E-cigarette use grew an astounding 900 percent among high school students from 2011 to 2015. That’s according to a report by the U.S. Surgeon General’s office, released December 8. It highlights the harmful effects of e-cigarettes, especially to young people.
E-cigarettes first went on sale in the United States in 2007. Back then, companies advertised them as an aid to help adults give up smoking tobacco. But nonsmokers soon took up e-cigs too . Among them have been teens and even preteens. The Surgeon General’s report says the newly recognized drastic leap in e-cig use could lead many teens to try smoking.
And that would put a new generation of Americans at risk of nicotine addiction, says Thomas Wills. He works at the University of Hawaii at Manoa. He’s also an expert on teen smoking rates.
The Surgeon General's report and other information about the health effects of e-cigarettes can be found at anew website: Know the Risks: E-cigarettes & Young People.
Two additional new studies back up what the Surgeon General’s office is saying. Both also shine some light on why teens choose to vape — and why some young vapers transition to smoking cigarettes.
Studies had shown that teens who vape are more likely to try cigarette smoking. And that’s disturbing because in the United States alone, the number of teen vapers nearly quadrupled between 2013 and 2015 — to more than 3 million. However, it has not been clear whether these kids who move on to tobacco “are just experimenting with smoking or whether they go on to become regular users,” says Adam Leventhal. He’s an addiction scientist at the University of Southern California, in Los Angeles.
The distinction is important, he says. Teens who become regular smokers during high school are more likely to develop a lifelong addiction to nicotine. According to the Surgeon General’s Report, nine out of 10 adult smokers tried their first cigarettes during adolescence.
To dig into why some teens make this transition, Leventhal and his colleagues recruited more than 3,000 Los Angeles-area 10th graders into a study. The students filled out surveys in the fall and spring. Those questions asked the teens about whether they had vaped or smoked. The researchers then looked at whether the answers had differed between early and late in the school year.
And indeed they did. Vaping seemed to up the likelihood that a teen would start smoking, these data showed.
The researchers broke students into groups, based on their answers in the fall to whether and how often they vaped. One group reported never vaping. A second group said they had tried vaping, but not within the past month. A third group reported vaping on one or two days in the past month. The last group said they had vaped even more than that in the last 30 days.
And the likelihood that a student smoked in the spring doubled in each successive group. For instance, by the spring, students who had previously tried vaping were about two times as likely to use cigarettes as were teens who had never vaped. Each jump to a group that vaped more frequently roughly doubled the likelihood that a student would report frequent, heavy cigarette smoking in the spring. (People who smoked cigarettes on three or more days in the past month were deemed frequent smokers. Lighting up two or more cigarettes on any day was considered heavy use.)
Leventhal’s group published its findings online November 8 in the Journal of the American Medical Association.
The share of teens in this study who reported vaping was slightly lower than the national average. One in three students in the study said they had ever tried vaping. That’s about 4 percentage points lower than the national average for 10th graders. Similarly, about 9 percent of the California kids surveyed said they had vaped in the past month. That’s 5 percentage points lower than the U.S. average 10th graders, according to a February 2016 report. It was conducted by researchers at the University of Michigan in Ann Arbor.
One reason for the lower vaping rate in California could be that kids there also are somewhat less likely to smoke than elsewhere in the country, notes Wills.
It still isn’t clear why some teens make the transition from vaping to smoking, he says. Young people who vape might learn to like the feeling of lighting up, holding a cigarette-like device or inhaling. These are behaviors that are common to both electronic and tobacco cigarettes. That might make it easier for teens to transition to tobacco cigarettes. It’s also possible that kids who use e-cigarettes are getting hooked on nicotine, says Wills. This is the chemical that makes tobacco smoking so addictive. It’s also found in most e-cig liquids.
More research is needed, Wills says, to probe the role of nicotine in teens’ transition from vaping to smoking.
The influence of ads
“Use of e-cigarettes has been rising exponentially among youth,” says Hongying Dai. “Little is known about the factors contributing to this rise," she adds. Dai is an epidemiologist — a scientist who studies disease risk. She works at the University of Missouri-Kansas City. This researcher wondered whether the number of e-cig advertisements that kids see might affect how likely they were to vape. So she analyzed data from a national survey for clues that might confirm this.
More than 22,000 U.S. middle- and high-school students had filled out the survey about their smoking and vaping habits.
Compared to kids who rarely saw e-cig ads, those who saw them at least “sometimes” were much more likely to vape. Students who frequently ran into ads on the internet were about three times as likely to vape as were teens who reported never seeing such online ads. Kids who vaped also reported high exposure to e-cigarette ads in stores, newspapers and magazines, on TV and at the movies.
Family also seemed to play some role. Kids were more likely to vape if someone in their household used e-cigarettes, the researchers showed.
E-cigarette ads that target teens often portray vaping as glamorous or attractive, notes the Surgeon General’s report. Wills says the tobacco industry used these same tactics to encourage cigarette smoking by young people a generation ago.
Still, some questions remain. For instance, Dai asks, how accurately did the teens report encountering e-cigarette ads? And do all kids notice e-cig ads equally? Or are kids who vape just more likely to pay attention to vape ads?
Dai says she expected to see a link between ads and vaping. Tobacco advertising has been linked to increases in youth smoking rates, she notes. It therefore makes sense that exposure to e-cig advertising could affect teen vaping, she says.
Findings from the second study appear in the August Journal of Adolescent Health.
behavior The way a person or other organism acts towards others, or conducts itself.
chemical A substance formed from two or more atoms that unite (become bonded together) in a fixed proportion and structure. For example, water is a chemical made of two hydrogen atoms bonded to one oxygen atom. Its chemical symbol is H2O. Chemical can also be an adjective that describes properties of materials that are the result of various reactions between different compounds.
colleague Someone who works with another; a co-worker or team member.
data Facts and/or statistics collected together for analysis but not necessarily organized in a way that gives them meaning. For digital information (the type stored by computers), those data typically are numbers stored in a binary code, portrayed as strings of zeros and ones.
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.
epidemiologist Like health detectives, these researchers figure out what causes a particular illness and how to limit its spread.
factor Something that plays a role in a particular condition or event; a contributor.
high school A designation for grades nine through twelve in the U.S. system of compulsory public education. High-school graduates may apply to colleges for further, advanced education.
journal (in science) A publication in which scientists share their research findings with the public. Some journals publish papers from all fields of science, technology, engineering and math, while others are specific to a single subject. The best journals are peer-reviewed: They send out all submitted articles to outside experts to be read and critiqued. The goal, here, is to prevent the publication of mistakes, fraud or sloppy work.
link A connection between two people or things.
liquid A material that flows freely but keeps a constant volume, like water or oil.
nicotine A colorless, oily chemical produced in tobacco and certain other plants. It creates the ‘buzz’ effect associated with smoking. It also is highly addictive, making it hard for smokers to give us 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 A term that refers to things that can be found or done on the Internet.
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. Among cancer risks that the people faced were radiation and drinking water tainted with arsenic.
sibling An offspring that shares the same parents (with its brother or sister).
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. Dried tobacco leaves are burned in cigars, cigarettes, and pipes. Tobacco leaves are also sometimes chewed. The main constituent of tobacco leaves is nicotine.
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.
Report: E-cigarette use among youth and young adults: A report of the Surgeon General. U.S. Department of Health and Human Services. Rockville, Md. December, 2016.
Journal: A.M. Leventhal et al. Association of e-cigarette vaping and progression to heavier smoking patterns of cigarette smoking. Journal of the American Medical Association. Vol. 316, November 8, 2016, p. 1918. doi: 10.1001/jamapediatrics.2016.2639.
Journal: H Dai et al. Exposure to advertisements and susceptibility to electronic cigarette use among youth. Journal of Adolescent Health. Published online August 12, 2016. doi: 10.1016/j.jadohealth.2016.06.013.
Report: L.D. Johnston et al. 2015 Overview: Key findings on adolescent drug use. University of Michigan Institute for Social Research. Ann Arbor, Mich. February 2016.