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Teens who use e-cigarettes are more likely to smoke tobacco, study finds

A sales associate demonstrates the use of a electronic cigarette and the smokelike vapor that comes from it in Aurora, Colo., on Wednesday, March 2, 2011. (Ed Andrieski / Associated Press)
A sales associate demonstrates the use of a electronic cigarette and the smokelike vapor that comes from it in Aurora, Colo., on Wednesday, March 2, 2011. (Ed Andrieski / Associated Press)

Los Angeles teenagers are giving health experts a new reason to worry about electronic cigarettes.

In a study of more than 3,000 students in L.A. County public schools, those who were vaping at the beginning of their sophomore years were more likely to become cigarette smokers over the next six months, compared with their classmates who didn’t vape. The vapers were also more likely to become daily smokers and to smoke more cigarettes.

The findings, published Tuesday in the Journal of the American Medical Association, suggest that public health officials have some justification for considering e-cigarettes to be a gateway to smoking for teens who would otherwise steer clear of tobacco products.

Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, has been one of the most relentless proponents of that idea. Since at least 2013, he has warned that e-cigarettes – despite their innocuous image – have the potential to get teens hooked on nicotine. Once they’re addicted, they’re more susceptible to trying regular cigarettes.

The teenage years are pivotal, because 90 percent of adult smokers picked up the habit in their teens, according to the Campaign for Tobacco-Free Kids. The U.S. surgeon general warns that nicotine exposure during adolescence “may have lasting adverse consequences for brain development.”

Surveys and studies have validated Frieden’s fears. A report this summer in the journal Pediatrics found that high school students were six times more likely to start smoking cigarettes if they had a history of vaping than if they didn’t. The link between vaping and later smoking was particularly strong in students who said they had “no intention of smoking” when they were first interviewed.

On Monday, Pediatrics published a study blaming flavors like “gummy bear” and “bubble gum” for making e-cigarettes seem appealing and less dangerous to kids in middle school and high school across the country.

The study, led by researchers from the University of Southern California’s Keck School of Medicine, found that one-third of the 10th-graders surveyed had tried e-cigarettes at least once. Most of those students told interviewers they hadn’t vaped in the last 30 days, while 4 percent said they vaped once or twice in the past month and 5 percent said they vaped more often than that.

Six months later, 20 percent of the frequent vapers had become frequent smokers and an additional 12 percent had become occasional smokers, according to the study.

In comparison, about 2 percent of the students who had never vaped went on to become either occasional or frequent cigarette smokers during the same period.

And among those who vaped once or twice a month when they started 10th grade, 9 percent were occasional cigarette smokers and 5 percent were frequent cigarette smokers six months later, the researchers found.

Frequent vapers were also most likely to be smoking two or more cigarettes a day by the spring of their sophomore years – 12 percent of them did so, compared with 4 percent of the students who were occasional vapers at the beginning of the school year and 0.4 percent of those who didn’t vape at all.

This trend held up when the researchers analyzed the results based on the students’ cigarette smoking history at the start of the school year. For instance, among the 96 percent of students who started out as nonsmokers, fewer than 1 percent of those who never vaped became frequent cigarette smokers over the next six months, compared with 10 percent of those who were frequent vapers.

Even for those who started out as occasional or frequent smokers, the researchers found that the more a student vaped at the start of the school year, the greater the odds that they would be frequent cigarette smokers six months later.

The Los Angeles-area students in the study may not be representative of students across the nation, the study authors noted, so it’s not clear whether these findings can be generalized to the country as a whole.

Still, the results show that although some teens who make the leap from e-cigarettes to traditional cigarettes are just experimenting, others are getting hooked. This “may warrant particular attention in tobacco control policy,” the researchers concluded.


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