- The Washington Times - Monday, October 23, 2017

A study suggests that high school students who smoke electronic cigarettes with high nicotine levels are more likely to smoke e-cigarettes long term and start smoking regular cigarettes.

Adam Leventhal, associate professor of preventive medicine and psychology at the University of Southern California, led a team of researchers who explored how differing levels of nicotine in e-cigarettes and vaping devices affect adolescents’ smoking habits and their likelihood of smoking combustible cigarettes.

“Our study raises an important issue regarding how policymakers may regulate nicotine in e-cigarettes,” Mr. Leventhal said in an email to The Washington Times.

“On one hand, adult smokers who switch to a less harmful nicotine product may experience significant health benefits,” he wrote. “On the other hand, our study indicates that teens who vape more nicotine may be at greater risk for critical adverse health effects like becoming a more frequent smoker of conventional cigarettes and becoming a regular user of e-cigarettes.”

The study was published Monday in the Journal of the American Medical Association Pediatrics. It comes as the Food and Drug Administration is evaluating implementing a standard level of nicotine in cigarettes that would curb addiction, especially among youths. Each day, about 2,500 young people in the U.S. smoke their first cigarette.

“Unless we change course, 5.6 million young people alive today will die prematurely later in life from tobacco use,” FDA Commissioner Scott Gottlieb said in July. “Envisioning a world where cigarettes would no longer create or sustain addiction, and where adults who still need or want nicotine could get it from alternative and less-harmful sources, needs to be the cornerstone of our efforts — and we believe it’s vital that we pursue this common ground.”

A typical cigarette has about 15.8 milligrams of nicotine per gram of tobacco. E-cigarettes and vaping devices, in which a liquid containing nicotine is heated and the vapor is inhaled, can have nicotine levels that range from zero to 18 milligrams per milliliter of liquid.

In the study, USC researchers surveyed 181 10th-graders across Los Angeles who reported smoking e-cigarettes. The nicotine concentration in their products was recorded as a baseline, and a six-month follow-up assessed whether they continued vaping, increased their nicotine levels or started smoking cigarettes.

The study participants were essentially distributed evenly between boys and girls and were majority Hispanic with parents who had not graduated from college, the researchers wrote. Though their sample size was small, the researchers said, it had a high rate of retention and a detailed assessment of smoking and vaping intensity.

In the six-month follow-up, teenagers who used e-cigarettes with higher concentration levels of nicotine were more likely to report an increased frequency of vaping and greater levels of smoking cigarettes, the study found.

“Use of electronic cigarettes with higher nicotine concentrations may contribute to the progression to smoking and vaping at higher levels of frequency and intensity among youths,” the study concludes.

However, the researchers noted limitations in their study, including that the data were self-reported and not objectively verified.

Mr. Leventhal, director of USC’s Health, Emotion and Addiction Laboratory at the Keck School of Medicine, said there is little definitive research on e-cigarettes’ effects on the health of adults — and even less on the health of teenagers.

In an accompanying “patient page” in JAMA Pediatrics, Dr. Megan Moreno, program director of the University of Washington Department of Pediatrics, advises parents to be aware of campaigns targeting youths with e-cigarettes, particularly as the “vape juice” is developed in flavors such as bubble gum and peach.

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