Los Angeles

Teens' E-Cigarette Use Linked With Later Smoking

Teens who use e-cigarettes are more likely than others to later smoke conventional cigarettes and other tobacco products, a study at 10 Los Angeles high schools suggests.

The study doesn't prove that electronic cigarettes are a "gateway drug" but some doctors say it bolsters arguments that the devices should be strictly regulated as proposed by the Food and Drug Administration.

Adam Leventhal, a USC clinical psychologist and lead researcher for the study says they used 2,530 students in the ninth grade at various LA high schools, all of them 14 years old and about half boys and half girls.

Of those, 222 had used e-cigarettes. When the test subjects were surveyed six months later, more than 30 percent of them had moved on to either hookah, regular cigarettes or cigars and 8 percent of those who had not used e-cigarettes had started smoking.

Leventhal says the study, funded by the National Institutes of Health, is statistically adjusted based on risk factors.

“If your parents smoke, you’re more likely to smoke,” he said. “These are well-established risk factors. Lower socioeconomic levels are more likely to smoke. If you’re depressed you’re more likely to smoke.”

The study cannot conclude that e-cigarettes directly lead to tobacco use, though. Leventhal believes more studies need to be done to be sure, but says his case should raise the concern.

“They’ve become very high tech and sleek,” he said. “They’re available in flavors enticing to youth like bubble gum.”

And while there is a perception that “vaping” is not as harmful as regular tobacco use, Leventhal says there isn’t enough studies to believe that either. He does, however, believe that among adults, vaping is often used as a way to stop smoking. However, he says that’s not the case among teens.

“Among teens, they’re not using e-cigarettes as a means to help them quit,” he said. “There’s many teens out there who never smoked and are using e-cigarettes for recreational purposes.”

Whether teens had tried just one e-cigarette or were habitual users isn't known, nor is whether they became heavy smokers or just had a few puffs. That information would be needed to help determine whether nicotine from e-cigarettes predisposed users to seek out other sources.

Despite those limitations, the study "is the strongest evidence to date that e-cigarettes might pose a health hazard by encouraging adolescents to start smoking conventional tobacco products," said Dr. Nancy Rigotti, director of a tobacco research and treatment center at Massachusetts General Hospital. Her commentary and the study were both published in Tuesday's Journal of the American Medical Association.

E-cigarettes haven't been extensively studied and there's no scientific consensus on any potential benefits or harms, including whether they lead kids to become regular smokers.

The researchers considered traits that might make teens more likely to use tobacco, including impulsiveness, delinquent behavior and parents' smoking habits. Their analysis showed those traits played a role but didn't fully explain the link between e-cigarettes and later tobacco use.

Leventhal noted that e-cigarettes were initially introduced as a potentially safer alternative to tobacco for smokers who were trying to cut down, but they have evolved into a recreational product for some users.

Available for nearly a decade, e-cigarettes are battery-powered devices that turn nicotine-containing liquid into vapor that is inhaled. Although nicotine can be addictive, e-cigarettes lack the chemicals and tars of burning tobacco.

National data show e-cigarettes have become more popular among teens than regular cigarettes.

Leventhal said his study "does little to dispel concerns that recreational e-cigarette use might be associated with moving on to these very harmful tobacco products."

But he said more research is needed to determine if e-cigarettes are really the culprit. He says he believes his research should lead lawmakers to consider action to find preventive initiatives when it comes to vaping.

“We need more information like this,” he said. “We need to find out what the potential consequences are of e-cigarette use, which is not well-known yet. Ultimately, we need things like prevention programs.”

The Smoke-Free Alternatives Trade Association said in a statement that vapor products should only be used by adults.

“Vapor products are adult-only products sold by adults to adults. We are adamantly opposed to minors using vapor products, and support efforts both on the state and federal levels to keep them out of the hands of underage consumers," the statement read, adding that parents should talk to their children about the issue.

The statement cited other research that shows a majority of "vapers" are former smokers, and that 95 percent of young e-cig users were already tobacco cigarette smokers.

“Vapor products are significant and less harmful alternatives to smoking, which kills 480,000 U.S. adults each year with a cost of $300 billion in economic and healthcare losses," the statement read. "The more we move away from the debate on how vapor products can help reduce the public harm caused by smoking, the less we will realize their full economic, public health and societal benefits.”

Copyright AP - Associated Press
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