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Adolescent e-cigarette use may not lead to combustible cigarette use
Previously published data suggesting that people, especially teenagers, who use electronic cigarettes are more likely to start smoking combustible cigarettes may not be accurate, according to findings published in Drug and Alcohol Dependence.
“The national trends in vaping and cigarette smoking do not support the argument that vaping is leading to smoking,” Lynn T. Kozlowski, PhD, of the School of Public Health and Health Professions, University at Buffalo, said in a press release. “There is little evidence that those who have never smoked cigarettes or never used other tobacco products and first try e-cigarettes will later move on to cigarette usage with great frequency or daily, regular smoking.”
Kozlowski and Kenneth E. Warner, PhD, of the School of Public Health, University of Michigan, wrote that one shortcoming of existing prospective studies is that they use small sample population sizes, which in turn leads to smaller risk.
“The aggregate risk implied by [these] studies is very small. Further — and we consider this very important — the data from large national cross-sectional studies provide no evidence that kids’ use of e-cigarettes is increasing smoking. If anything, those data suggest the opposite,” they wrote.
Although “unpleasant to contemplate,” Kozlowski and Warner also wrote that the public health community and policymakers must weigh the financial pros and cons associated with keeping e-cigarettes on the market for use as a cessation tool vs. the costs that would come from people who transition from e-cigarettes to combustible cigarette smoking.
The researchers also suggested that because many young smokers grew up in an era that largely proclaimed the dangers of traditional smoking, they will not move onto those devices.
“We need to appreciate that growing antismoking sentiment, accompanied and reinforced
by more stringent tobacco control policies, is likely to increase the ranks of former smokers in the coming decades,” Kozlowski and Warner wrote. “With smoking cessation rates up in recent years, the odds that a youth who begins smoking now remains a smoker 30 years from now are likely to decline substantially.”
Kozlowski and Warner concluded by acknowledging that future research could debunk their findings.
“Overall, we conclude that the risks for youth posed by e-cigarettes likely fall far short of those feared by the products’ opponents. Conceivably, e-cigarettes may create a net benefit for some high-risk young people. We are mindful of our own risk of falling victim to signal-detection biases. Readers will judge for themselves the probity of our effort to avoid such biases,” they wrote. “Is it possible we could have our cake and eat it too? Perhaps, especially if sensible comprehensive harm reduction policies can earn a place in modern tobacco control efforts.” – by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.
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Drs. Kozlowski and Warner’s claims that “the risks for youth posed by e-cigarettes likely fall far short of those feared” and “that youth use of e-cigarettes is unlikely to increase the ranks of future cigarette smokers” are based on wishful thinking and misinterpretation of the literature.
Prior to the e-cigarette epidemic, combustible tobacco use had been falling, but the 2015 National Youth Tobacco Survey shows that the rate of use of cigars and cigarettes is starting to rise among high school students.
They try to explain away compelling evidence that adolescents who use electronic cigarettes and experiment with combustible tobacco are more likely to become combustible tobacco users and less likely to stop combustible tobacco use, and that adolescents who appear otherwise not at risk for combustible tobacco use are using electronic nicotine delivery systems. They offer behavioral explanations for the observation of more smoking among e-cigarette users, but ignore the obvious that once you are nicotine-addicted, there is a much lower bar to other tobacco product use.
They ignore both laboratory animal and population research that nicotine functions as a gateway to other drug abuse. They ignore data that electronic nicotine delivery systems are used for substances other than nicotine in close to one-third of middle and high school e-cigarette users.
In the 20th century, there were many academic apologists for the tobacco industry. The AMA endorsed low tar and nicotine cigarettes based on similar faulty reasoning as Kozlowski and Warner. Fool me once, shame on you. Fool me twice, shame on me.