In 2011, a mere 1.5% of American high school students reported using electronic cigarettes, according to research from the US Centers for Disease Control. By 2014, that proportion had jumped nearly nine-fold, to an estimated 13.4%. Smoking among high schoolers, on the other hand, saw a fairly drastic decline over the same time period, dropping from 15.8% to 9.2%. All in all, those trends should be seen as a big win, proponents of vaping say.
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One day, they argue, e-cigs will entirely replace traditional cigarettes, leading to drastic improvements in public health, declining health care costs and major tax savings for US citizens. Opponents of the new technology, like Connecticut State Representative Elizabeth Esty, offer a very different analysis: vaping is a pipeline to nicotine addiction, which in turn will get previous non-smokers hooked on combustible smokes.
Speaking to CBS News in January 2015, Esty said: "E-cigarette companies are using shameful tactics, such as Joe Camel-like cartoons in advertisements and creating e-cigarette flavors like bubblegum and cotton candy, to addict our children early - and guarantee another generation of smokers."
E-cig marketing might be bad, or at least irresponsible, but Esty's read on the situation doesn't really get at the core of the question. Although it's likely that e-cigs will hook a young generation on nicotine, vaping doesn't necessarily get kids to smoke. That transition, from vaping to smoking, is still a gap in our knowledge, one only empirical data can bridge.
Now we have some of that data. In a new study, researchers at the University of Southern California followed 298 high school students to find out what would happen after they took their first puff of vapor. The researchers interviewed the kids, all in 11th or 12th grade, finding 146 who used e-cigarettes, but had never smoked, and 152 who had never smoked or vaped. After 16 months, the students were interviewed again. The results were drastic.
Of the 146 e-cigarette users, more than 40% had begun smoking. Only 10.5% of the students who had never tried either method had started smoking after 16 months. That means teens who vaped were over 6 times as likely to start smoking than teens who didn't vape. The e-cig users were also more likely to start using hookahs, pipes and cigars.
Oddly, the switch to smoking was most prevalent for teens who expressed "no intention" of taking up cigarettes at their initial evaluation. The researchers even classified students as more or less vulnerable to smoking across a range of "social environment characteristics," like whether or not someone at home smoked, but these additional factors didn't move the needle. Turns out, being "more susceptible to smoking" didn't make students more susceptible to smoking. Only vaping did.
Writing in the journal Pediatrics, lead author Jessica Barrington-Trimis says that her team's "findings suggest that e-cigarette use may promote smoking during the transition to adulthood, even in those considered to be at lower risk because or personal or environmental factors."
The researchers focused on students who were on the verge of turning 18, at which point they can purchase cigarettes legally in California. Three previous studies have found moderate to substantial links between vaping and an eventual turn to smoking, but only in younger adolescents.
Results like this could be especially bad for California, which has the 11th lowest youth smoking rate in the country.
Why were e-cigarette users more likely to begin smoking?
Barrington-Trimis proposes several theories to explain the link. Nicotine intake is actually fairly harsh on young lungs, she writes, but the flavorings in e-cigarettes may "desensitize" teens to those harsh effects, making the transition to traditional cigarettes simpler. There's also the brute fact of nicotine dependence; getting young people addicted to nicotine may open the door to other methods of inhaling the chemical. Vaporizers, for that matter, may be helping to normalize behaviors similar to smoking, like inhaling clouds of smoke-like vapor.
While not contradicting the results found in California, other studies have suggested that young people perceive e-cigarettes very differently from vaping.
Perceptions, of course, are an inconsistent predictor of reality, but young people in Scotland and England seem to view vapes as a "roadblock" to smoking cigarettes. In a new paper presented at the Global Forum on Nicotine, interviews with English and Scottish people between 16 and 25 revealed "very little indication [...] that e-cigarettes were resulting in an increased likelihood of young people smoking. In fact," lead author Neil McKeganey MD says, "the majority we interviewed, including those who were vaping, perceived smoking in very negative terms and saw vaping as being entirely different to smoking." Again, we can't take these results as proof that vaping will cut down on smoking among young people, but we shouldn't discount their beliefs, either.
If anything is clear, it's that we're still very far from understanding how the rapid rise in e-cigarette use will impact smoking rates.
Continue Reading: Do E-Cigs Really Help Smokers Quit?