Kids Using E-Cigarettes More Likely to Graduate to Smoking

By Rose Hoban

Adolescents who get their start on nicotine using e-cigarettes are more likely to move onto smoking traditional cigarettes than kids who don’t use any nicotine products at all, according to new research published this week.

In a study published in JAMA Pediatrics, researchers from several universities banded together to follow about 700 adolescents aged 16 to 26 over the course of a year.

A man smokes an e-cigarette. Often the devices are made to look like traditional cigarettes. Photo by Taylor Dahlin, flickr creative commons — A man “vapes” an e-cigarette. Often e-cigarettes are made to look high tech and sophisticated, which can be attractive to teens. Photo by Taylor Dahlin, flickr creative commons

At the beginning, some were nonsmokers and others were users of e-cigarettes, but no one used traditional combustible cigarettes.

“They also said, ‘Yuk! I’d never use tobacco products,’” said Brian Primack, a primary care doctor from the University of Pittsburgh who also does research into how media exposure affects health behavior.

Primack said they followed the study group over the course of a year to see how many of them might start smoking regular cigarettes. During that time, 38 percent of the e-cigarette users went on to smoke regular cigarettes, while for the non-e-cigarette users that number was only 10 percent.

He said the 10 percent is pretty much in line with what would usually be expected.

“If you ask a bunch of young people who don’t intend to smoke, 10 percent will still go on to start smoking,” Primack said. “But the 38 percent is a dramatic increase over what we’d expect.”

He said the use of nicotine in the e-cigarettes probably “primes” people to go on to use regular cigarettes, which might be cheaper or easier to get ahold of.

“I see young people who are drawn to e-cigarettes and will be at later risk for cigarette use, when they could have had a life without nicotine,” he said.

Increased use among teens

Pam Seamans from the North Carolina Alliance for Health wasn’t surprised by the study results.

“I think that the outcome of the study is troubling, that the use of e-cigarettes are leading people to the use of traditional cigarettes, which are more dangerous,” Seamans said.

In recent surveys conducted by the Centers for Disease Control and Prevention, North Carolina high school students have greatly increased their use of e-cigarettes over the past four years. In 2011, 1.7 percent of kids used e-cigarettes; by 2013, that had jumped to 7 percent.

“The industry is using flavoring and marketing, and the coolness of the tech gadgets of the e-cigarettes are all qualities that draw young people to them,” Seamans said. “It’s not surprising [that] e-cigarettes could be considered a gateway drug to more traditional tobacco.”

For several years, Seamans’ organization has been pushing state legislators to reinstate funding for the Tobacco. Reality. Unfiltered. program that had contributed to historically low rates of youth smoking in North Carolina.

Legislators cut that program from $17 million to zero in 2013, and the appropriation has not been restored since.

Seamans said the norms had been changing toward making smoking “uncool,” and through the T.R.U. program kids had been learning about the dangers of cigarette smoke and nicotine use.

“With the lack of information on the dangers and potential harms, young people see lots of people using e-cigarettes in restaurants and movie theaters,” she said. “The more people see e-cigarettes in common areas, they see it as something that is more normal.”

Primack said one of the things “re-normalizing” nicotine use is the fact that e-cigarettes are advertised on television and on the Internet.

Reducing harms?

Both Seamans and Primack said they understand that many adults who are smokers already have found e-cigarettes to be a way to reduce their cigarette habit, and many “vapers” say they can use e-cigarettes instead of tobacco, which they claim are safer.

But, actually, the jury is still out.

“We don’t have the definitive science we’d like yet,” Seamans said.

The Food and Drug Administration, which has jurisdiction over tobacco products, has been amassing data for several years. It’s been expected to promulgate rules on e-cigarettes for more than a year. Many in the vaping community fear the agency will move to make access to e-cigarettes more difficult.

However, Primack said he’s increasingly doubtful e-cigarettes are actually an answer to kicking the nicotine habit for smokers.

“What we see more frequently is that an adult tries using an e-cigarette and for the first month or two he’s able to cut down on the number of cigarettes he uses,” he said. “But the evidence at this point is that often he’ll convert back to regular cigarettes or be a dual user: vape in places where he can’t and then uses cigarettes at home.”

“The person doesn’t’t actually get less toxin. in fact, their cycle of nicotine addiction is just continuing.”

Nicotine isn’t harmless; studies have shown it contributes to reductions in lung function, increased blood pressure and stroke risk and changes to the adolescent brain. Primack said we really don’t know the safety profile of e-cigarettes yet.

“If you could just tomorrow make every single smoker only smoking e-cigarettes, I’m not sure I buy the argument that there’d be less disease,” he said. “We don’t know about the safety profile.”

And nicotine is potently addictive, which is why Primack called e-cigarettes a “lifeline” for tobacco companies, which have purchased the major e-cigarette brands.

For example, North Carolina’s Reynolds American has purchased the VUSE e-cigarette brand and is ramping up production.

“They’re good at what they do, and they wouldn’t do this if it wasn’t a benefit for them,” he said. “Before e-cigarettes, one could look at the trend over time and think we could get rid of cigarettes.”