Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents.” This was the conclusion of a cross-sectional analysis of survey data from a representative sample of middle and high school students who completed the National Youth Tobacco Survey (NYTS) in 2011 (n = 17,353) and 2012 (n = 22,529). The results were reported in JAMA Pediatrics by Lauren M. Dutra, ScD, and Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco.1
The National Youth Tobacco Survey is an anonymous, self-administered questionnaire “developed to inform national and state tobacco prevention and control programs,” the study authors explained. “Conventional cigarette experimenters were defined as adolescents who responded yes to the question ‘Have you ever tried cigarette smoking, even 1 or 2 puffs?’ Ever smokers of conventional cigarettes were defined as those who replied ‘100 or more cigarettes (five or more packs)’ to the question ‘About how many cigarettes have you smoked in your entire life?’ Current smokers of conventional cigarettes were those who had smoked at least 100 cigarettes and smoked in the past 30 days.”
Among cigarette experimenters, ever using an e-cigarette was associated with higher odds of ever smoking cigarettes (odds ratio [OR] = 6.31; 95% confidence interval [CI] = 5.39–7.39) and current cigarette smoking (OR = 5.96; 95% CI = 5.67–6.27). Current use of e-cigarettes was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI = 5.63–9.79) and current cigarette smoking (OR = 7.88; 95% CI = 6.01–10.32). Use of e-cigarettes also was associated with lower 30-day, 6-month, and 1-year abstinence from cigarettes.
“This is a cross-sectional study, which only allows us to identify associations, not causal relationships. Our results are also limited by the lack of information about motivation for using e-cigarettes,” the authors acknowledged.
“As with adults, dual use of e-cigarettes and conventional cigarettes is high among adolescents and increasing rapidly,” the investigators stated. “Adolescents who had ever experimented with cigarettes (smoked at least a puff) and used e-cigarettes were more likely to report having smoked at least 100 cigarettes and to be current smokers than adolescents who never used e-cigarettes. Thus, in combination with the observations that e-cigarette users are heavier smokers and less likely to have stopped smoking cigarettes, these results suggest that e-cigarette use is aggravating rather than ameliorating the tobacco epidemic among youths. These results call into question claims that e-cigarettes are effective as smoking cessation aids.”
An accompanying editorial by Frank J. Chaloupka, PhD, of the Institute for Health Research at the University of Illinois at Chicago, points out that the rapid rise in the use of e-cigarettes has “stimulated a vigorous debate in the tobacco control community over the potential public health impact” and how e-cigarettes, also known as electronic nicotine delivery systems should be regulated.2 Currently, they are largely unregulated and aggressively marketed, although the U.S. Food and Drug Administration “is soon expected to release a proposed deeming rule that would encompass the variety of other tobacco products currently not subject to FDA regulation, including [electronic nicotine delivery systems],” Dr. Chaloupka reported.
The struggle to develop appropriate policies for e-cigarettes, in part “reflects the desire to maximize the use of [these devices] as a smoking cessation tool, while at the same time preventing youths from starting with [e-cigarettes] and moving on to conventional cigarettes,” Dr. Chaloupka wrote, adding:
While not harmless, moving current smokers from cigarettes to [e-cigarettes] would almost certainly lead to significant reductions in the health and economic consequences of smoking. However, the high rates of use of both [e-cigarettes] and conventional cigarettes among current [e-cigarette] users suggest that many are using them as a way to satisfy their nicotine addiction in venues where smoking is not allowed rather than as a means to quit smoking entirely, raising concerns that the public health impact of [e-cigarettes] could be minimal.
“Adopting the right mix of policies will be critical to minimizing potential risks to public health while maximizing the potential benefits,” he concluded. ■
1. Dutra LM, Glantz SA: Electronic cigarettes and conventional cigarette use among US adolescents. JAMA Pediatr. March 6, 2014 (early release online).
2. Chaloupka FJ: Tobacco control policy and electronic cigarettes. JAMA Pediatr. March 6, 2014 (early release online).