In the Journals

Teens who vape may be on 'one-way bridge' to cigarette smoking

A sample of 12th graders who had never smoked a cigarette, but did use an e-cigarette, were more than four times likely to smoke a cigarette than those who had not vaped, according to an analysis recently published in Tobacco Control.

“These results bolster findings for vaping as a one-way bridge to cigarette smoking among adolescents,” Richard Miech, MPH, PhD, Institute of Social Research, University of Michigan, and colleagues wrote. “To the best of our knowledge, the risk for future cigarette smoking is currently one of the strongest, scientific-based rationales for restricting youth access to e-cigarettes.”

The study was released a few weeks after a different study that appeared in Pediatrics suggesting that e-cigarettes are not linked to the decline in smoking rates among adolescents. That study also raised concerns about youth being more likely to smoke traditional cigarettes after starting with e-cigarettes.

Miech and colleagues analyzed information from 347 participants in both the 2014 and 2015 Monitoring the Future Survey. They found that among youth vapers who had never smoked a cigarette by 12th grade at baseline, recent vapers were more than four times more likely (RR = 4.78) to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among never-smokers at baseline, recent vapers were also more than four times (RR = 4.73) likely to move away from the perception of cigarettes as posing a ‘great risk’ of harm, a finding consistent with a desensitization process, and vaping did not predict quitting of smoking among recent smokers at baseline. Among participants who had smoked in the past but had not recently smoked at baseline, recent vapers were more than twice (RR = 2.15) as likely to report smoking in the past year at follow-up.

The researchers wrote that the ‘kid-friendly’ flavors of e-cigarettes lead many youth to begin vaping and that they may not experience immediate adverse effects. This may lead them to surmise that the dangers of combustible cigarettes are overblown and move onto these cigarettes. 

Miech and colleagues said there is a lack of a developed body of scientific evidence that documents the known dangers of e-cigarette use. Researchers said that could mean curbing underage use of e-cigarettes will not be an easy fix.

“Developing a rationale to regulate youth access to e-cigarettes will require more than a simple extension of the arguments used to regulate combustible cigarettes,” Miech and colleagues wrote. “The development of such evidence for the direct effects of e-cigarettes may require many years or even decades, as it did for regular cigarettes, and once this body is developed e-cigarette manufacturers could change their ingredients and the process may need to start all over again. In addition, recent research shows that the majority of youth who vape report that they vape ‘just flavoring’ and not nicotine. Consequently, regulations and policies based on a rationale of nicotine regulation may not necessarily apply to youth e-cigarette use in a straightforward way.” – by Janel Miller

Disclosure: The researchers reported no relevant financial disclosures. 

A sample of 12th graders who had never smoked a cigarette, but did use an e-cigarette, were more than four times likely to smoke a cigarette than those who had not vaped, according to an analysis recently published in Tobacco Control.

“These results bolster findings for vaping as a one-way bridge to cigarette smoking among adolescents,” Richard Miech, MPH, PhD, Institute of Social Research, University of Michigan, and colleagues wrote. “To the best of our knowledge, the risk for future cigarette smoking is currently one of the strongest, scientific-based rationales for restricting youth access to e-cigarettes.”

The study was released a few weeks after a different study that appeared in Pediatrics suggesting that e-cigarettes are not linked to the decline in smoking rates among adolescents. That study also raised concerns about youth being more likely to smoke traditional cigarettes after starting with e-cigarettes.

Miech and colleagues analyzed information from 347 participants in both the 2014 and 2015 Monitoring the Future Survey. They found that among youth vapers who had never smoked a cigarette by 12th grade at baseline, recent vapers were more than four times more likely (RR = 4.78) to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among never-smokers at baseline, recent vapers were also more than four times (RR = 4.73) likely to move away from the perception of cigarettes as posing a ‘great risk’ of harm, a finding consistent with a desensitization process, and vaping did not predict quitting of smoking among recent smokers at baseline. Among participants who had smoked in the past but had not recently smoked at baseline, recent vapers were more than twice (RR = 2.15) as likely to report smoking in the past year at follow-up.

The researchers wrote that the ‘kid-friendly’ flavors of e-cigarettes lead many youth to begin vaping and that they may not experience immediate adverse effects. This may lead them to surmise that the dangers of combustible cigarettes are overblown and move onto these cigarettes. 

Miech and colleagues said there is a lack of a developed body of scientific evidence that documents the known dangers of e-cigarette use. Researchers said that could mean curbing underage use of e-cigarettes will not be an easy fix.

“Developing a rationale to regulate youth access to e-cigarettes will require more than a simple extension of the arguments used to regulate combustible cigarettes,” Miech and colleagues wrote. “The development of such evidence for the direct effects of e-cigarettes may require many years or even decades, as it did for regular cigarettes, and once this body is developed e-cigarette manufacturers could change their ingredients and the process may need to start all over again. In addition, recent research shows that the majority of youth who vape report that they vape ‘just flavoring’ and not nicotine. Consequently, regulations and policies based on a rationale of nicotine regulation may not necessarily apply to youth e-cigarette use in a straightforward way.” – by Janel Miller

Disclosure: The researchers reported no relevant financial disclosures.