Teens who smoke e-cigs more likely to try full-blown smoking later

Teenagers who smoke e-cigarettes before they are legally allowed to buy cigarettes are six times more likely to turn to cigarettes when they have access. They are also more likely to smoke hookah pipes, cigars or pipes.

When youngsters are introduced to nicotine via e-cigarettes, they face the risk of developing nicotine dependence. This in turn encourages them to move onto other forms of nicotine — like cigarettes.

A study conducted by a group of US researchers in the Department of Preventive Medicine at the University of Southern California in Los Angeles shows that four in every 10 teens swopped e-cigarettes for cigarettes after initially smoking e-cigarettes. In contrast only 10% of those who had never used an e-cigarette adopted the habit of smoking later.

Their study was published in the Pediatrics Journal.

There has been a marked increase in the number of teenagers who use of e-cigarettes in recent years. In 2014 in the US more high school students were using e-cigarettes than traditional cigarettes. The country’s National Youth Tobacco Survey shows that just over 13% of high school children said they used an e-cigarette in the month before the study. About 9% had smoked a cigarette in same period.

Similar studies are yet to be conducted in the developing world.

Little known about children and e-cigarettes

 The researchers embarked on the study due to the lack of research into the effect of e-cigarettes on young people. They wanted to establish if it increases the likelihood of young people eventually smoking cigarettes when they became adults and could legally purchase them.

They followed a group of students in Southern California, collecting data on e-cigarette use among 17-year-olds. They then followed up with the teens 16 months later. It involved a mix of teens: some had never-smoked e-cigarettes, others had never smoked.

Three previous studies have shown the association between e-cigarette use and teens smoking cigarettes later. But less is known about the risks of turning to cigarettes after smoking e-cigarettes. What this study suggests is that e-cigarette use may increase the risk of smoking during the transition to adulthood.

Traditional smoking criteria

The research shows there are several factors that can have an impact on whether children pick up the habit of smoking. This includes whether they grow up around smokers and secondly whether their friends’ perception of them would change if they smoked. These factors have, more recently, been applied to e-cigarettes.

But the link between teens who started smoking after using e-cigarettes was much stronger among those who were not susceptible to becoming smokers because of personal or environmental factors.

The research suggests that among teens who were likely to smoke, using e-cigarettes may have delayed them from picking up the habit.

But there is a higher risk among teens who had no intention of smoking but picked up the habit after using an e-cigarette compared to those who said they were likely to start smoking. According to the numbers, among non-susceptible teens, 36% of e-cigarette users initiated cigarette use, compared with only 6% of nonusers.

This suggest two things: not only do teens who smoke e-cigarettes go onto smoke cigarettes but that smoking e-cigarettes “likely introducing new youth to tobacco products and is increasing the likelihood of future smoking among the low-risk group who expressed confidence that they would not do so”.

Mechanisms that encourage smoking

According to the study there were several plausible mechanisms that could lead young people to move from e-cigarettes to cigarettes.

One of these mechanisms is flavoured tobacco based products. This is because these products desensitise users’ lungs to the harsh and aversive effects that come with inhaling nicotine.

“The e-cigarette therefore provides a more gradual transition for those who have never smoked to try cigarettes,” the research stated.

Technie type e-gadgets are another mechanism. These appeal to youth who are part of the “technological age” and could promote smoking and could encourage the teens to maintain the smoking habit or progress to heavier use.

The problem is that this leads to regular nicotine use which in turn leads to nicotine dependence.

People who are genetically susceptible to the addictive properties of nicotine may be at particularly high risk.

The researchers found that e-cigarettes had become “normal” among teens as a result of its rapid use in this age group. This indirectly normalised “smoking-like” behaviour, which could later lead to cigarette smoking if society becomes more accepting of alternative tobacco product use.

Link to the full research here.