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Teens who smoke e-cigarettes more likely to become cigarette smokers

Among non-smoking teens who had ever used e-cigarettes, 43.9% said they intended to smoke conventional cigarettes within the next year, compared with 21.5% of those who had never used e-cigarettes
Among non-smoking teens who had ever used e-cigarettes, 43.9% said they intended to smoke conventional cigarettes within the next year, compared with 21.5% of those who had never used e-cigarettesRobin Wulffson, MD

E-cigarettes are rapidly increasing in popularity among adolescents. The Centers for Disease Control and Prevention (CDC) note that 263,000 teens who had never smoked a cigarette used e-cigarettes in 2013, marking approximately a three-fold increase from 79,000 in 2011. On August 25, the agency published a study in the journal Nicotine and Tobacco Research that examined the relationship between e-cigarettes and transitioning to tobacco products. The data was obtained from the 2011, 2012, and 2013 National Youth Tobacco surveys of middle and high school students. The investigators found that teens who had never smoked conventional cigarettes but who used e-cigarettes were almost twice as likely to intend to smoke conventional cigarettes as those who had never used e-cigarettes. Among non-smoking teens who had ever used e-cigarettes, 43.9% said they intended to smoke conventional cigarettes within the next year, compared to 21.5% of those who had never used e-cigarettes.

“We are very concerned about nicotine use among our youth, regardless of whether it comes from conventional cigarettes, e-cigarettes or other tobacco products. Not only is nicotine highly addictive, it can harm adolescent brain development.” noted Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health. He added that evidence exists that nicotine’s adverse effects on adolescent brain development could result in lasting deficiencies in cognitive function. Nicotine is highly addictive. Approximately 75% of teen smokers become adult smokers, even if they intend to quit in a few years.

“The increasing number of young people who use e-cigarettes should be a concern for parents and the public health community, especially since youth e-cigarette users were nearly twice as likely to have intentions to smoke conventional cigarettes compared with youth who had never tried e-cigarettes.” noted lead author Rebecca Bunnell, Sc.D., M.Ed., Associate Director for Science in CDC’s Office on Smoking and Health.

The investigators also examined the association between tobacco advertisements and smoking intentions among middle and high school students. Students were asked whether they had seen tobacco ads on the Internet, in magazines and newspapers, in retail stores, and in television programs and movies. Similar to previous studies, the CDC study found that teens who reported exposure to tobacco ads had higher rates of intention to smoke than those who were not exposed to such ads.

The authors also found the greater the number of advertising sources to which young people were exposed, the greater their rate of intention to smoke cigarettes. Only 13% of students who said they had no exposures to such ads had intentions to smoke, compared to 20.4% among those who reported exposures from one to two ad sources and 25.6% among those who reported exposures from three to four of the sources.

The CDC notes that more than 50 years since the landmark Surgeon General’s Report linking cigarette smoking to lung cancer, smoking remains the leading cause of preventable death and disease in the US. Each year, smoking kills nearly half a million Americans. More than 16 million Americans suffer from a smoking-related disease. These smoking-related diseases cost Americans $132 billion a year in direct healthcare expenses, much of which comes in taxpayer-supported payments. Each day, more than 3,200 American teens smoke their first cigarette. The Surgeon General has concluded that unless the smoking rate is rapidly reduced, 5.6 million American children alive today (approximately one in every 13) will die prematurely from a smoking-related disease.