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 Overall, adolescents who used e-cigarettes before trying any other
tobacco products were more than four times as likely to be smoking
traditional cigarettes within a couple of years compared to those
who had never tried any type of vaping device or non-cigarette
tobacco products, the study team reports in JAMA Network Open.
"E-cigarettes may be a pathway to cigarette smoking, and a sizeable
one," said senior study author Andrew Stokes of the Boston
University School of Public Health.
Overall, smoking rates have dropped significantly, Stokes said.
"That's been a real success story for public health and in that
context, it's pretty alarming that a new product has come on the
market potentially drawing a whole generation into using tobacco,"
he added.
Stokes and his colleagues explored the influence of e-cigarettes
through the Population Assessment of Tobacco and Health Study
(PATH), a nationally-representative sample of kids aged 12 to 15 who
completed annual questionnaires between 2013 and 2016.
Along with questions about vaping and smoking, the surveys asked
about kids' socioeconomic backgrounds and their attitudes about
smoking. They were also asked questions designed to illuminate how
prone they were toward risky behaviors and sensation-seeking.
Those who reported using a tobacco product in the three years of
surveys were asked which of 12 products they had "tried first,"
including traditional cigarettes, cigars, pipes, hookahs, chewing
tobacco, snus and e-cigarettes.
Stokes and his colleagues focused on the 6,123 kids who said in the
first-wave survey that they had never used any tobacco product. By
the third survey, 6.1 percent of these kids reported smoking or
having tried traditional cigarettes.
Among kids who had first tried e-cigarettes, just over 20 percent
had tried or were regularly smoking cigarettes by wave three, and
among kids who first tried other non-cigarette tobacco products,
more than 21 percent had tried or were smoking cigarettes. That
compares with just 4 percent of kids who had not used any type of
non-cigarette tobacco products.
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Researchers calculated that the odds of trying traditional
cigarettes or becoming regular smokers were 4.09 times higher for
those who tried e-cigarettes first, and 3.84 times higher after
trying other non-cigarette tobacco products first.
But for those kids considered to be at low risk for taking up
smoking – who had initially said they had no interest in smoking,
were risk averse and less likely to seek out new experiences - first
using e-cigarettes raised the risk of eventual smoking by 8.57
times. This added risk wasn't seen among first users of other
non-cigarette products.
Stokes suspects that there are several reasons why kids who don't
see themselves ever smoking cigarettes might be open to vaping.
First, he said, many don't realize that nicotine is a highly
addictive substance. "And there is also the 'cool factor,'" he said.
"The flavors are very appealing and we know that they are
disproportionately appealing to youth, who are exposed to a lot of
marketing targeted to them on social media."
The new findings are "pretty consistent with what we've seen before
in this area in terms of demonstrating that people who experiment
with electronic cigarettes, even if they swear at baseline that they
would never smoke regular cigarettes, are at much more risk of
transitioning to regular cigarettes," said Dr. Brian Primack,
director of the Center for Research on Media, Technology and Health
at the University of Pittsburgh in Pennsylvania.
The new study "strengthens earlier findings in a couple of ways,"
Primack said. "First, this is a very large and prestigious database
and that is important with an area as controversial as this. You
want to make sure your evidence is as strong as possible. The other
thing it does is show that the magnitude of risk is even higher for
those at low risk for using cigarettes. We've been seeing hints of
this all along. And this is particularly problematic for people who
probably would never have touched a cigarette to begin with."
SOURCE: https://bit.ly/2MKNMJE JAMA Network Open, online February 1,
2019.
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