November 10, 2017
2 min read

Teens who use e-cigarettes with high levels of nicotine more likely to smoke regularly

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When adolescents use e-cigarettes with higher nicotine concentrations, they are over two times more likely to smoke frequently and nearly two times more likely to vape, according to research published in JAMA Pediatrics.

Teenagers who use e-cigarettes with higher nicotine concentrations are more likely to smoke more frequently.

“In 2016, 11% of American 10th grade students reported using e-cigarettes in the past 30 days. Prospective data demonstrate that youths who vape are more likely to initiate and progress to more frequent and heavy smoking,” Nicholas I. Goldenson, BA, from the department of preventive medicine at the University of Southern California Keck School of Medicine, and colleagues wrote. “… Identifying factors that underlie the progression of smoking and vaping among adolescents is critical for understanding, estimating and preventing adverse health consequences of e-cigarette use among youths.”

To examine if a correlation exists between the use of e-cigarettes with higher nicotine content and later increased frequency and intensity of both combustible cigarette smoking and vaping, the researchers conducted a prospective cohort study that included students attending 10 high schools located in the Los Angeles, California., metropolitan area. Adolescents included in this study completed surveys in the spring of 10th grade, which set a baseline.

In these surveys, Goldenson and colleagues conducted a follow-up after 6 months for teens who reported e-cigarette use within 30 days, as well as the nicotine concentrations used. Students reported frequency of combustible cigarette use and e-cigarette use, including 0 days (none), 1 to 2 days (infrequent) or at least 3 days (frequent). The concentrations included 0 mg/mL (none), 1 to 5 mg/mL (low), 6 to 17 mg/mL (medium) or at least 18 mg/mL (high). The researchers also collected data on the number of daily smoking or vaping episodes and puffs per episode.

Of the teens included in the study, 53% were male and the average age was 16.1 years. As teenagers increased nicotine concentrations (zero to low, low to medium, medium to high), they became 2.26 times more likely to smoke frequently (95% CI, 1.28-3.98) and were 1.65 times more likely to vape frequently (95% CI, 1.09-2.51) at follow-up with each increase. Teens smoked more cigarettes per day when they used high nicotine concentrations, as compared with no nicotine, at follow-up (adjusted RR, 7.03; 95% CI, 6.11-7.95),

When adolescents used low (aRR, 3.32; 95% CI, 2.61-4.03) medium (aRR, 3.32; 95% CI, 2.54-4.10) or high (aRR, 2.44; 95% CI, 1.63-3.24) levels of nicotine, they were more likely to have a significant number of vaping episodes compared with those who used no nicotine at baseline. This trend was reflected in data regarding puffs per session, with increased puffs reported at low (aRR, 2.05; 95% CI, 1.41-2.70), medium (aRR, 3.39; 95% CI, 2.66-4.11) and high (aRR, 2.23; 95% CI, 1.42-3.03) nicotine concentrations.

“One reason why nicotine vaping may have been more common in the present sample is that participants in this study vaped within the past 30 days and were asked what nicotine concentration they typically vaped during that period, whereas the 2015 U.S. Monitoring the Future Study assessed the substance vaped in the most recent episode,” Goldenson and colleagues wrote.

“Because youths may alternate use of different liquids that may or may not contain nicotine, youths who vape nicotine may not necessarily have used an e-cigarette containing nicotine during their most recent vaping occasion, which would result in lower nicotine vaping prevalence estimates than would result when assessing the substance typically vaped,” they continued. – by Katherine Bortz

Disclosure: The authors report no relevant financial disclosures.