Teens who use e-cigs more likely to start smoking

One reason e-cigarettes may serve as a gateway to traditional cigarettes is that they're designed to mimic the behavioral and sensory act of cigarette smoking. (Credit: iStockphoto)

Electronic cigarettes are loosely regulated in the United States and fairly easy for teenagers to purchase, but a new study finds that using e-cigarettes increases the likelihood those teens will start smoking traditional cigarettes.

“E-cigarettes are not subject to many laws that regulate traditional cigarettes, such as age limits on sales, taxation, and labeling requirements. They also come in youth-oriented flavorings that laws have limited in traditional cigarettes, such as apple bubble gum and chocolate candy cane,” says Brian A. Primack, the study’s lead author and director of the University of Pittsburgh Center for Research on Media, Technology, and Health.

James D. Sargent, a professor of pediatrics at Dartmouth’s Geisel School of Medicine and senior author of the study published in JAMA Pediatrics, says it’s also notable that e-cigarettes are marketed on television.

“This represents the first time in more than 40 years that a smoking-related device has been advertised on this medium, which has tremendous reach and could drive appeal of these products among youth.”

From ‘definitely no’ to ‘okay’

Primack, Sargent, and colleagues analyzed data on a national sample of nearly 700 16- to 26-year-old nonsmokers surveyed in 2012 and again in 2013 through the Dartmouth Media, Advertising, and Health Study. All participants were considered “non-susceptible” to initiating traditional cigarette smoking at the beginning of the study, because they had responded “definitely no” when asked if they would try a cigarette offered by a friend or believed they would smoke a cigarette within the next year.

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By the next year, 38 percent of the baseline e-cigarette users had initiated traditional cigarette smoking. In comparison, only 10 percent of the youths who were not baseline e-cigarette users started smoking traditional cigarettes.

“These differences remained statistically significant and robust even when we controlled for multiple known risk factors for initiating cigarette smoking, such as age, sex, race, ethnicity, socioeconomic status, sensation seeking, parental smoking, and friend smoking,” Primack says.

3 reasons why

The researchers theorize why e-cigarette smoking may serve as a gateway to traditional cigarette smoking:

1. E-cigarettes deliver nicotine more slowly than traditional cigarettes, allowing a new user to advance to cigarette smoking as he or she becomes tolerant of nicotine side effects.

2. Unlike other forms of nicotine, such as smokeless tobacco, e-cigarettes are designed to mimic the behavioral and sensory act of cigarette smoking, allowing the user to become accustomed to the act of smoking.

3. E-cigarettes are not subject to the same regulations as traditional cigarettes, potentially renormalizing the act of smoking after decades of public health efforts to shift public norms around smoking.

The National Cancer Institute funded the study.

Source: University of Pittsburgh