E-Cigs May Encourage Conventional Cigarette Use Among Adolescents


A recent study, published on March 6th, by JAMA (The Journal of the American Medical Association) Pediatrics, found that adolescents who used e-cigs (electronic cigarettes) were more likely to be concurrent smokers of conventional cigarettes, and less likely to quit. The researchers looked at nearly 40,000 completed National Youth Tobacco Surveys, completed in 2011 and 2012, by middle and high school students in the United States.  They concluded that present e-cig use was associated with greater odds of wanting to quit conventional cigarettes, but a decreased likelihood of overall abstention from them. “Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. Adolescents”.

The fallout of opinion following the study’s publication seems aligned with three typical stances regarding electronic cigarettes. The first, that e-cigs serve as a gateway drug that leads to conventional cigarette smoking, finds itself in the firm embrace of the study’s lead author, Lauren M. Dutra, a postdoctoral fellow at the UCSF School of Medicine. The second view regards electronic cigarettes as a nicotine substitute less harmful than conventional cigarettes. Dr Michael Siegal, a professor at Boston University School of Public Health argues that the study data equally lends itself to the view that people are attracted to e-cigs as an aid to help them stop smoking conventional cigarettes. Others, taking the third view, that electronic cigarettes serve as a supplemental nicotine consumer item, suggest that the research merely shows the tendency for potential future smokers to experiment with various products. In this view, e-cigs are neither gateways drugs or aids to quitting tobacco smoking, but just an additional object of vice for the person on the path to becoming a regular and, perhaps, long-term smoker.

In light of the distinct views just mentioned, it may be helpful to note that the U.S. adult population, overall, has seen a marked decrease in conventional cigarette smoking, and that arguments for or against e-cigs as an aid for quitting might do better if it remained focused on this older population of long term smokers. For them, the desire to take up the electronic cigarette may less likely be for experimentation than out of a sincere effort to reduce the number of conventional cigarettes smoked on a regular basis.

But the story for a child starting off on a nicotine-laden e-cig turns out to be vastly different than the older smoker looking for a nicotine substitute. The JAMA study focused on the youth, and the researchers were clearly motivated by the near absence of government regulation of electronic cigarettes as it applies to teenagers. Right now we see e-cig company marketing strategies targeted at the youth demographic, with the shell designed in a variety of teen-friendly colors and designs, not to mention the candy-like flavors of their refill offerings. And these offerings contain nicotine, the addictive ingredient in both electronic and conventional cigarettes.

Over the last few years, there has been much debate as to the health hazards versus benefits of the electronic cigarette. Publications have surfaced decrying e-cigs as a carrier of toxic chemicals while others see the dangers of conventional cigarettes as justification for the marketing of the e-cig alternative. In reality, it will take years to determine whether e-cigs can help long-term smokers quit conventional cigarettes; or whether adolescents using electronic cigarettes today will turn into habitual conventional smokers as they grow older.

By Robert Wisnewski



The New York Times

Modern Healthcare