As the healthcare and retail industries await federal regulation on electronic cigarettes, a new JAMA study has found that young e-smokers are more likely to try tobacco than those who have never “vaped.”
In 2013, researchers with Keck School of Medicine at the University of Southern California at Los Angeles surveyed 2,530 ninth-graders from 10 Los Angeles-area high schools who said they had never smoked tobacco. But 222 students in this group of mostly 14-year-olds did report trying e-cigarettes. When surveyed six and then 12 months later, the adolescents that had previously vaped were more likely to have tried smoking tobacco.
In the first follow up, 31% of those who admitted using e-cigarettes in the original survey said they had subsequently tried smoking tobacco compared with 8% in the group that had never used e-cigarettes. After 12 months, 25% of the e-smoking group said they had smoked tobacco in the past six months compared with 9% in the non-e-smoking group.
“These data provide new evidence that e-cigarette use is prospectively associated with increased risk of combustible tobacco use initiation during early adolescence,” the researchers concluded.
They noted that their study covered a “brief window of susceptibility,” and focused on “initiation outcomes.” The researchers suggested that further studies be conducted to determine whether e-cigarette use increased the risk of regular tobacco smoking.
The JAMA report was accompanied by two editorials that noted how electronic smoking is a $2.2 billion industry in the U.S. and sales are projected to reach $10 billion by 2017. It noted that in a recent national study, 16% of 10th-graders had reported using e-cigarettes. And, of that group, 43% had tried smoking tobacco.
Some argue that e-cigarettes help smokers quit or receive their nicotine in a less harmful way. One of the editorial writers, however, noted that the argument does not apply to adolescents, so that advertising to teens should cease.
“Regardless of whether e-cigarettes are a gateway to tobacco product initiation, there is no reason for adolescents to use a product for which the hypothesized public health benefit is harm reduction for adult smokers,” Dr. Nancy Rigotti, with Massachusetts General Hospital and Harvard Medical School in Boston, wrote in a JAMA editorial. “A rational approach is to extend to e-cigarettes the same sales, marketing and use restrictions that apply to combustible cigarettes."
The USC researchers note that “the social backdrop of early adolescence” and the teens' still-developing brains make them particularly susceptible to the effects of nicotine. Dr. Jennifer Lowry, chief medical toxicologist at Children's Mercy Kansas City in Missouri agreed.
“The brain is not fully developed until probably the mid-20s and the last part to develop is the pre-frontal lobe which is in charge of motivation, memory, behavior and movement,” Lowry said. “Nicotine can impair connections being made in the frontal lobe and increase addiction so it's harder to come off of later.”
Lowry said most states have passed their own restrictions on e-smoking, but enforcement can be spotty. She acknowledged that electronic smoking may be less harmful to habitual smokers than regular tobacco, but she said she would like to see the nicotine content regulated like a drug and the “cigarette” regulated as a device—adding that they are often used to disguise smoking other substances besides nicotine.
The American College of Cardiology agreed.
“This research provides one more piece of evidence that what common sense tells us is likely true: inhaling an addictive chemical is not good for anyone,” said ACC President Dr. Kim Allan Williams Sr. in a news release. “We should not wait for a new generation to become addicted tobacco users to regulate e-cigarettes and prohibit marketing to minors.”
The FDA issued a proposed rule in April 2014 and closed its public comment period on it last month.
FDA Spokesman Michael Felberbaum said that, under the Family Smoking Prevention and Tobacco Control Act of 2009, the FDA can “deem” that additional products meet the legal definition of a tobacco product—including electronic cigarettes—and thereby can be subject to similar regulation.
The FDA is committed to moving forward expeditiously to finalize the rule, Felberbaum said.
An industry group known as the American Vaping Association said the FDA is moving too expeditiously and has “jumped the gun on e-cigarette regulations.”
The group agreed that measures need to be taken to keep the products out of the hands of children, but It argues that regulation cannot be implemented before deeming has been finalized.