Are E-Cigs a Gateway to Smoking for Teens?

Aug 21, 2014, 3:44 PM, Posted by Sheree Crute

As you step through the door of Beyond Vape, you are enveloped in the warm scent of vanilla, tinged with butterscotch. The sleek glass counters and display cases are reminiscent of a high-end cigar shop, but there are no tobacco leaves on hand here. This popular, high-end “vaping” parlor, on one of Williamsburg Brooklyn’s more popular streets, is one of seven the company owns on the East and West Coasts.

Vaping—or inhaling richly flavored, heated vapor through a slender, battery-powered tube—is the latest trend in “smoking,” without actually lighting a traditional cigarette. Cindy Hsu, the store’s manager, explains that some of her customers “vape" without even adding liquid nicotine to the tube’s cylinder. “They prefer to just enjoy the extensive menu of flavors such as mocha mint, kiwi strawberry and pineapple.”

Tasty flavors are one thing, but there’s another popular incentive to vape: the claim that vaping can help you stop smoking. Another neighborhood shop, Brooklyn Vaper, advertises its wares with a video explaining that vaping is a “greener, cheaper alternative to help you quit smoking effortlessly... while vaping in 40 flavors.”

Is that true? Can vaping or pre-packaged e-cigarettes help smokers quit?

It depends on which research you're reading. One recently published survey of almost 6,000 adult smokers in Britain found that those who used e-cigarettes were 60 percent more likely to quit than those who tried nicotine replacement therapy or willpower alone.

However, many other researchers have come to very different conclusions. For example, an analysis published in the May 2014 JAMA Internal Medicine found no evidence to support the contention that e-cigarettes help conventional smokers quit, and the Center for Tobacco Control, Research & Education at the University of California, San Francisco, has called upon the Food and Drug Administration to "prohibit e-cigarette marketing that promotes false health claims."

And that's not even taking account the potential health risks associated with e-cigarette vapors, which are regarded as toxic.

That's the debate swirling around adult e-cigarette smoking and vaping, but there is an even more worrisome issue: What do we know about the effect of e-cigarettes on adolescent smoking behavior?

The Impact on Teens

Sociologist and demographer Adam Lippert, PhD, a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2013-2015), is one of many researchers asking the same question.

“My research was motivated by 2011-2012 data showing that the rate of adolescent e-cigarette use had doubled (from 5 percent to 10 percent) in a single year,” he says. The rate is increasing even though many states, including New York, ban the sale of e-cigarettes to people under 21. (Editor's note: Newly published research by the Centers for Disease Control and Prevention shows a threefold increase in the number of young people who had tried an e-cigarette in 2013, from roughly 79,000 in 2011 to more than 263,000 in 2013.)

Understanding why adolescents begin smoking is critical because almost nine out of 10 smokers pick up the habit by age 18, and 99 percent start before 26, according to the Centers for Disease Control and Prevention (CDC).

“I wanted to know whether adolescents were also using e-cigarettes to quit conventional cigarettes, like adults, or if e-cigarettes were used along with conventional tobacco,” Lippert explains.

His research found that teen smokers in general were most likely to be white and male, and that this group was also most likely to use e-cigarettes. The bad news: Those teen smokers tended to use conventional cigarettes and e-cigarettes together. Lippert reported that for teens, “e-cigarette use does not appear to be part of a [smoking] cessation regimen among conventional cigarette smokers wishing to quit.”

He makes his argument in the article “Do Adolescent Smokers Use E-Cigarettes to Help Them Quit? The Sociodemographic Correlates and Cessation Motivations of U.S. Adolescent E-Cigarette Use,” published online in the American Journal of Health Promotion in June.

Protecting Kids

Not only does Lippert express concern about the possible unknown health effects of e-cigarettes, he also suggests that for some young people, e-cigarettes might serve as an easy introduction to smoking. (A March study published in the journal JAMA Pediatrics makes just that assertion. The CDC research cited above paints an even more distressing picture. It shows that young people who had tried e-cigarettes were about twice as likely to intend to smoke tobacco cigarettes.)

“Other research has shown us that for adolescents, peers are the greatest influence on substance use,” Lippert says. And as every parent knows, even with legal restrictions in place, hot social trends, like vaping and e-cigarette products, transcend legal barriers and easily end up in the hands of teens.

“When smoking is portrayed as a social norm among others who are seen as cool, sophisticated, rebellious, or fun-loving, teens often respond by copying the behavior and trying cigarettes themselves,” according to the CDC report Preventing Tobacco Use Among Youth and Young Adults.

For parents and policy-makers, Lippert advises:

The danger, he adds, is slipping backward in time when it comes to adolescent tobacco use. “Teen smoking is at a historic low now, so we have something to protect. If we do nothing, we risk losing that. We do not want to go back to the days of Joe Camel.”

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