Teen data find vapers often become smokers

New study shows teens who might not normally smoke begin doing so after using e-cigarettes


Mounting evidence suggests that high-school students who use e-cigarettes are more likely to start smoking. 


Many people see vaping as being less harmful than smoking cigarettes. After all, unlike tobacco, e-cigarettes don’t deliver dozens of lung-cancer-causing chemicals, called carcinogens, with each puff. So the fact that more teens are vaping than smoking might be viewed as a good thing. Except — that more and more studies are showing e-cigarettes can cause harm. They irritate lungs and make asthma worse. They also raise the risk a teen will take up smoking. A new study not only confirms this risk but also suggests that vaping may encourage smoking by even those teens who would have seemed the least likely to have taken up the habit.

E-cigarettes have been widely available for less than a decade. So there’s not yet much long-term data on how they affect health. But vaping liquids do contain nicotine, a chemical known to cause harm. Indeed, this chemical is what makes smoking so addictive. And it now may explain why many young people who vape move on to try smoking. 

Two studies published last year (see Related Readings below) showed that vaping can act as a gateway habit for teens. That means it can lead to more harmful addictions. Those may include smoking tobacco or a hookah. (A hookah  delivers cooled tobacco smoke through a pipe.) The new study found worrisome support for that.

“All the information that’s come out in the past few months suggests that there is a risk associated with e-cigarette use,” says Thomas Wills. He studies alcohol and smoking in teenagers at the University of Hawaii Cancer Center in Honolulu.  

For their new study, Wills and his colleagues surveyed more than 2,200 9th and 10th graders in Hawaii. They asked whether, and how often, a student had vaped or had smoked cigarettes. They also asked about the students’ relationships with their parents. And some questions probed how much the kids liked to take risks and whether they liked to do things they’re not supposed to do.

One year later, the scientists surveyed these students again. The researchers then compared the teens’ answers. And those who said in the first survey that they had vaped were nearly three times as likely as the nonvapers were to have begun smoking over the next year.

Teasing out the role of vaping

Some people might think that those teens who moved from vaping to smoking were likely to have done so anyway. To test this idea, the researchers looked at one big factor that predicts whether teens will start smoking: personality.

Studies have shown that rebellious teens, those who are more likely to take risks and who don’t have a close relationship with their parents are all more likely to take up cigarettes. Those same traits aren’t as strongly linked to vaping. Why? Vaping isn’t seen as dangerous. So even students who are not rebellious or risk takers often try vaping. And many of these teens — who would otherwise have been at low risk of smoking — later moved on to real cigarettes.

In other words, vapers who moved on to cigarettes probably wouldn’t have done so if they hadn’t first used e-cigs, Wills says: “The effect we detected is truly an effect of e-cigarette use.”

His team reported its findings January 26 in Tobacco Control.

“What this shows is that, as much as people might think that it’s safer to vape, that’s not necessarily true,” says William Shadel. He is a behavioral scientist at the RAND Corporation in Pittsburgh, Penn. “Vaping could make you more dependent on nicotine, and cause you to later want to take up cigarette smoking.” And, he adds, “That may not be something you have control over.”

The U.S. Food and Drug Administration (FDA) has proposed a rule that would prevent the sale of e-cigarettes and associated products to minors, just as they do for tobacco cigarettes. But it hasn’t yet gone into effect. This new study and those that came before may help push that along.

“The question of whether e-cigarette use will prevent or promote smoking is the number one public health question of our time,” Wills says. “I think we need as much data as possible so as to provide the FDA with a scientific basis for making decisions about whether or not to regulate e-cigarettes — and, if so, how.”

Power Words

(for more about Power Words, click here)

addiction  (adj. addictive) The uncontrolled use of a habit-forming drug or uncontrolled and unhealthy habit (such as video game playing or phone texting). It results from an illness triggered by brain changes that occur after using some drugs or engaging in some extremely pleasurable activities. People with an addiction will feel a compelling need to use a drug (which can be alcohol, the nicotine in tobacco, a prescription drug or an illegal chemical such as cocaine or heroin), even when the user knows that doing so risks severe health or legal consequences. (For instance, even though 35 million Americans try to quit smoking each year, fewer than 15 out of 100 succeed. Most begin smoking again within a week, according to the National Institute on Drug Abuse.)

asthma  A disease affecting the body’s airways,which are the tubes through which animals breathe. Asthma obstructs these airways through swelling, the production of too much mucus or a tightening of the tubes. As a result, the body can expand to breathe in air, but loses the ability to exhale appropriately. The most common cause of asthma is an allergy. It is a leading cause of hospitalization and the top chronic disease responsible for kids missing school.

cancer   Any of more than 100 different diseases, each characterized by the rapid, uncontrolled growth of abnormal cells. The development and growth of cancers, also known as malignancies, can lead to tumors, pain and death.

carcinogen  A substance, compound or other agent (such as radiation) that causes cancer.

chemical  A substance formed from two or more atoms that unite (become bonded together) in a fixed proportion and structure. For example, water is a chemical made of two hydrogen atoms bonded to one oxygen atom. Its chemical symbol is H2O. Chemical can also be an adjective that describes properties of materials that are the result of various reactions between different compounds.

e-cigarette  (short for electronic cigarette) Battery-powered devices that disperse nicotine and other chemicals as tiny airborne particles that users can inhale. They were originally developed as a safer alternative to cigarettes that users could use as they tried to slowly break their addiction to the nicotine in tobacco products.

Food and Drug Administration (or FDA)   A part of the U.S. Department of Health and Human Services, FDA is charged with overseeing the safety of many products. For instance, it is responsible for making sure drugs are properly labeled, safe and effective; that cosmetics and food supplements are safe and properly labeled; and that tobacco products are regulated.

hookah  A water pipe used to cool smoke — usually tobacco smoke — that will be inhaled. According to the U.S. Centers for Disease Control and Prevention, “hookah smoking carries many of the same health risks as cigarettes.”

minors  Children and adolescents below an age that would make them legally adults.

nicotine  A colorless, oily chemical produced in tobacco and certain other plants. It creates the ‘buzz’ effect associated with smoking. It also is highly addictive, making it hard for smokers to give us their use of cigarettes. The chemical is also a poison, sometimes used as a pesticide to kill insects and even some invasive snakes or frogs.

survey  (in statistics) A questionnaire that samples the opinions, practices (such as dining or sleeping habits), knowledge or skills of a broad range of people. Researchers select the number and types of people questioned in hopes that the answers these individuals give will be representative of others who are their age, belong to the same ethnic group or live in the same region.

tobacco   A plant cultivated for its leaves. Dried tobacco leaves are burned in cigars, cigarettes, and pipes. Tobacco leaves are also sometimes chewed. The main constituent of tobacco leaves is nicotine.

vaping   A slang term for the use of e-cigarettes because these devices emit vapor, not smoke. People who do this are referred to as vapers.

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