Electronic cigarettes (e-cigarettes) have been positioned by proponents as a smoking deterrent, but a new NIH study suggests otherwise. Published online Aug. 18 in JAMA: the Journal of the American Medical Association,(jama.jamanetwork.com) the study found that students who used e-cigarettes before starting ninth grade were more likely than their nonuser peers to start smoking traditional cigarettes and other combustible tobacco products within the next year.
Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News that there currently is insufficient evidence to support the use of e-cigarettes to help with smoking cessation, and now this JAMA study suggests the opposite may be the case. But it's important to keep the study findings in the proper perspective, she added.
"This study looks at a potential effect of e-cigarettes as a gateway to initiation of smoking," said Frost. "It shows that using e-cigarettes is associated with an increased risk of using combustible tobacco products. This does not prove that using e-cigarettes caused the eventual use of combustible tobacco, but it is certainly concerning."
The NIH study compared tobacco use initiation among students starting ninth grade at 10 public high schools in Los Angeles, with 222 students reporting use of e-cigarettes but no combustible tobacco products and 2,308 saying they had not used e-cigarettes or combustible tobacco products. These students were surveyed again at six months and one year regarding their tobacco use during the previous six months.
- A recent NIH study found that students who used electronic cigarettes (e-cigarettes) before starting ninth grade were more likely than their nonuser peers to start smoking traditional cigarettes and other combustible tobacco products within the next year.
- The study examined tobacco use initiation among students at 10 public high schools in Los Angeles.
- A six-month follow-up survey of the students found 30.7 percent of e-cigarette users had started using combustible tobacco products since the baseline survey compared with only 8.1 percent of those who had never used e-cigarettes.
The six-month follow-up survey found 30.7 percent of e-cigarette users had started using combustible tobacco products -- such as cigarettes, cigars and hookahs -- since the baseline survey compared with only 8.1 percent of those who had never used e-cigarettes.
The follow-up survey conducted among the students at the start of 10th grade produced similar findings, with 25.2 percent of e-cigarette users having used combustible tobacco products in the past six months compared with 9.3 percent of nonusers.
Frost said there are many variables that determine who is at greater risk for starting smoking.
"This study attempted to adjust for several of these risks, such as sociodemographics, environment and interpersonal characteristics, but there potentially are other factors that were not accounted for," she said. "Also, it was limited to one geographic region, so it may not be generalizable."
The authors recommended further studies to determine whether the observed link between e-cigarettes and smoking initiation was causal. In addition, the study focused solely on smoking initiation and the researchers said further research is needed to assess whether e-cigarette use is associated with an increased risk of ongoing, frequent combustible tobacco use.
Educating Teen Patients
Part of the family physician's role is to educate teens and their parents about risky behaviors, Frost said, and this includes smoking because the risks of tobacco use are widely known. But the same cannot yet be said of e-cigarettes, as their potential negative health effects are still not fully known.
However, e-cigarettes' association with increased tobacco use certainly increases vaping's potential risk, Frost said, which should be explained to teens and their parents.
"There is a lot that is still unknown (about e-cigarettes), but as we learn more, the message is getting clearer: E-cigarettes are harmful," she said. "The fact that e-cigarettes are being marketed to adolescents and use is increasing significantly is a big concern."
Related AAFP News Coverage
Studies Suggest E-cigarettes Don't Aid Long-term Smoking Cessation
Continued Rise in Teen E-cigarette Use Becomes Greater Concern