In the JournalsPerspective

Rise in e-cigarette popularity may cause increase in teenage smoking

Social influences associated with the increased prevalence of electronic cigarettes may be causing more teens to engage in traditional and electronic smoking behaviors, according to study results in Pediatrics

“Psychosocial variables indicating a favorable e-cigarette social environment were associated with cigarette use, as well as with e-cigarette use,” Jessica L. Barrington-Trimis, PhD, MS, of the department of preventive medicine at the University of Southern California, and colleagues wrote. “This finding is a cause for concern because e-cigarettes were the dominant tobacco product used, and a substantial proportion of e-cigarette users had no history of cigarette use.”

To study the social impact of electronic cigarettes among adolescents, the study researchers collected information through questionnaires from 2,084 Southern California students in grades 11 and 12 during 2014. Tobacco usage was evaluated through questions regarding past use of traditional cigarettes, past use of e-cigarettes, age at initiation of smoking and frequency of use. Responses allowed the researchers to categorize respondents into “never users,” “past users” and “current users” for electronic and traditional cigarettes.

The researchers also assessed the psychosocial characteristics of e-cigarette use. Respondents were asked how many of their friends used either type of cigarette, their friends’ attitudes about cigarettes and whether or not cigarette use is bad for their health.

Data indicated that the use of e-cigarettes was the most prevalent smoking behavior among teens, with 24% of respondents saying they had used the devices compared with 18.7% who reported ever smoking traditional cigarettes.

Current use of traditional cigarettes was significantly related to the current use of e-cigarettes (OR = 62.9; 95% CI, 35.6-111). Dual use of both types of cigarettes was reported by 3.2% of respondents, including 33% of current e-cigarette users.

Despite this correlation, 40.5% of current e-cigarette users reported never smoking a traditional cigarette, while 44.2% of past e-cigarette users reported never using cigarettes.

The researchers also found that social factors and perception of the harm of electronic cigarettes were heavily associated with the use of electronic and traditional cigarettes. Almost half (49.5%) of current e-cigarette users reported having three or four friends who also used the devices. Ninety-one percent of current electronic cigarettes users reported that they would receive a “friendly” or “very friendly” response from their best friend as a result of smoking. Perceptions of safety also were skewed for current users, with 48% saying they disagreed that electronic cigarettes were bad for their health.

“The health hazards of e-cigarettes are not yet well studied, although the adverse health effects of nicotine, including neonatal, neurodevelopmental, and carcinogenic effects, are well established, and several studies have identified additional potential hazards of e-cigarette aerosols,” Barrington-Trimis and colleagues wrote. – by David Costill

Disclosure: The researchers report no relevant financial disclosures.

Social influences associated with the increased prevalence of electronic cigarettes may be causing more teens to engage in traditional and electronic smoking behaviors, according to study results in Pediatrics

“Psychosocial variables indicating a favorable e-cigarette social environment were associated with cigarette use, as well as with e-cigarette use,” Jessica L. Barrington-Trimis, PhD, MS, of the department of preventive medicine at the University of Southern California, and colleagues wrote. “This finding is a cause for concern because e-cigarettes were the dominant tobacco product used, and a substantial proportion of e-cigarette users had no history of cigarette use.”

To study the social impact of electronic cigarettes among adolescents, the study researchers collected information through questionnaires from 2,084 Southern California students in grades 11 and 12 during 2014. Tobacco usage was evaluated through questions regarding past use of traditional cigarettes, past use of e-cigarettes, age at initiation of smoking and frequency of use. Responses allowed the researchers to categorize respondents into “never users,” “past users” and “current users” for electronic and traditional cigarettes.

The researchers also assessed the psychosocial characteristics of e-cigarette use. Respondents were asked how many of their friends used either type of cigarette, their friends’ attitudes about cigarettes and whether or not cigarette use is bad for their health.

Data indicated that the use of e-cigarettes was the most prevalent smoking behavior among teens, with 24% of respondents saying they had used the devices compared with 18.7% who reported ever smoking traditional cigarettes.

Current use of traditional cigarettes was significantly related to the current use of e-cigarettes (OR = 62.9; 95% CI, 35.6-111). Dual use of both types of cigarettes was reported by 3.2% of respondents, including 33% of current e-cigarette users.

Despite this correlation, 40.5% of current e-cigarette users reported never smoking a traditional cigarette, while 44.2% of past e-cigarette users reported never using cigarettes.

The researchers also found that social factors and perception of the harm of electronic cigarettes were heavily associated with the use of electronic and traditional cigarettes. Almost half (49.5%) of current e-cigarette users reported having three or four friends who also used the devices. Ninety-one percent of current electronic cigarettes users reported that they would receive a “friendly” or “very friendly” response from their best friend as a result of smoking. Perceptions of safety also were skewed for current users, with 48% saying they disagreed that electronic cigarettes were bad for their health.

“The health hazards of e-cigarettes are not yet well studied, although the adverse health effects of nicotine, including neonatal, neurodevelopmental, and carcinogenic effects, are well established, and several studies have identified additional potential hazards of e-cigarette aerosols,” Barrington-Trimis and colleagues wrote. – by David Costill

Disclosure: The researchers report no relevant financial disclosures.

    Perspective
    Gerald B. Whitman

    Gerald B. Whitman

    This study presented some very disturbing issues for pediatricians who care for adolescent patients, highlighting psychosocial factors that are correlated with an increased risk of using e-cigarettes. These risk factors included having friends or family members who use cigarettes or e-cigarettes, a more positive attitude by friends concerning the use of these products and a feeling that e-cigarettes were not harmful to the user’s health. While the number of adolescents using cigarettes has not increased in the past 4 years — and has actually decreased about 40% in studies — the use of e-cigarettes has increased in the same time period ninefold. The total number of adolescents using some form of nicotine delivery system has also increased over the past 4 years.

    The authors voiced some concern that the more relaxed social perceptions by adolescents of e-cigarettes compared with cigarettes could contribute to a “renormalization” of tobacco products. It is important that those of us caring for adolescents be aware of this disturbing trend and address the potential long-term health issues that could result from the use of e-cigarettes. Although studies of the long-term consequences of e-cigarettes may take a few decades to prove, there are already emerging studies suggesting adverse health effects. It seems important that part of all medical contacts with adolescents should include questions about e-cigarette usage and the long-term consequences of nicotine.

    • Gerald B. Whitman, MD
    • Infectious Diseases in Children Editorial Board member Pediatrician, Cedars-Sinai Medical Center