Non-smoking teens who use e-cigarettes are more likely to turn to the real thing compared to their non-vaping counterparts, according to a new study that made risqué headlines Tuesday. The study authors also reported that vapers were more likely to become daily and heavy smokers, highlighting the potential danger.
On the face of it, the findings seem to confirm fears that e-cigarettes act as a gateway to tobacco, potentially resolving lifelong addictions in young people. Health organizations, such as the Centers for Disease Control and Prevention, have repeatedly raised red flags that electronic smoking devices could undo the hard-won successes of decades-old anti-tobacco campaigns. Many experts have argued for tight regulation.
But others argue that e-cigarettes should remain easily accessible because they are undoubtedly less harmful than traditional cigarettes and can help smokers quit. Proponents also rightly point out that the data supporting the idea that e-cigarettes act as a gateway to tobacco is meager at best. Cigarette use among teens has reached an all-time low. And despite the increase in the number of children experimenting with e-cigs, smoking has continued to decline.
The new study does little to detract from the discussion, despite what the headlines might lead you to think. In short, the study was small, short, and produced mixed and impossible to interpret results.
The study was led by researchers at the University of Southern California and lasted just six months — a quick timeline to decipher whether habits are formed or kicked. At the beginning and end, researchers collected smoking and vaping data from 3,084 tenth grade students (average age of 15.5 years at start) from 10 schools in Los Angeles, California.
About 33 percent (1,009) of the 3,084 students said they had tried e-cigarettes at least once – that’s similar to the findings of other studies. However, only 133 reported “irregular” vaping (1-2 days in the past 30 days) and 146 reported “frequent” vaping (≥3 days in the past 30 days). At the end of the study, only 151 students said they rarely or often smoked cigarettes.
The researchers’ disturbing conclusion comes from a focused look at the teens who said they were nonsmokers at the start of the study — by far the largest group with 2,966 students. After six months, 94 of those children had switched to frequent or infrequent smokers.
The researchers sorted the original 2,966 non-smoking adolescents into bins based on whether the children reported never (1) vaping, (2) ever vaping but not in the last 30 days (earlier vapers), (3) vaping infrequently , or (4) often. Next, the researchers looked at the proportional shifts within each group from nonsmoker to smoker. The biggest of these were teens who said they vape often or infrequently. For example, 15 percent of frequent vapers switched from non-smokers to smokers, while only 1.2 percent of never-vapers switched in six months.
The finding led the researchers to conclude that vaping increases the likelihood of nonsmokers becoming smokers. But it’s important to point out that the conclusion hinges on just 26 teens — less than one percent of the 3,084 students in the study. Moreover, it is impossible to say why the children tried smoking; was it because they were vaping or would they have tried to smoke anyway?
The researchers also noted that the smokers who also vape frequently were the most likely to smoke daily and smoke more than two cigarettes per day. That finding hinges on just 30 students, and again, it’s unclear how vaping and smoking are related in those students.
The findings get darker when we zoom in on the kids who identified as infrequent and frequent vapers. Of the 146 frequent vapers, 93 said they were non-smokers at the start of the study. By the end, there were 100 of them, that is, seven of them quit smoking. Likewise, 112 of the 133 infrequent vapers started out saying they were non-smokers and eventually there were 114. While the shifts are teeny tiny, they go against the suggestion that e-cigs are a slippery slope for cigarettes. In fact, the students who initially said they rarely smoked and vaped (once or infrequently) saw the largest shifts to non-smokers (77.8 and 73.3 percent) by the end of the study.
While the data is interesting, the findings can easily go up in smoke with larger and longer studies.
JAMA2016. DOI: 10.1001/jama.2016.14649 (About DOIs).