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University of California study: e-cigs “new route” to nicotine addiction

Study found adolescents who use e-cigs are less likely to quit smoking tobacco cigarettes

Here’s the latest chapter in the continuing debate over whether e-cigarettes are a cure or an affliction: a study from the University of California San Francisco that finds e-cigs may in fact be a new route to conventional smoking and nicotine addiction.

In what is said to be the first analysis of the relationship between e-cigarette use and smoking among adolescents in the United States, UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” she said. The study was published online on March 6 in JAMA Pediatrics.

A trade group took issue with the study, saying it “is implying conclusions that simply aren’t borne out by the data.”

In a prepared statement, Cynthia Cabrera, Executive Director, Smoke Free Alternatives Trade Association (SFATA), said: “As the survey summary itself states, it wasn’t designed to derive any insight about motivation or a possible causal relationship between use of e-cigarettes and combustible cigarettes. What the survey data does show is that cigarette smoking among teens has decreased.”

FDA action expected

The U.S. Food and Drug Administration (FDA) has been considering regulations that could restrict advertising and sales of the popular battery-powered devices, which look like cigarettes and deliver an aerosol of nicotine and other chemicals.

Several states and cities, including New York and Los Angeles, have banned the use of e-cigs, generally treating them as though they were tobacco products.

In Congress, five U.S. Senators introduced the “Protecting Children from Electronic Cigarette Advertising Act” last month. It would prohibit the marketing of e-cigs to children and teens.

“We cannot risk undoing decades of progress in reducing youth smoking by allowing e-cigarette makers to target our kids,” Sen. Barbara Boxer (D-Calif.) said. “This bill will help protect our children from an industry that profits from addiction.”

Manufacturers promote the devices as safer alternatives to cigarettes and as smoking cessation aids. They are sold in flavors such as chocolate and strawberry that are banned in conventional cigarettes because of their appeal to youth.

Cabrera denied that the e-cig industry is targeting children.

“Our industry does not sell or market to minors, and it is our view that no one under 18 should use electronic cigarettes. Electronic cigarettes and vaping products are intended strictly for adults who smoke cigarettes. We fully support limitations on the sale of these products to youth at retail to further reduce access to anyone under 18,” she said.

Students studied

In the new UCSF study, the researchers examined survey data from middle and high school students who completed the National Youth Tobacco Survey in 2011 and 2012.

The authors found that the devices were associated with higher odds of progression from experimenting with cigarettes to becoming established cigarette smokers. Additionally, adolescents who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users.

“It looks to me like the wild west marketing of e-cigarettes is not only encouraging youth to smoke them, but also it is promoting regular cigarette smoking among youth,” said senior author Stanton A. Glantz, PhD, UCSF professor of medicine and director of the Center for Tobacco Control Research and Education.

Contrary to advertiser claims that e-cigarettes can help consumers stop smoking conventional cigarettes, teenagers who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months, or year. At the same time, they were more likely to be planning to quit smoking in the next year than smokers who did not use e-cigarettes.

The new results are consistent with a similar study of 75,000 Korean adolescents published last year by UCSF researchers, which also found that adolescents who used e-cigarettes were less likely to have stopped smoking conventional cigarettes.

In combination, the two studies suggest that “e-cigarettes may contribute to nicotine addiction and are unlikely to discourage conventional cigarette smoking among youths,” said the scientists.

The federal Centers for Disease Control and Prevention reported last year that the majority of adolescents who have ever smoked e-cigarettes also have smoked regular cigarettes. An estimated 1.78 million U.S. students have used the devices as of 2012, the CDC reported.

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