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June 13th, 2016:

E-Cigarettes a Gateway to Smoking for Teens: Study

Teens in the United States who use electronic cigarettes are six times more likely to move on to traditional cigarettes compared to kids who never use the devices, a new study reports.

A survey of about 300 high school students found a troubling pattern, although some experts disagree with the conclusions.

“Adolescents who had never smoked, but who had used e-cigarettes, were substantially more likely to begin smoking combustible cigarettes over the next year,” said study lead author Jessica Barrington-Trimis. She is a postdoctoral researcher with the University of Southern California’s Tobacco Center of Regulatory Science.

“The increase in e-cigarette use, which may be followed by increases in cigarette use, could result in an erosion of the progress that has been made over the last several decades in tobacco control,” Barrington-Trimis said.

In recent years, scientists have debated whether e-cigarettes help smokers quit, or act as a gateway to tobacco smoking. Because of these concerns, the U.S. Food and Drug Administration is banning the sale of e-cigarettes to minors starting mid-summer.

According to new survey results from the U.S. Centers for Disease Control and Prevention, last year just 11 percent of high school students said they’d smoked cigarettes in the previous 30 days — a significant decline since the 1990s. However, 24 percent said they’d used vape products, such as electronic cigarettes, within the last month.

E-cigarettes are electronic devices that vaporize a fluid that often includes nicotine and flavorings.

For the new study, researchers surveyed 11th and 12th graders, average age 17, about use of e-cigarettes, cigarettes, cigars, pipes and hookahs. Of those, 146 used e-cigarettes and 152 had never tried them. None had smoked cigarettes.

But 16 months later, the researchers found that 40 percent of e-cigarette users had begun smoking traditional cigarettes. This compared to 11 percent of those who’d never “vaped” — the term for using electronic cigarettes. The study authors determined the vapers were just over six times more likely to have tried smoking compared to teens who weren’t using e-cigarettes.

The difference held even after the investigators adjusted their statistics for factors such as gender, parents’ education level (which hints at family income) and ethnicity.

“We can’t definitively conclude the e-cigarettes cause kids to smoke cigarettes,” Barrington-Trimis said. However, “those who had used e-cigarettes at baseline were substantially more likely to begin smoking cigarettes.”

The fact that many who tried regular cigarettes had vowed not to do so at the start of the study suggested that e-cigarette use wasn’t simply an indicator of kids who would have smoked anyway, the researchers said.

E-cigarette users were also more likely to try hookahs, pipes or cigars, the survey found.

The study results drew mixed reviews.

Peter Hajek, director of tobacco research with the Wolfson Institute of Preventive Medicine at Queen Mary, University of London, criticized the work.

“The authors misinterpret their findings,” Hajek said. “Like several previous studies of this type, this one just shows that people who try things, try things.”

Other research shows that overall smoking by adolescents is declining even as e-cigarette use rises, Hajek said.

“In fact, the decline in youth smoking over the past few years has been faster than ever before. This does not necessarily mean that e-cigarette experimentation prevents the uptake of smoking, although this is possible,” he added. “But there is clear and strong evidence that such experimentation does not contribute to smoking uptake.”

Barrington-Trimis questioned this contention, saying it’s not proven by research.

Gregory Conley, president of the American Vaping Association, said there’s nothing new or “particularly helpful” about showing that some young adults try e-cigarettes and then experiment with smoking.

“The bottom line is that as more teens have experimented with vapor products, youth smoking has experienced massive and unprecedented declines that no one predicted just five years ago,” Conley said.

However, the study elicited praise from Thomas Wills, interim director of the Cancer Prevention and Control Program with the University of Hawaii Cancer Center. It “adds a lot of support” to the idea that e-cigarettes can cause cigarette smoking, Wills said.

“Some people have previously suggested that since e-cigarettes are available, this will prevent teenagers from smoking,” Wills said. This study and others debunk that idea, he added.

The study was published online June 13 in the journal Pediatrics.

Interventions for tobacco use cessation in people living with HIV and AIDS



Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality.


To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions.

Search methods

We searched the Cochrane Tobacco Addiction Group’s Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases.

Selection criteria

Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA.

Data collection and analysis

Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria.

Main results

We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.

There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I2 = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I2 = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study.

Authors’ conclusions

There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.

Plain language summary

Interventions to help people living with HIV and AIDS to stop using tobacco

Background: Tobacco use is common amongst people living with HIV and AIDS (PLWHA); it causes a range of health problems and accounts for many deaths. There is good evidence about interventions to help people quit tobacco use in the general population, however the effectiveness in PLWHA was not known.

Methods: We reviewed the available evidence from trials to help PLWHA stop using tobacco. This evidence is correct up to June 2015. We conducted analyses of whether people were able to successfully quit tobacco use in the long-term (six months and over) and short-term (measured at less than six months).

Results: We found 14 relevant studies including over 2000 participants. All studies, except one, were conducted in the United States (US). All studies compared a behavioural intervention with medication, to a control group. The behavioural intervention was delivered via a range of methods including face-to-face, telephones, computers, and text messages. Nicotine replacement therapy or varenicline (medications that help tobacco users quit) was also given. Control participants typically received a less intensive, brief behavioural intervention, and the same medication as the intervention group. Six studies of moderate quality evidence investigated long-term abstinence; they did not show clear evidence of benefit of the more intense intervention. Eleven studies of very low quality evidence investigated short-term abstinence. The evidence suggested that a more intense intervention combining behavioural support and medication might help people to quit in the short-term.

Quality of the evidence: The quality of the evidence was judged to be moderate for the long-term abstinence outcome and very low for the short-term abstinence outcome, and so further research is needed to increase our confidence in our findings.

Vaping IS a gateway to smoking: Teenagers who use e-cigarettes ‘are six times more likely to smoke tobacco’

• Study based on smoking habits of 300 teenagers over a two-year period
• It found 40% who vaped in previous year had also tried tobacco products
• Devices banned for sale to under 18’s in US and UK due to health concerns
• Previous research found devices expose developing brains to nicotine

Teenagers who vape are six times more likely to take up smoking than those who have never tried it, scientists have warned.

Those who experiment with e-cigarettes are at higher risk of smoking within two years than those who have never tried the device, a study found.

The investigation, which looked at the smoking habits of 18-year-olds, adds weight to the argument electronic cigarettes can act as a gateway to tobacco products for teenagers.

Jessica Barrington-Trimis, lead author of the study from University of Southern Carolina, said she wanted to investigate the link between vaping and tobacco use.

She said: ‘We’re concerned that kids who experiment with e-cigarettes may be moving on to other types of tobacco products, like combustible cigarettes, which are arguably a lot more dangerous.’

E-cigarettes are handheld devices that vaporise a fluid, usually involving nicotine and another more attractive flavour.

Although experts agree that e-cigarettes are far safer than smoking tobacco, some are concerned that they are also used as a fashionable ‘lifestyle’ habit for people who have never smoked.

In the latest study, researchers used surveys conducted by USC on 300 teenagers in 2014, with around half of those asked saying they had previously tried an e-cigarette.

A follow-up survey a year later discovered that 40 per cent of those who had vaped the year before had also tried regular cigarettes.

Those who vaped were six times more likely to try tobacco products, the study found

This compared to about 11 per cent of those who said they had not tried an e-cigarette in the prior year’s survey.

The survey participants were at least 18 years old by the second survey.

After adjusting the statistics around gender, ethnicity, grade and parental education, scientists calculated teens who tried vaping were six times more likely to take up smoking than those who never tried.

When looking at teenagers who said they had no intention to smoke on the first survey, researchers found the risk of moving from vaping to regular cigarettes by the next year was 10 times greater.

However, Dr Michael Siegel, a professor at the Boston University School of Public Health, said he had concerns over the study.

He argued there was no proof vaping had prompted the teens to take up smoking as the initial surveys did not determine how many times the teenagers had used e-cigarettes..

Dr Siegel said: ‘What’s probably happening is these kids did not become regular vapers, they turned to smoking.

‘If they turned into regular vapers, they wouldn’t have turned to smoking.’

The US Food and Drug Administration began a crackdown on e-cigarettes last month by banning under 18’s from purchasing the devices, following the same rules imposed by UK government.

The American Academy of Pediatrics recommended in 2015 that the devices be regulated as tobacco products due to concerns they would lead teens to regular cigarettes and also expose their developing brains to nicotine.

Previous research found vaping is more dangerous than experts once thought and can cause infertility.

The devices contain one million times more harmful substances than polluted air – including cancer-causing substances and flame retardants, some experts claim.

Furthermore, scientists from the Baptist University in Hong Kong discovered for the first time some contain toxins linked to fertility problems and fetal development issues.

The latest study by USC was published in the journal Pediatrics.