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Teen data find vapers often become smokers

New study shows teens who might not normally smoke begin doing so after using e-cigarettes

Many people see vaping as being less harmful than smoking cigarettes. After all, unlike tobacco, e-cigarettes don’t deliver dozens of lung-cancer-causing chemicals, called carcinogens, with each puff. So the fact that more teens are vaping than smoking might be viewed as a good thing.

Except — that more and more studies are showing e-cigarettes can cause harm. They irritate lungs and make asthma worse. They also raise the risk a teen will take up smoking. A new study not only confirms this risk but also suggests that vaping may encourage smoking by even those teens who would have seemed the least likely to have taken up the habit.

E-cigarettes have been widely available for less than a decade. So there’s not yet much long-term data on how they affect health. But vaping liquids do contain nicotine, a chemical known to cause harm. Indeed, this chemical is what makes smoking so addictive. And it now may explain why many young people who vape move on to try smoking.

Two studies published last year (see Related Readings below) showed that vaping can act as a gateway habit for teens. That means it can lead to more harmful addictions. Those may include smoking tobacco or a hookah. (A hookah delivers cooled tobacco smoke through a pipe.) The new study found worrisome support for that.

“All the information that’s come out in the past few months suggests that there is a risk associated with e-cigarette use,” says Thomas Wills. He studies alcohol and smoking in teenagers at the University of Hawaii Cancer Center in Honolulu.

For their new study, Wills and his colleagues surveyed more than 2,200 9th and 10th graders in Hawaii. They asked whether, and how often, a student had vaped or had smoked cigarettes. They also asked about the students’ relationships with their parents. And some questions probed how much the kids liked to take risks and whether they liked to do things they’re not supposed to do.

One year later, the scientists surveyed these students again. The researchers then compared the teens’ answers. And those who said in the first survey that they had vaped were nearly three times as likely as the nonvapers were to have begun smoking over the next year.

Teasing out the role of vaping

Some people might think that those teens who moved from vaping to smoking were likely to have done so anyway. To test this idea, the researchers looked at one big factor that predicts whether teens will start smoking: personality.

Studies have shown that rebellious teens, those who are more likely to take risks and who don’t have a close relationship with their parents are all more likely to take up cigarettes. Those same traits aren’t as strongly linked to vaping. Why? Vaping isn’t seen as dangerous. So even students who are not rebellious or risk takers often try vaping. And many of these teens — who would otherwise have been at low risk of smoking — later moved on to real cigarettes.

In other words, vapers who moved on to cigarettes probably wouldn’t have done so if they hadn’t first used e-cigs, Wills says: “The effect we detected is truly an effect of e-cigarette use.”

His team reported its findings January 26 in Tobacco Control.

“What this shows is that, as much as people might think that it’s safer to vape, that’s not necessarily true,” says William Shadel. He is a behavioral scientist at the RAND Corporation in Pittsburgh, Penn. “Vaping could make you more dependent on nicotine, and cause you to later want to take up cigarette smoking.” And, he adds, “That may not be something you have control over.”

The U.S. Food and Drug Administration (FDA) has proposed a rule that would prevent the sale of e-cigarettes and associated products to minors, just as they do for tobacco cigarettes. But it hasn’t yet gone into effect. This new study and those that came before may help push that along.

“The question of whether e-cigarette use will prevent or promote smoking is the number one public health question of our time,” Wills says. “I think we need as much data as possible so as to provide the FDA with a scientific basis for making decisions about whether or not to regulate e-cigarettes — and, if so, how.”

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