September 8, 2015

Stanton A. Glantz, PhD

Another longitudinal study shows that kids at low risk of smoking who use e-cigs are a lot more likely to progress to cigarettes

Brian Primack and his colleagues just published the second longitudinal study demonstrating that adolescents who use e-cigarettes are much more likely to progress to smoking cigarettes than adolescents who do not use e-cigarettes.
Their paper, “Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults,” published in JAMA Pediatrics, is especially strong because it is a national study of youth who were at low risk of smoking (called susceptibility) at the beginning of the study when they assessed e-cigarette use. 
What they found was that the kids who used e-cigarettes were 8.3 times more likely to be actuall smoking cigarettes a year later.
In addition, among those kids who had not yet started smoking a year later, they were 8.5 times more likely to be susceptible to future smoking.  In other words, the use of e-cigarettes moved them along to behavioral continuum towards smoking during the year.
The results in this study are consistent with the longitudinal study of Southern California youth published by Leventhal and colleagues at USC a couple weeks ago as well as our earlier cross-sectional studies and other papers demonstrating that many kids at low risk of smoking cigarettes were initiating nicotine addiction with e-cigarettes.
An accompanying editorial by Jon Klein calls on the FDA (really the Obama Administration) to get off its duff and start regulating e-cigarettes.  (We had been told by FDA officials to expect the “deeming” rule in June, now 3 months ago.)  The reality is, however, that the FDA’s proposed rule would simply assert jurisdiction over e-cigarettes and would not impose any meaningful controls on kid-attracting flavors (which were explicitly left out of the draft rule) or marketing.   Even, if by some miracle, the White House were to allow the FDA to take meaningful action it would be tied up in court anyway.
So, as always, the responsibility to deal with e-cigarettes will remain with local and state governments to include e-cigarettes in clean indoor air laws, educational campaigns, and tax them at levels that will discourage use.
The full paper is here and Klein’s commentary is here.

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