantities.

The vast majority of tobacco-dependent adults – up to 90% – started smoking before age 18 years. The authors also point out that the earlier a child starts smoking, the greater the risk of continuing to smoke in adulthood.

Approximately two thirds of children who smoke in sixth grade, for example, become regular smokers as adults. In comparison, 46% of youth who begin smoking in the eleventh grade go on to become regular smokers as adults.

In addition, compared to adult smokers, youths require more attempts to quit smoking before being successful. In addition, only about 4% of smokers aged 12 to 19 years have been shown to successfully quit each year, the authors report.

Although e-cigarettes are marketed as a tool for smoking cessation, there is no strong evidence to support these claims, the authors note.

In fact, research, including a study published in JAMA Pediatrics in 2014, indicates that e-cigarettes, which contain nicotine, encourage, rather than discourage, tobacco use in youth.

Since that study's publication, a number of other studies have shown similar harms, the study's coauthor, Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco, told Medscape Medical News.

"There are now seven published longitudinal studies showing that youths who initiate smoking with e-cigarettes are about three times more likely to be smoking conventional cigarettes a year later," he said.

"So clearly, e-cigarettes are acting as a gateway to conventional cigarette smoking."

Instead of making quitting easier, e-cigarettes make it harder, Dr Glantz added.

"What the evidence shows is youths who use e-cigarettes are much less likely to stop smoking than youths who don't use e-cigarettes, so not only are they not beneficial, as promoted, or even useless, they actually [work against] cessation."

Among key attractions to e-cigarettes – and arguments that adolescents are likely to raise with parents ― is the idea that at least they are not as harmful as tobacco, Dr Siqueira said.

"It's not unlike the prescription drug epidemic – adolescents think, 'If my grandmother takes it, then it must be safe,' so this is sort of the same thing," she said.

The report also notes that e-cigarettes are not without toxic hazards of their own. Accidental poisonings associated with e-cigarette use have increased from one per month in 2010 to 215 per month in 2014, including one death.

"The take-home message is that there's no arguing that nicotine is highly addictive, and it's not just in cigarettes but it's in all of these other products that are being cleverly marketed to youths to include ingredients and flavors to increase the palatability," she said.

A new report from the University of Michigan's Monitoring the Future study shows some encouraging trends regarding e-cigarettes. According to the study, after gaining popularity earlier in the decade, the percentage of US teens who use e-cigarettes declined for the first time from 2015 to 2016. The percentage of adolescents who used e-cigarettes in the past 30 days declined from 16% to 13% for 12th graders, from 14% to 11% for 10th graders, and from 8% to 6% among 8th graders; each change was statistically significant.

The report had even more encouraging news for cigarette smoking. The levels of smoking among 8th-, 10th-, and 12th-grade teens are the lowest they have been since annual tracking began 42 years ago.

"Since the peak year in 1997, the proportion of students currently smoking has dropped by more than three quarters — an extremely important development for the health and longevity of this generation of Americans," principal investigator Lloyd Johnston, PhD, University of Michigan, Ann Arbor, said in a release.

The authors have disclosed no relevant financial relationshps. Dr Glantz has received research funding from the National Institutes of Health and from the Truth Initiative, a tobacco use prevention nonprofit organization.

Pediatrics. 2017;173:e1-e13. Full text

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