E-cigarettes attract low risk adolescents to smoking, say researchers

Electronic cigarettes can encourage young people to smoke and to consume nicotine and are expanding the tobacco market, warn the authors of a large US study published in the journal Pediatrics.1

The study examined data from more than 140 000 middle and high school students who completed the Centers for Disease Control and Prevention’s national youth tobacco survey from 2004 to 2014.

Current smoking among adolescents decreased from 15.8% in 2004 to 6.4% in 2014. However, the decline in cigarette smoking did not accelerate after the advent of e-cigarettes, which occurred in the US in 2007-09. And the total combined use of cigarettes and e-cigarettes, accounting for dual use, increased from 11.4% in 2011 to 12.2% in 2014.

The researchers also analysed the psychosocial characteristics of adolescents who used e-cigarettes. Previous research has found that smokers tend to display certain characteristics that non-smokers are less likely to show, such as living with a smoker or wearing clothing with a tobacco product logo. The smokers in the national youth survey tended to display these characteristics, but the adolescents who were using only e-cigarettes displayed few of these qualities. This suggested, said the researchers, that e-cigarettes are attracting low risk youth who would probably not have initiated tobacco product use with cigarettes.

Lauren Dutra, study author from the University of California San Francisco’s Center for Tobacco Control Research and Education, said, “We didn’t find any evidence that e-cigarettes are causing youth smoking to decline. 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.

“Recent declines in youth smoking are likely due to tobacco control efforts, not to e-cigarettes.”

The authors said that the long term decline in cigarette smoking may reverse in future years and that the latest data from 2015 show that this may already be happening. The small decline in middle school smoking from 2014 to 2015 (2.5% to 2.3%) and a small increase in high school smoking (9.2% to 9.3%) show that adolescents who started using only e-cigarettes were more likely to be smoking cigarettes a year later, they added.

In August 2016 the US Food and Drug Administration banned the sale of e-cigarettes to under 18s, and California set this age restriction to 21. From August 2018 e-cigarettes will also be required to carry a warning label about the addictive nature of nicotine.

However, the FDA ruling does not regulate advertising of e-cigarettes or place any restrictions on flavours designed to appeal to young people.

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Anthony Devlin/PA