Are E-cigarettes Leading More Kids to Smoke?
Posted on by Dr. Francis Collins
Today, thanks to decades of educational efforts about the serious health consequences of inhaled tobacco, fewer young people than ever smoke cigarettes in the United States. So, it’s interesting that a growing of number of middle and high school kids are using e-cigarettes—electronic devices that vaporize flavored liquid that generally contains nicotine.
E-cigarettes come with their own health risks, including lung inflammation, asthma, and respiratory infections. But their supporters argue that “vaping,” as it’s often called, might provide an option that would help young people steer clear of traditional cigarettes and the attendant future risks of lung cancer, emphysema, heart disease, and other serious health conditions. Now, a new NIH-funded study finds that this is—pardon the pun—mostly a pipe dream.
Analyzing the self-reported smoking behaviors of thousands of schoolkids nationwide, researchers found no evidence that the availability of e-cigarettes has served to accelerate the decline in youth smoking. In fact, the researchers concluded the opposite: the popularity of e-cigarettes has led more kids—not fewer—to get hooked on nicotine, which meets all criteria for being an addictive substance.
The study, published recently in the journal Pediatrics, builds on publicly available data from the Centers for Disease Control’s National Youth Tobacco Survey (NYTS) . First administered in 1999, the survey was designed to capture the attitudes, behaviors, and exposure of kids in grades 6 through 12 to cigarettes and other tobacco products.
To capture youth smoking behaviors before and after e-cigarettes came on the scene in 2007, Lauren Dutra at RTI International, Berkeley, CA, and Stanton Glantz at the University of California, San Francisco, specifically analyzed survey data collected from 2004 to 2014. Not surprisingly, the data show a decline in cigarette smoking. In 2004, almost 16 percent of kids said they had smoked cigarettes within the last month, which is the definition of a current smoker. By 2014, only about 6 percent of kids said they had. But did the rate of decline accelerate with the arrival of e-cigarettes on the market?
Researchers say the answer is no. Many kids who smoked cigarettes also started vaping, as did some nonsmokers. But the sudden popularity of e-cigarettes had no apparent effect on curbing cigarette use.
Dutra and Glatz decided to drill down further. They turned their attention to survey questions that could help tease out contributing factors that increase a kid’s risk of smoking cigarettes, such as rebelliousness, sensation seeking, and whether their friends or parents smoked. Such questions included, “Do you think smoking cigarettes makes young people look cool or fit in?” and “If one of your best friends offered you a cigarette, would you smoke it?”
Based on the answers, Dutra and Glantz developed a behavioral model to predict whether an adolescent was likely to be a smoker. The model showed that they were very much on the right track, correctly classifying as smokers more than 75 percent of kids who reported lighting up in the last 30 days.
But the model didn’t work so well for e-cigarettes. The researchers found less than a quarter of e-cigarette users fit the profile of a cigarette smoker.
The finding shows that vaping has expanded the market for tobacco products to include kids at low risk of smoking cigarettes. As a result, the number of tweens and teens who used e-cigarettes, traditional cigarettes, or both in 2014 is greater than the number that smoked cigarettes in 2009. That’s a concern because e-cigarettes do come with health risks. Also of great concern is the possibility that vaping is a gateway to traditional cigarettes. Other studies have shown that people who use e-cigarettes are three times as likely to take up smoking within a year [2,3].
In fact, there are signs this has already begun. The 2015 NYTS survey data, which became available only after the researchers had completed their newly reported analysis, show almost no decline in smoking among middle schoolers between 2014 and 2015. The percentage of kids in high school who reported smoking in 2015 actually ticked up slightly compared to the previous year.
The findings highlight the importance of public health measures to discourage vaping, and there has been some progress on this front. Last August, the FDA restricted the sale of e-cigarettes to adults age 18 or older. By August 2018, e-cigarettes will bear labels warning of the addictive nature of the nicotine. Policymakers are also talking about prohibiting the sale of e-cigarettes with flavors known to attract young people. As this study also shows, e-cigarettes seem to be making the tobacco problem worse, not better.
 E-cigarettes and National Adolescent Cigarette Use: 2004-2014. Dutra LM, Glantz SA. Pediatrics. 2017 Jan 23. pii: e20162450. doi: 10.1542/peds.2016-2450.
 Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD. JAMA Pediatr. 2015 Nov;169(11):1018-23
 Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, Stone MD, Khoddam R, Samet JM, Audrain-McGovern J. JAMA. 2015 Aug 18;314(7):700-7
Tobacco (National Cancer Institute/NIH)
National Youth Tobacco Survey (Centers for Disease Control and Prevention)
Stanton Glantz (University of California, San Francisco)
NIH Support: National Cancer Institute