A landmark study from the USA joins the mounting body of research linking e-cigarette use with youth uptake of cigarette smoking.
Young adults who use e-cigarettes are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not vape, according to the research from the University of Pittsburgh. The findings demonstrate that e-cigarettes are serving as a gateway to traditional smoking, contrary to their purported value as a smoking cessation tool, say the study authors.
“Early evidence on the potential value of e-cigarettes for cessation or reduction of cigarette smoking has been mixed,” says lead author Brian A. Primack, director of Pitt’s Center for Research on Media, Technology and Health, and dean of Pitt’s Honors College. “Our study finds that in nonsmokers, e-cigarettes make people more likely to start smoking. This supports policy and educational interventions designed to decrease the use of e-cigarettes among nonsmokers.”
More research will be needed to determine why e-cigarettes increase the risk of someone transitioning to tobacco cigarettes, but Primack notes several factors are likely at play, including that using e-cigarettes mimics the behavior of smoking traditional cigarettes, the “sweet vape” is a gentle introduction to smoking harsher tobacco and the build-up of nicotine addiction could lead e-cigarette users to seek out more nicotine-packed tobacco cigarettes. “Young adulthood is an important time when people establish whether they use tobacco or not,” says Primack.
Three other recent studies have confirmed links between e-cigarette use and cigarette uptake. A study to be published in January 2018 has found that US college students who exclusively used e-cigarettes had a greater odds of non-users of subsequent cigarette initiation, while a Canadian study found e-cigarette use “strongly associated” with cigarette smoking behaviour, including smoking initiation. A US study found that ratcheting up nicotine content in e-cigarettes had a direct impact on the number of e-cigarette users who subsequently turned to combustible cigarettes.
E-cigarettes dominate “endgame” agenda
While academic research continues to gain ground in establishing scientific links, the discussion on e-cigarettes dominated the agenda at the recent Hong Kong Council on Smoking and Health (COSH) conference. US expert Brian King, deputy director for research translation, CDC Office on Smoking and Health, presented statistics showing the “vast majority” of e-cigarette users also smoke – ie, are “dual use” tobacco users. But he pointed out that the small percentage who only use e-cigarettes are predominantly younger people. In 2014, he said, young people (18-24) were the largest group of those who had tried e-cigarettes but never smoked combustible cigarettes.
Meanwhile a European public health figure, who spoke on the conference sidelines on condition of anonymity, said e-cigarettes had polarised the previously united field of tobacco control. “My observation is we’ve gone from a situation where you had probably one of the most unified academic communities, in the fight against big tobacco, but as the new technology has come in, we’ve seen a real schism, a divide, it’s quite polarised.” The source said his own agency had taken the stance that while e-cigarettes are certainly not “safe”, they are less harmful than cigarettes or heat-not-burn products based on current evidence. “We’re not saying they are risk free, but in comparison to tobacco, which is so so damaging, they may be less harmful,” he said. However, he said his agency was interested in the more aggressive stance against e-cigarettes shown by peers in Hong Kong, and would be taking this news home.
Appendix: Summary table on recent studies into youth cigarette uptake on e-cigarette smoking
|Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study||October 2017||14-17||Canada||Youth who reported e-cigarette use in the past 30 days were more likely to initiate cigarette smoking and more likely to report having smoked daily at follow-up, even after adjustment for a range of other factors at baseline.|
|December 2017||18-30||USA||Baseline e-cigarette use was independently associated with initiation of traditional cigarette smoking at 18 months. This finding supports policy and educational interventions designed to decrease use of e-cigarettes among non-smokers.|
|Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents||December 2017||15-17||USA||Each successive increase in nicotine concentration vaped was associated with a 2.26 increase in the odds of frequent (vs no) smoking and a 1.65 increase in the odds of frequent (vs no) vaping at follow-up. Use of e-cigarettes with high (vs no) nicotine concentration was associated with a greater number of cigarettes smoked per day at follow-up.|
|January 2018||18-25||USA||11% of college students initiated cigarette use over the 1.5 year study period. More e-cigarette users than non-users initiated cigarette use during the study period. Exclusive e-cigarette use predicted subsequent cigarette initiation.|