Vaping can lead to teen smoking, new study finds

Data come from a year-long follow-up of Los Angeles high school students

Teens with e-cigs

Teens who vape are three times as likely to take up smoking conventional cigarettes, a new study finds. 


Teens who vape are more likely to start smoking tobacco products than are teens who don’t use electronic cigarettes. That’s the finding of a new study.

Stanton Glantz is a tobacco-control researcher of the University of California, San Francisco. He and many health officials had worried that e-cigarettes might serve as a “gateway” habit. By that they meant it might serve as a stepping stone to tobacco smoking, hookah use and cigars. But until now, there had been no data to support this idea.

“The question of whether e-cigarette use promotes cigarette smoking has now been answered — and the answer is yes,” says Glantz, who  was not involved in the new study.

Some scientists had argued that vaping should actually prevent smoking by giving teens a tobacco-free alternative, says Adam Leventhal. He’s an addiction scientist at the University of Southern California in Los Angeles. To investigate, Leventhal’s team surveyed 2,530 nonsmoking ninth-graders from 10 Los Angeles public schools.

The teens answered questions about their background, family history and habits. Among these students, 222 had vaped. The researchers then repeated their survey of high school students after six months, and again after one year. Compared with teens who didn’t use e-cigarettes at the beginning of ninth grade, those who did were about three times as likely to start smoking tobacco products during the year.

VAPING TEENS In this interview, Adam Leventhal explains the results of his recent study showing teens who vape are more likely to start smoking. JAMA Network

Leventhal’s team published its findings August 18 in JAMA.

Teen vaping rates have been skyrocketing

Unlike tobacco products, e-cigarettes can be advertised on both TV and the radio in the United States. In some states, e-cig makers can even sell their products to minors. E-cigarettes don’t contain tobacco, but they usually do deliver hits of nicotine. That’s the chemical in tobacco that makes smoking addictive.

The U.S. Food and Drug Administration has been waging a campaign to discourage teen vaping. Mitch Zeller directs FDA’s Center for Tobacco Products in Silver Spring, Md. “What I can say definitively,” he notes, “is that nicotine is harmful to the developing teenage brain.” As such, he argues, “No teenager, no young person, should be using any tobacco or nicotine-containing products.” His agency’s concerns have focused largely on e-cigs’ nicotine and the potential it might foster addiction.

But nicotine is not the only risk vaping may pose. Many of the flavorings vaporized in these devices have kid-friendly names. These include cotton candy, gummy bears and banana pudding. Their names might suggest they are safe. Yet chemists are finding that the vaporization of these substances can release chemicals into the air that irritate and inflame the lungs.

Still, few teens see e-cigs as dangerous. That’s one important finding of a University of Michigan study. Released last December, that study found that only 14.2 percent of the 12th-graders it surveyed thought vaping might be harmful.

That may help explain the growing youth interest in vaping. Last year, Glantz and his colleagues reported that the number of teens who had tried e-cigarettes had more than doubled between 2011 and 2012. E-cigarette users also were more likely than nonusers to smoke tobacco, the researchers found.

But because the survey from which their data came had not followed vapers over time, Glantz’s team could not be sure that vaping had led these teens to try tobacco. Indeed, Glantz recalls, back then “We got yelled at because we suggested that e-cigarettes were promoting smoking.”

Meanwhile, adolescent vaping rates have continued to grow since the analysis by Glantz’s team. In the past year alone, youth vaping rates tripled. That’s according to the latest annual National Youth Tobacco Survey by FDA and another federal agency. By last year, it found, 13.4 percent of U.S. high school students used e-cigarettes. Among middle school students, the rate had climbed in the past year from 1.1 percent up to 3.9.

For now, Leventhal plans to continue following the study’s participants to find out if teens who use e-cigarettes are more likely than non-vapers to become addicted to the nicotine that e-cigarettes dispense.

The idea that vaping would steer teens away from tobacco just doesn’t fit, Leventhal says. And now, he reports, “We actually found the opposite.”

Indeed, adds Glantz, the new findings “blow away one of the head-in-the-sand arguments that a lot of the e-cigarette advocates have been making.”

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.)

adolescence     A transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.

cell   The smallest structural and functional unit of an organism. Typically too small to see with the naked eye,it consists of watery fluid surrounded by a membrane or wall. Animals are made of anywhere from thousands to trillions of cells, depending on their size.

Centers for Disease Control and Prevention, or CDC  An agency of the U.S. Department of Health and Human Services, CDC is charged with protecting public health and safety by working to control and prevent disease, injury and disabilities. It does this by investigating disease outbreaks, tracking exposures by Americans to infections and toxic chemicals, and regularly surveying diet and other habits among a representative cross-section of all Americans.

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.

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.”

inflammation  The body’s response to cellular injury and obesity; it often involves swelling, redness, heat and pain. It is also an underlying feature responsible for the development and aggravation of many diseases, especially heart disease and diabetes.

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.

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

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