- The Washington Times - Tuesday, January 2, 2018

Teenagers who use e-cigarette tobacco products are twice as likely to start smoking conventional cigarettes, compared to those who have never used such a device, a new study shows.

The findings from the Center for Tobacco Control Research and Education suggest that the increasing popularity of e-cigarettes or “vaping” could reverse declining trends in overall teen smoking rates.

In a survey of more than 10,000 youths between 12 and 17 years old, researchers found that any use of e-cigarettes, hookahs, non-cigarette combustible tobacco or smokeless tobacco was “independently associated” with cigarette smoking at least one year later.

The study was published online Tuesday in the Journal of the American Medical Association (JAMA) Pediatrics.

According to the Centers for Disease Control and Prevention, about 90 percent of adult smokers tried their first cigarette before the age of 18.

Meanwhile, teen smoking rates have declined amid national antismoking efforts: About 5.4 percent of teenagers reported smoking cigarettes in 2017, compared to 5.9 percent in 2016, according to the University of Michigan’s annual “Monitoring the Future” survey on teens’ use of substances.

Even though fewer teens are smoking cigarettes, vaping is growing increasingly popular, with 17 percent of 12th-graders reporting using some sort of vaping device (either with nicotine, a flavored liquid or marijuana) last year, compared to 13 percent in 2016, according to the Center for Tobacco Control Research and Education, based at the University of California-San Francisco.

This prompted researchers to try to assess the impact vaping products have on teens and their future smoking habits.

“[It] is important to know whether use of these alternative products diverts youths from smoking conventional cigarettes or encourages smoking initiation,” the researchers said in their JAMA Pediatrics study.

Lead author Dr. Benjamin W. Chaffee noted that survey respondents weren’t asked whether any of the products they used contained nicotine.

“We found that the association with future smoking was of approximately the same strength regardless of what type of product adolescents had tried initially,” Dr. Chaffee said in an email to The Washington Times.

“The first wave of the [Population Assessment of Tobacco and Health] study did not ask adolescents whether or not the e-cigarettes that they used contained nicotine, but taking all kinds of e-cigarettes together, the increase in risk of future smoking was about the same as the risk associated with use of cigars and other combustibles,” he told The Times.

Co-author Shannon Watkins said in an email that while the survey didn’t explore why adolescents graduate from e-cigarettes to real cigarettes, but surmised that “vapers” and “smokers” might meet in the same social situations, increasing exposure.

“For example, using tobacco products might expose adolescents to a different social group or social norms around cigarette smoking. Vaping non-nicotine e-cigarettes would not necessarily protect an adolescent from those social factors,” Ms. Watkins wrote.

For the study, researchers surveyed a nationally representative population of 10,384 teenagers twice: The first survey asked if they had ever smoked or used an e-cigarette or similar product in the past 30 days; the second survey, conducted a year later, asked if they had ever smoked a cigarette.

Cigarette use reported in the follow-up survey was higher among youths who had ever used e-cigarettes (19 percent); hookahs (18.3 percent); non-cigarette combustible tobacco (19.2 percent) or smokeless tobacco (18.8 percent), the researchers found.

The odds were three-fold at follow-up for respondents who had tried more than one type of tobacco product before the first survey.

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