In the United States, last year, more than one high-school student in every 10 used e-cigarettes. While e-cigs do not burn tobacco (as conventional cigarettes do), they usually do provide nicotine. That’s the potentially addictive chemical in tobacco plants that gives smokers a “buzz.” A new study finds that teens who vaped high-nicotine liquids were likely to vape more — and smoke too — six months later.
The findings are not surprising. Earlier studies had shown that teens who vape are about three times more likely than non-vapers to start smoking tobacco. But not all vapers encounter the same levels of nicotine. Vape liquids can vary widely in how much nicotine they contain. What’s more, certain vape techniques and e-cigs can boost how much nicotine come out per puff.
Jessica Barrington-Trimis studies teen smoking and tobacco use at the University of Southern California in Los Angeles. She wanted to explore whether e-cig’s nicotine affected vape habits — or any transition to smoking.
To do this, her team surveyed 181 10th-graders. They came from 10 different Los Angeles area schools. All had vaped within the past month. The teens answered questions about how much and how often they had smoked and vaped in the previous 30 days. They also reported how much nicotine was in their vaping liquid.
The scientists classified those e-liquids on the basis of how much nicotine they had per milliliter (.034 fluid ounce). Some had none. Low-nicotine liquids had no more than 5 milligrams (0.00018 ounce). Medium-nicotine liquids had from 6 to 17 milligrams. High-nicotine e-liquids contained 18 milligrams or more.
Six months later, the researchers surveyed the students again. Now these teens were 11th-graders.
Those who had reported vaping more nicotine in the earlier survey were now more likely to report they also smoked. And the more nicotine they had been vaping before, the more likely they were to now smoke. With each increase in nicotine level — from none to low, from low to medium or from medium to high — teens were now about twice as likely to report frequent smoking. For instance, those who had vaped high-nicotine liquids six months earlier now smoked seven times as many cigarettes per day as did those who had earlier vaped no nicotine.
Nicotine also boosted future vaping frequency and intensity.
Teens who reported vaping more nicotine in the earlier survey were now more likely to vape frequently. Six months out, teens were about 1.5 times as likely to report frequent vaping with each increase in their initial nicotine use. Those who had earlier vaped the most nicotine now vaped almost 2.5 times as often per day as did those who had initially vaped nicotine-free liquids. Moreover, the more frequent vaping also was more intensive. Teens now took more puffs each time they vaped.
Barrington-Trimis and her team published their findings in the December JAMA Pediatrics.
Richard Miech is a sociologist, someone who studies human behavior. His work at the University of Michigan in Ann Arbor focuses on adolescent drug use. (And yes, nicotine is a drug.) “This study is important,” he says. “It begins to chip away at the ‘black box’ that links e-cigarette use with later use of regular cigarettes.”
“Ideally,” he says, “studies like this will encourage government agencies to develop policies that will make it very difficult for youth to obtain e-liquids with nicotine.”
Teens are especially prone to nicotine addiction. But that is not the only concern. Nicotine has been linked to many health risks in teens. These include problems with learning, with attention and with impulse control. In 2016, the U.S. Surgeon General released a report on e-cigarettes. It concluded that nicotine in any form is not safe for young children or teens.
adolescent Someone in that transitional stage of physical and psychological development that begins at the onset of puberty, typically between the ages of 11 and 13, and ends with adulthood.
behavior The way something, often a person or other organism, acts towards others, or conducts itself.
e-cigarette (short for electronic cigarette) Battery-powered device that disperses nicotine and other chemicals as tiny airborne particles that users can inhale. They were originally developed as a safer alternative to cigarettes that users could use as they tried to slowly break their addiction to the nicotine in tobacco products. These devices heat up a flavored liquid until it evaporates, producing vapors. People use these devices are known as vapers.
e-liquid A term for the solutions heated to the evaporation point in an electronic cigarette. These solutions are the basis of the vapors that will be inhaled. The liquid typically contains a solvent into which flavorings and nicotine have been dissolved.
frequency The number of times a specified periodic phenomenon occurs within a specified time interval. (In physics) The number of wavelengths that occurs over a particular interval of time.
link A connection between two people or things.
nicotine A colorless, oily chemical produced in tobacco and certain other plants. It creates the “buzz” associated with smoking. Highly addictive, nicotine is the substance that makes it hard for smokers to give up their use of cigarettes. The chemical is also a poison, sometimes used as a pesticide to kill insects and even some invasive snakes or frogs.
online (n.) On the internet. (adj.) A term for what can be found or accessed on the internet.
pediatrics A field of medicine that has to do with children and especially child health. A doctor who works in this field is known as a pediatrician.
risk The chance or mathematical likelihood that some bad thing might happen. For instance, exposure to radiation poses a risk of cancer. Or the hazard — or peril — itself. (For instance: Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.)
smoke Plumes of microscopic particles that float in the air. They can be comprised of anything very small. But the best known types are pollutants created by the incomplete burning of oil, wood and other carbon-based materials.
smoking A term for the deliberate inhalation of tobacco smoke from burning cigarettes.
Surgeon General A doctor who serves as the leading spokesperson on public health from within the U.S. government. This person also serves as the primary deputy on medical matters to the Assistant Secretary for Health (within the Department of Health and Human Services).
survey (v.) To ask questions that glean data on the opinions, practices (such as dining or sleeping habits), knowledge or skills of a broad range of people. Researchers select the number and types of people questioned in hopes that the answers these individuals give will be representative of others who are their age, belong to the same ethnic group or live in the same region. (n.) The list of questions that will be offered to glean those data.
tobacco A plant cultivated for its leaves, which many people burn in cigars, cigarettes, and pipes. Tobacco leaves also are sometimes chewed. The main active drug in tobacco leaves is nicotine, a powerful stimulant (and poison).
transition The boundary where one thing (paragraphs, ecosystems, life stage, state of matter) changes or converts into another. Some transitions are sharp or abrupt. Others slowly or gradually morph from one condition or environment to another.
vaping (v. to vape) A slang term for the use of e-cigarettes because these devices emit vapor, not smoke. People who do this are referred to as vapers.
Journal: N. Goldenson et al. Associations of electronic cigarette nicotine concentration with subsequent cigarette smoking and vaping levels in adolescents. JAMA Pediatrics. Vol. 171, December 2017., p. 1192. doi: 10.100/jamapediatrics.2017.3209.