February 8, 2017

Stanton A. Glantz, PhD

Even non-nicotine e-cigarettes are a gateway to cigarettes and promote youth relapse

Richard Miech and colleagues at the University of Michigan just published a very strong longitudinal study adding more details to not just that but also how and why e-cigarettes are a gateway to cigarette smoking.  To date, all the studies of the relationship between e-cigarette use and smoking have shown a gateway effect.
Their study, “E-cigarette use as a predictor of cigarette smoking: Results from a 1-year follow-up of a national sample of 12th grade students,” published in Tobacco Control, examined several different aspects of the relationship between e-cigarette and cigarette use.   Using the respected Monitoring the Future national sample, they showed that initiating with e-cigarettes both was followed by more than 4 times the odds of smoking cigarettes a year later.  They also showed that e-cigarette use increased the likelihood of relapse to cigarette smoking among youth who had stopped smoking.
The most interesting new finding in the study, however, is the evidence on how and why e-cigarette use increases the risk of cigarette smoking:  Using e-cigarettes lowers the perceived risk of smoking cigarettes.  Most interestingly, this effect occurs even among youth who say they are using nicotine-free e-cigarettes.  This finding diffuses the argument made by some e-cigarette advocates, that we need not be concerned by the use of non-nicotine e-cigarettes.
This paper contributes to the growing body of evidence that e-cigarette use is an independent risk factor for future smoking,  both among youth who are non-smokers and also among youth with past smoking experience. Results support a desensitization process, whereby youth who vape lower their perceived risk of cigarette smoking.
Objective To prospectively examine vaping as a predictor of future cigarette smoking among youth with
and without previous cigarette smoking experience.  A secondary aim is to investigate whether vaping may desensitise youth to the dangers of smoking.
Methods Analysis of prospective longitudinal panel data from the nationally representative Monitoring the Future study. The analysis is based on 347 12th grade students who were part of a randomly selected subsample that completed in-school surveys in 2014 and were resurveyed 1-year later.
Results Among youth who had never smoked a cigarette by 12th grade, baseline, recent vapers were more than 4 times (relative risk (RR)=4.78) more likely to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among 12th grade students who had smoked in the past but had not recently smoked at baseline, recent vapers were twice (RR=2.15) as likely to report smoking in the past 12 months at the follow-up. Vaping did not predict cessation of smoking among recent smokers at baseline. Among never-smokers at baseline, recent vapers were more than 4 times (RR=4.73) more likely to move away from the perception of cigarettes as posing a ‘great risk’ of harm, a finding consistent with a desensitization process.
Conclusions These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Vaping as a risk factor for future smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes.
The full citation is Miech R, Patrick ME, O’Malley PM, et al. E-cigarette use as a predictor of cigarette smoking: Results from a 1-year follow-up of a national sample of 12th grade students  Tob Control doi:10.1136/tobaccocontrol-2016-053291.  It available here.

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