Youngsters who smoke e-cigarettes are more likely to start smoking traditional cigarettes within a year, according to a new study which suggests that e-cigarettes may act like a pathway to smoking.
"E-cigarettes are not subject to many laws that regulate traditional cigarettes, such as age limits on sales, taxation and labelling requirements," said lead author Brian Primack, director of University of Pittsburgh Centre for Research on Media, Technology and Health. "They also come in youth-oriented flavourings that laws have limited in traditional cigarettes, such as apple bubble gum and chocolate candy cane," said Primack.
It also is notable that electronic cigarettes are marketed on television, said senior author James Sargent, professor at Dartmouth's Geisel School of Medicine. "This represents the first time in more than 40 years that a smoking-related device has been advertised on this medium, which has tremendous reach and could drive appeal of these products among youth," Sargent said.
The research team analysed data on nearly 700 16- to 26-year-old nonsmokers surveyed in 2012 and 2013 in US.
All participants were considered "non-susceptible" to initiating traditional cigarette smoking at the beginning of the study, because they had responded "definitely no" when asked if they would try a cigarette offered by a friend or believed they would smoke a cigarette within the next year.
By the next year, 38% of the baseline e-cigarette users had initiated traditional cigarette smoking. In comparison, only 10% of the youths who were not baseline e-cigarette users started smoking traditional cigarettes.
"These differences remained statistically significant and robust even when we controlled for multiple known risk factors for initiating cigarette smoking, such as age, sex, race, ethnicity, socioeconomic status, sensation seeking, parental smoking and friend smoking," Primack said.
E-cigarettes deliver nicotine more slowly than traditional cigarettes, allowing a new user to advance to cigarette smoking as they become tolerant of nicotine side effects, the researchers said.
Unlike other forms of nicotine, such as smokeless tobacco, e-cigarettes are designed to mimic the behavioural and sensory act of cigarette smoking, allowing the user to become accustomed to the act of smoking.
E-cigarettes are not subject to the same regulations as traditional cigarettes, potentially renormalising the act of smoking after decades of public health efforts to shift public norms around smoking, researchers said. Regulating e-cigarettes is controversial because they are sometimes used as harm reduction tools by established smokers.
The researchers theorise that these factors may be why e-cigarette smoking may serve as a gateway to traditional cigarette smoking.
The study appears in the journal JAMA Pediatrics.
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