Significant Rise in E-Cigarette Use Among Youth in Poland: E-Cigarettes not replacing conventional tobacco cigarettes

Roswell Park-Led Study Documents Significant Rise in E-Cigarette Use Among Youth in Poland
 Cigarettes not replacing conventional tobacco cigarettes among this group, findings indicate
 
BUFFALO, N.Y. — Use of electronic cigarettes (e-cigarettes) has more than tripled among students in Poland, according to research led by Maciej Goniewicz, PhD, PharmD, a researcher in the Department of Health Behavior at Roswell Park Cancer Institute (RPCI). The study, published online ahead of print in the Journal of Adolescent Health, was conducted in collaboration with researchers at the Medical University of Silesia in Poland.
 
“Our research suggests that e-cigarette use is rapidly increasing among youth in Poland,” said Dr. Goniewicz. “This study adds to a growing body of evidence that e-cigarette use is increasing not only among adult smokers, but also among adolescents around the world. Further studies are necessary to illuminate our understanding of the reasons for this phenomenon and to help determine if e-cigarettes are a gateway to traditional cigarette use.”
 
Electronic cigarettes are battery-operated products that heat a liquid solution that vaporizes nicotine and other additives, which are then inhaled by the user. The researchers analyzed e-cigarette use among 1,760 students aged 15 to 19 attending 17 schools in 2010-2011 and 1,970 students attending 21 schools in 2013-2014. Students from 13 schools participated in both studies. E-cigarette use was substantially higher in the 2013-2014 sample than in the 2011-2012 sample.
 
The share of students who ever tried e-cigarettes increased from 16.8% (2010-2011) to 61.1% (2013-2014). Similarly, current e-cigarette use increased from 5.5% to 29.9%. A striking finding was that with increasing prevalence of c-cigarette use, the number of adolescents who use traditional tobacco products also increased, from 23.9% of adolescents who routinely smoked in the first survey to 38% in the second survey. Use of both e-cigarettes and traditional cigarettes increased from 65.3% (2010-2011) to 72.4% (2013-2014). These findings suggest that e-cigarettes are not replacing conventional tobacco cigarettes, at least in this age group, according to Dr. Goniewicz.
 
Results of a similar study – the National Youth Tobacco Survey (NYTS) – conducted in the United States showed that ever-use and current use of e-cigarettes doubled among U.S. young people. Dr. Goniewicz noted that the higher rates of use by youth in Poland might be attributed to a combination of factors, including age differences, more aggressive marketing campaigns and less comprehensive tobacco-control policies that cover e-cigarettes.
 
Two researchers from the University of California–San Francisco, Stanton Glantz, PhD, Professor of Medicine, and Lauren Dutra, ScD, Postdoctoral Fellow, were invited to comment on this research in an editorial also published in the Journal of Adolescent Health. “E-cigarette use is increasing rapidly among youth around the globe,” they concluded. “Although some public health researchers are hopeful about e-cigarettes’ potential as a harm reduction product, the business model that tobacco companies use to promote e-cigarettes (promoting addiction to maintain a strong consumer base) is inconsistent with the concept of e-cigarettes as a harm reduction tool. In combination with the existing literature, findings by Goniewicz et al. emphasize the fact that rapid penetration of the youth market, including use of e-cigarettes among never smokers, may be accompanied by increasing youth smoking with potential long-term health impacts.”
 
“While overall e-cigarettes appear to be less harmful than conventional cigarettes, they are not safe,” added Andrew Hyland, PhD, Chair of the Department of Health Behavior at RPCI. “Scientific research ongoing at Roswell Park and at other research facilities will help to more clearly delineate the health risks and net public health impact of e-cigarettes.”
 
Dr. Goniewicz reports that in 2011 he received a research grant from Pfizer, a manufacturer of smoking-cessation medication. One of the co-authors of the paper reports support from a manufacturer of e-cigarettes. Both awards apply to projects that fall outside the scope of this newly published research.       
 
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The full paper is available here.
 
Lauren Dutra and I wrote a commentary on this paper which summarized the evidence from around the world that there are a substantial of never-smoker kids using e-cigarettes.
 
Here are the first and last paragraphs:
 

Discussion of electronic cigarettes (e-cigarettes) has focused primarily on their potential as a less dangerous alternative to cigarettes or as a smoking cessation aid for adult smokers. But because regular e-cigarette use is low among never smokers, these discussions have so far failed to consider seriously the rapidly rising e-cigarette use among adolescents. Indeed, in its 2014 policy statement on e-cigarettes, the American Heart Association stated, “Among never smokers, 0.7% were currently users (past 30 days), which indicates that few never smokers who try e-cigarettes continue their use”.
 
Results from Poland challenge this assumption. Goniewicz et al. found rapidly rising e-cigarette use among adolescents aged 15–19 years. Ever e-cigarette use increased from 16.8% in 2010–2011 to 62.1% in 2013–2014, and current e-cigarette increased from 5.5% to 29.9%. This increase in prevalence was nearly twice (1.7 times) the increase in prevalence for smoking conventional cigarettes (23.9%–38.0%). Prevalence of dual use of e-cigarettes and conventional cigarettes also increased from 3.6% in 2010–2011 to 21.8% in 2013–2014, with 72.4% of current e-cigarette users also smoking cigarettes in 2013–2014. If adolescents were adopting e-cigarettes as alternatives to conventional cigarettes, conventional cigarette smoking and dual use of e-cigarettes and cigarettes would have declined.
 
...
 
 
The same types of policies used to protect youth from cigarettes included in the World Health Organization Framework Convention on Tobacco Control need to be implemented for e-cigarettes. E-cigarette advertising should be prohibited, as should sponsorship of events attended by youth (such as sporting and music events). The use of e-cigarettes should be prohibited wherever smoking cigarettes is prohibited, age restrictions should be placed on e-cigarettes for purchase, and the prices of e-cigarettes should be increased through taxation. Policy makers and researchers need to base e-cigarette policies on the fact that they are a source of nicotine initiation among youth not just a possible tool to help adult smokers quit smoking.

 
The full commentary is available here.