More evidence that youth are using e-cigs to initiate nicotine addiction, also growing evidence for moving on to cigarettes

There are four surveys that have been recently published that show increaing e-cigarette use among youth from Wales, Scotland, Hawaii, and Connecticut.  These data support earlier findings in young adults that e-cigarette use is associated with higher susceptability to cigarette smoking.
 
Data collected in 2014 for the Welsh government among 10 and 11 year olds reported  "Exposure to secondhand smoke in cars and homes, and e-cigarette use among 10-11 year old children in Wales: CHETS Wales 2" found:
 

• 6% of children report having used an e-cigarette. The vast majority of children who reported having used an e-cigarette had never smoked a tobacco cigarette.
• Among non-smoking children who reported having used an e-cigarette 14% reported that they might start smoking within the next 2 years (compared to 2% of those who had not used an e-cigarette).
• While few children said that they will smoke within two years, children who had used an e-cigarette were substantially less likely to say that they definitely will not smoke, and more likely to say that they might.
• E-cigarette use appears to represent a new form of childhood experimentation with nicotine, which is more prevalent among 10-11 year old children than smoking.
• Data are consistent with a hypothesis that children use e-cigarettes to imitate behaviours of parents and peers, and offer tentative support for the ‘gateway’ hypothesis (that use of e-cigarettes may act as a pathway into later smoking behaviour).

 
The Scottish National Health Services report  2013 Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)  found among 13 and 15 year olds found less use, but that some never-smoking young teens had initiiated nicotine use with e-cigarettes:
 

• 17% of 15 year olds reported trying or using e-cigarettes compared to 7% of 13 year olds;with14% of 15 year olds and 6% of 13 year olds having tried or used e-cigarettes only once or a few times. 
• 4% of youth who had never smoked had tried them (3% trying them once and 1% having tried them a few times).
• Those who have tried smoking once were more likely than those who had never smoked to have tried e-cigarettes with 24% having ever used e-cigarettes (15% having tried them once and 7% having tried them a few times and 1% having used them in the past).
• Former smokers were more likely to have tried e-cigarettes than those who had never smoked or had tried smoking once. Thirty nine per cent of former smokers had used them (19% had tried them once, 14% had tried them a few times, 3% used to use them and 2% are using them once a month or more).
• Two-thirds (66%) of regular smokers and just under half (46%) of occasional smokers had used e-cigarettes, however the majority of these had only tried them once or a few times (48% of regular and 38% of occasional smokers).
• Thirteen year old boys were more likely to have ever used e-cigarettes than 13 year old girls (8% compared to 6%). There was no difference between 15 year old boys and girls
• 6% of regular and 2% of occasional smokers reported using an e-cigarette on a weekly basis.
• Eleven per cent of regular smokers and 6% of occasional smokers reported using e-cigarettes at least once a month. 

 
 
The Hawaii Department of Health's  "Hawaii Department of Health’s Youth Tobacco Survey Shows Significant Increase in E-Cigarette Use among Public School Teens" reported that
 

• 5.5 percent of middle school students and 10 percent of high school students in Hawaii were regular e-cigarette users
• Lifetime e-cigarette use was 7.9 percent for middle school students and 17.9 percent for high school students in Hawaii.
• These numbers are substantially higher than national numbers.

 
There are two papers from Suchitra Krishnan-Sarin's group at Yale:  "E-cigarette use among high school and middle school adolescents in Connecticut" and "Reasons for Electronic Cigarette Experimentation and Discontinuation among Adolescents and Young Adults" in Nicotine and Tobacco Research that reports results of focus groups and a survey of 1175 students in Connecticut middle and high school and college on e-cigarettes in November 2013 and May 2014.  They found that
 

• Among middle school students who had used e-cigarettes, 51.2% reported that e-cigarettes were the first tobacco product they tried.  (only 17.1% initiated tobacco use with cigarettes.)
• Among high school students (who were older before e-cigarette mass marketing ramped up), 18.7% started tobacco use with e-cigarettes compared to 18.5% with e-cigarettes.
• 37.3% of lifetime e-cigarette users were never smokers, including 58.5% in middle school, 41.8% in high school, and 13.2% in college)
• 28.7% were ever cigarette smokers (24.4% in middle school, 26.6% in high school, and 38.7% in college)
• 34.0% were current cigarette smokers (17.1% in middle school, 31.6% in high school, and 48.0% in college)
• Flavors and menthol were important reasons kids liked e-cigarettes.

 
The high fraction of e-cigarette users who never smoked cigarettes, particularly among the younger students,adds to the case the e-cigarettes are an important route for nicotine initiation.  The fact that there were increasing levels of dual use of e-cigarettes and cigarettes among older youth indicates that many were starting with e-cigarettes and adding cigarettes.