More details on how e-cigarettes are recruiting kids to nicotine addiction

Thomas Wills and colleagues just published "Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents" in Pediatrics.  This large (1941 high school students, mean age 14.6 years, conducted in 2013) found:

  • High levels of e-cigarette use (17% e-cigarettes only, 12% dual use with cigarettes, compared to 3% cigarettes only)
  • E-cigarette only use concentrated among kids at lower risk of smoking cigarettes than those who typically smoke cigarettes.  (The dual users were had risk patterns more like cigarette smokers.)
  • Nearly two-thirds (18%/29%) of kids who experimented with e-cigarettes are current users, challenging the assumption by the American Heart Association and others that high every use of e-cigarettes found in many studies reflect kids who are just trying them once or twice and not becoming regular users (defined as use in the last 30 days, which is the definition of "current use" fo kids).

Taken with other recent papers on details of e-cigarette use patterns in kids, we can now conclude that e-cigarette use is

  • Expanding the population of kids addicted to nicotine beyond those who would start smoking cigarettes
  • Supporting cigarette smoking among kids

Here is the abstract from the paper:

OBJECTIVE: To describe electronic cigarette (e-cigarette) use and cigarette use among adolescents and determine whether established risk factors for smoking discriminate user categories.

METHODS: School-based survey of 1941 high school students (mean age 14.6 years) in Hawaii; data collected in 2013. The survey assessed e-cigarette use and cigarette use, alcohol and marijuana use, and psychosocial risk and protective variables (eg, parental support, academic involvement, smoking expectancies, peer smoking, sensation seeking). Analysis of variance and multinomial regression examined variation in risk and protective variables across the following categories of ever-use: e-cigarette only, cigarette only, dual use (use of both products), and nonuser (never used either product).

RESULTS: Prevalence for the categories was 17% (e-cigarettes only), 12% (dual use), 3% (cigarettes only), and 68% (nonusers). Dual users and cigarette-only users were highest on risk status (elevated on risk factors and lower on protective factors) compared with other groups. E-cigarette only users were higher on risk status than nonusers but lower than dual users. E-cigarette only users and dual users more often perceived e-cigarettes as healthier than cigarettes compared with nonusers.

CONCLUSIONS: This study reports a US adolescent sample with one of the largest prevalence rates of e-cigarette only use in the existing literature. Dual use also had a substantial prevalence. The fact that e-cigarette only users were intermediate in risk status between nonusers and dual users raises the possibility that e-cigarettes are recruiting medium-risk adolescents, who otherwise would be less susceptible to tobacco product use.
The full paper is available for free here.



Gateway evidence

In the USA Today you are quoted as saying there's "no question" ecigs are a gateway to smoking. I thought the data was still open to interpretation on this point. What's the overwhelming evidence that removes all doubt for you?

The evidence is the cumulation of the two new studies

.... plus the work that has come before.
The only question is the precise fraction of kids who are smoking that started smoking cigs via ecigs.