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 E-cigarette use, or vaping, was as least as strong a risk factor for
smoking traditional cigarettes as having a parent or sibling who
smokes or having a risk-taking and thrill-seeking personality,
researchers found.
"E-cigarette use among teens and young adults could increase the
future burden of tobacco by creating a new generation of adult
smokers who might have otherwise not begun smoking," said lead study
author Samir Soneji of the Dartmouth Institute for Health Policy and
Clinical Practice in New Hampshire.
Big tobacco companies, including Altria Group Inc, Lorillard Tobacco
Co and Reynolds American Inc, are all developing e-cigarettes. The
battery-powered devices feature a glowing tip and a heating element
that turns liquid nicotine and other flavorings into a cloud of
vapor that users inhale.
Soneji and colleagues analyzed data from nine smaller studies with a
total of 17,389 participants ages 14 to 30.
They didn't examine why many teens and young adults transitioned
from vaping to smoking traditional cigarettes, but both options
contain nicotine, an addictive drug, Soneji said by email.
The habit of vaping may also make the transition to smoking seem
more natural, and teens in particular may gravitate toward friends
who smoke once they try vaping, Soneji said.
"To the extent that e-cigarette use mimics the behavior of smoking a
cigarette - handling the e-cigarette, the action of puffing, and the
inhalation of smoke - it sets the adolescent up for easily
transitioning to smoking," Soneji said. "Like transitioning from
driving a Tesla to driving a Chevy."
Seven studies looked at smoking initiation among more than 8,000
youngsters who had never smoked before. Data pooled from these
studies showed that roughly 30 percent of e-cigarette users became
smokers, compared with only about 8 percent of people who hadn't
tried vaping. That translates into 3.6 times higher odds of smoking
for people who have tried e-cigarettes, researchers report in JAMA
Pediatrics.
One limitation of the study is that it included some results from
earlier studies with a high drop-out rate, and it's not clear
whether people who left these studies were different from
participants who remained in ways that would make them more or less
likely to smoke, the authors note. Researchers also lacked data on
the type of e-cigarettes used, and they only looked at U.S. studies.
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Even so, by pooling data from several smaller studies, the results
offer stronger evidence that vaping can encourage young people to
progress to smoking, said William Shadel, a researcher at RAND
Corporation in Pittsburgh who wasn't involved in the current study.
"The results are particularly compelling because the studies took
into account other variables that put kids at risk of cigarette
smoking, like alcohol use and peer cigarette smoking," Shadel said
by email. "These results should help to strengthen arguments for
regulatory action that limits young people's access to
e-cigarettes."
Enticing flavors of liquid nicotine used in e-cigarettes, like
strawberry or chocolate, may make vaping appealing to some young
people who might not like the taste of traditional cigarettes, said
Dr. Brian Primack, a researcher at the University of Pittsburgh who
wasn't involved in the study. Peer pressure may then encourage them
to graduate to smoking.
"Young people report that there is a lot of pressure among
e-cigarette only users to smoke a 'real' cigarette," Primack said by
email. "It may be somewhat analogous to the fact that teens who use
flavored alcohol are often pressured socially to step up their game
to harder forms of alcohol."
There's one clear way for young people to avoid this.
"The biggest thing that people can do is never start using them in
the first place," Primack said.
SOURCE: http://bit.ly/2tbQ8JY JAMA Pediatrics, online June 26, 2017.
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