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Youth E-Cigarette Use Seen as Smoking Gateway

E-cigarette smoker

(Michael Dorausch, Flickr)

9 September 2015. A survey of teens and young adults in the U.S. shows those who smoke electronic cigarettes are much more likely to start smoking tobacco within one year. Results of the study, conducted by a team from University of Pittsburgh and Dartmouth University medical centers, appear online in yesterday’s issue of the journal JAMA Pediatrics.

The researchers — led by Dartmouth pediatrics professor James Sargent and Brian Primack, director of Pittsburgh’s Center for Research on Media, Technology, and Health — sought to uncover connections between e-cigarettes and tobacco use among young people, particularly as they reach the age when these habits start forming. E-cigarettes are battery-powered nicotine delivery devices, that heat a liquid containing nicotine, moisturizing agents — propylene glycol or glycerol — and flavoring agents, as well as preservatives and artificial colorings.

Makers of e-cigarettes often market the devices as safer alternatives to tobacco-burning cigarettes and sometimes as a technique to help tobacco smokers quit conventional cigarettes. The authors cite evidence that e-cigarettes give off lower levels of toxic gases than burning tobacco, and among some smokers can reduce conventional cigarette use. More teens, however, are smoking e-cigarettes than conventional cigarettes and e-cigarette use is also increasing among young adults.

Sargent, Primack, and colleagues drew their data from a national survey of teenagers and young adults in the U.S., age 16 to 26, using landline and mobile telephone calls. The first wave of calls in 2012-13 yielded 694 respondents, who they contacted one year later. Participants were asked about their smoking behavior or intention to smoke, and were classified as nonsmokers or smokers, and among nonsmokers either susceptible or not susceptible to cigarette smoking.

All participants at the beginning of the survey did not smoke conventional cigarettes and were considered not susceptible to begin, as indicated by little interest or attraction to smoking. Of those participants, 16 or about 2 percent of all participants said they smoked e-cigarettes.

After one year, 6 of the 16 e-cigarette smokers (38%) progressed to smoking conventional cigarettes, compared to 10 percent of the remaining 678 participants who were not using either e-cigarettes or tobacco. Another 5 of the 16 original e-cigarette users (31%) expressed more of an interest or attraction to conventional cigarettes, although they had not yet started, compared to 9 percent of the original nonusers of e-cigarettes.

Primack says in a joint statement that these results hold up when accounting for demographic and environmental factors associated with smoking, noting “These differences remained statistically significant and robust even when we controlled for multiple known risk factors for initiating cigarette smoking, such as age, sex, race, ethnicity, socioeconomic status, sensation seeking, parental smoking and friend smoking.”

Regulating e-cigarettes is a complicated policy issue because of their potential to reduce the intake of toxic gases other than nicotine among established smokers. But Sargent points out that, “it is important to continue surveillance of both e-cigarettes and tobacco products among young people so policymakers can establish research-informed regulations to help prevent e-cigarettes from becoming gateway products on the road to youth smoking.”

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