The kind of teenager least interested in smoking appears to be the type most likely to try a cigarette after they experiment with vaping, a new study indicates.
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Overall, teens are four times more prone to trying traditional tobacco cigarettes if they’ve ever used an e-cigarette, the researchers said.
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But “low-risk” teens are nearly nine times more likely to try smoking after they’ve vaped, according to findings published online Feb. 1 in JAMA Network Open.
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These low-risk teens don’t drink or do drugs, show little affinity for frightening or exciting things, don’t have much interest in trends, aren’t curious about smoking and would turn down a cigarette if offered one by a friend, said senior researcher Andrew Stokes. He’s an assistant professor of global health at Boston University’s School of Public Health.
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Despite all this, there’s something about either e-cigarettes or the experience of vaping that appears to open the doorway for these particular kids, making them more likely to light up in the future, Stokes said.
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“We really isolated a very low-risk group of youth, and within that group experimentation with e-cigarettes had a pronounced effect on subsequent cigarette uptake,” Stokes said. “We do think there’s something unique about e-cigarettes, and they’re being taken up without knowledge of the extent of their consequences.”
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No other product has ever shown such potential to be a gateway for smoking, the researchers concluded.
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The recent enormous popularity of Juul e-cigarettes among teenagers probably has made vaping’s influence even stronger among low-risk teens, Stokes added.
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The study period was prior to the popularity of Juul, which is “a stronger product,” he said. “It gives you a stronger hit and has potentially more nicotine than the older-generation products. The associations we found here may grow more pronounced with Juul. If anything, we may have underestimated the gravity of the problem relative to where we stand today.”
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For this study, Stokes and his colleagues analyzed data from the Population Assessment of Tobacco and Health Study, an ongoing series of surveys on tobacco use co-sponsored by the U.S. Food and Drug Administration and the National Institutes of Health.
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The data tracked cigarette and e-cigarette use over two years among just over 6,100 kids aged 12 to 15.
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None of the kids had tried any tobacco product when they were first surveyed in 2013-2014, but the adolescents did answer a battery of questions designed to see how likely they were to try smoking in the future.
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A second survey in 2015-2016 assessed how many of the kids had tried either vaping or smoking in the interim.
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Kids who had vaped were four times more likely to experiment with cigarettes, and were three times more likely to be current smokers, the findings showed.
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More than 43,000 current young smokers started using tobacco after they had experimented with e-cigarettes during the two-year period of the study, the study authors estimated.
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The results were more startling when researchers compared low-risk kids to those more likely to take up smoking.
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Kids already inclined to smoke were about 3.5 times more likely to pick up cigarettes after they’d tried an e-cigarette.
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But kids not much interested in cigarettes were 8.5 times more likely to try smoking after they experimented with vaping, the investigators found.
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Nicotine addiction is one potential explanation for this effect, said Dr. Christy Sadreameli, a pediatric pulmonologist at Johns Hopkins Hospital in Baltimore, and a volunteer spokeswoman for the American Lung Association.
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Prior studies have shown that many teens don’t know that the vapor from e-cigarettes contains the same addictive substance found in tobacco, Sadreameli said.
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“This is a reminder that e-cigarettes are very addictive, and that’s one of the reasons why we’re concerned about teens using them,” Sadreameli said.
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While nicotine plays a part, Stokes thinks the influence of vaping is “more complex than just nicotine.”
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Low-risk teens who try vaping and have a pleasant experience might be less opposed to trying other tobacco products, Stokes said.
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“Another possibility is it reduces inhibition,” Stokes continued. “Once they try it and they’ve broken that boundary, they might be more viable for future experimentation.”
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Vaping might also place these kids in new social groups that are more casual regarding substance use.
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“You may be more likely to be offered a cigarette, and you may be more exposed to tobacco industry marketing,” Stokes said.
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The new study is “another piece of evidence adding that we urgently need the FDA to take meaningful action to prevent e-cigarette use and tobacco use among our most vulnerable, our teenagers,” Sadreameli said.
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SOURCES: Andrew Stokes, Ph.D., assistant professor, global health, Boston University School of Public Health; Christy Sadreameli, M.D., MHS, pediatric pulmonologist, Johns Hopkins Hospital, Baltimore, and volunteer spokeswoman, American Lung Association; Feb. 1, 2019, JAMA Network Open, online
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