While proponents of electronic cigarettes may claim that they are responsible for a decline in youth cigarette smoking, the University of California San Francisco (UCSF) reports that e-cigarettes actually are attracting a new population of adolescents who otherwise might not have begun smoking tobacco products.
In the first national analysis of the impact of e-cigarettes on trends in youth smoking in the United States, the researchers did not find evidence that e-cigarettes have caused youth smoking to decline. In fact, combined e-cigarette and cigarette use among adolescents in 2014 was higher than total cigarette use in 2009, the researchers report.
Low-risk youth who went on to smoke regular cigarettes might not have tried nicotine at all if e-cigarettes did not exist, the researchers concluded.
“We didn’t find evidence that e-cigarettes are causing youth smoking to decline,” said the study’s lead author, Lauren Dutra, ScD, a former postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education and a social scientist at the RTI International nonprofit research organization.
“While some of the kids using e-cigarettes were also smoking cigarettes, we found that kids who were at low risk of starting nicotine with cigarettes were using e-cigarettes,” said Dutra. “Recent declines in youth smoking are likely due to tobacco control efforts, not to e-cigarettes.”
Last August, the US Food and Drug Administration (FDA) restricted e-cigarette purchases to adults aged 18 years and older. The FDA also will require a warning label on e-cigarettes about the addictive nature of nicotine, beginning in August 2018. The FDA’s ruling does not regulate advertising or flavors, though, which often are designed to appeal to youth.
The researchers examined survey data from more than 140,000 middle and high school students who completed the Centers for Disease Control and Prevention (CDC) National Youth Tobacco Survey between 2004 and 2014. They found that cigarette smoking among US adolescents declined during that decade, but it did not decline faster after the advent of e-cigarettes in the United States between 2007 and 2009.
The CDC further reports that the percentage of high school students who smoked cigarettes in the previous 30 days declined from 15.8% in 2011 to 9.3% in 2015, though the percentage of those who used electronic cigarettes in the previous 30 days climbed from 1.5% in 2011 to 16.0% in 2015. In 2013, 17.7% of middle school students and 46% of high school students said that they had tried a tobacco product at some point in their lives.
The UCSF authors also analyzed the psychosocial characteristics of e-cigarette users. Research has established that smokers tend to display certain characteristics that nonsmokers are less likely to show, such as a tendency to live with a smoker or to wear clothing that displays a tobacco product logo. The smokers in the national youth survey displayed these characteristics, but the adolescents who only used e-cigarettes displayed few of these qualities.
“E-cigarettes are encouraging, not discouraging, youth to smoke and to consume nicotine and are expanding the tobacco market,” said senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the UCSF Center for Tobacco Control Research and Education.
The UCSF results are consistent with a similar study of youth in California conducted last year by the University of Southern California, which found that adolescents who used e-cigarettes but not cigarettes displayed few of the risk factors commonly found among cigarette smokers. Combined, the studies suggest that e-cigarettes are attracting low-risk youth, the researchers said.
The study, “E-cigarettes and National Adolescent Cigarette Use: 2004-2014,” was published by Pediatrics.
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