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E-cigarettes not linked to decline in teen smoking rate

There is no connection between the introduction of e-cigarettes and the decline in smoking rates among teenagers, and the popularity of e-cigarettes may actually indicate a future increase in use of traditional cigarettes, a study published in Pediatrics suggests.

Citing the misconceptions that exist among adolescents regarding e-cigarettes, the study’s authors suggested ways family doctors can discuss e-cigarettes with their young patients since use of e-cigarettes among this population group is on the rise.

“The lack of a demonstrable acceleration in the long-term rate of decline in youth smoking prevalence after the introduction of e-cigarettes does not support the hypothesis that this decline is due to youth substituting e-cigarettes for conventional cigarettes,” Lauren M. Dutra, ScD, of RTI International, and Stanton A. Glantz, PhD, of the department of medicine, University of California, San Francisco, wrote. “The observation that youth who initiate use with e-cigarettes are more likely to start smoking conventional cigarettes, and, among smokers, are less likely to have stopped smoking also raises the possibility that the long-term decline in cigarette smoking will reverse in future years.”

Dutra and Glantz collected data from sixth- through 12th-graders from 2004 to 2014 National Youth Tobacco Surveys. Their analysis used interrupted time series of ever cigarette smoking, defined as one or more puff, and current cigarette smoking, defined as smoking within the last 30 days. They used logistic regression to identify psychosocial risk factors associated with cigarette smoking in the 2004 to 2009 samples. This model was then applied to estimate the likelihood of cigarette smoking among cigarette smokers and e-cigarette users in the 2011 to 2014 samples.

Glantz and Dutra reported that youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking; P = .05 for current smoking). There were no distinct changes in this trend after 2009; they noted that e-cigarettes were first included in the survey in 2011.

The researchers also stated that the model categorized less than 25% of current e-cigarette–only users (between 11% in 2012 and 23.1% in 2013) as current smokers when traits such as use of tobacco products besides cigarettes or e-cigarettes, probability of smoking cigarettes from a friend, probability of smoking in the next year, living with someone who smokes, wearing clothing with a tobacco logo and demographic characteristics were considered.

Dutra suggested ways family doctors can discuss e-cigarettes with patients when the patient doesn’t seem to recognize the harmful nature of such products.

“Physicians should emphasize that even youth who think they will just ‘experiment’ with tobacco and quit using it later can get addicted to nicotine,” she told Healio Family Medicine. “If the patient endorses tobacco use, a physician or nurse can then ask the patient about the products they are using, emphasize the importance of being nicotine- and tobacco-free, and provide them with information about cessation resources.

Stanton addressed some misconceptions youth may have involving e-cigarettes that primary care physicians should know.

“[Doctors] should tell [patients] that they are not ‘harmless water vapor’ and that most contain nicotine, an addictive drug, even ones that say that the e-cigs do not contain nicotine,” he told Healio Family Medicine. “If they start with e-cigarettes they are much more likely to go on to cigarettes.”

In a blog post on NIH’s website, Director Francis Collins, MD, PhD, said Dutra and Glantz’s work highlights the significance of public health measures to deter e-cigarette use, such as the FDA’s decision last year to limit e-cigarette sales to those aged 18 and older. Collins also said another measure requiring e-cigarette packages to include information about the addictive nicotine they contain will start next year.

Stanton and Glantz also suggested other initiatives to discourage e-cigarette use, such as initiating media campaigns to warn youth of the dangers of e-cigarettes, including the devices in smoke-free laws and state tobacco control programs, taxing them to discourage youth trying them, and discontinuing sales of the “youth-friendly flavors” to curb e-cigarette use.

Although recent research unrelated to Stanton and Glantz’s study suggests e-cigarettes are safer than traditional cigarettes, the researchers’ concern that use of e-cigarettes is likely to lead to the use of traditional cigarettes underscores the importance of discouraging their use. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures. Collins works for the NIH.

Further reading:

https://directorsblog.nih.gov/2017/01/31/are-e-cigarettes-leading-more-kids-to-smoke/