August 20, 2017

Stanton A. Glantz, PhD

More evidence that e-cigs are gateway to smoking cigs, this time from England!

Our e-cigarette enthusiast colleagues in England have generally taken the position that England was different from the USA, so that evidence from America showing that ecigs were bringing low (of starting nicotine with cigarettes) risk kids were being drawn into the nicotine market by e-cigs than progressing to cigarettes was not happening in England.
Now a well-done longitudinal study from England (which includes among its coauthors some of the people who had been claiming e-cigarettes were not a problem for kids there) “Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study,” by Mark Conner and colleagues shows that, as in the USA  
These results are quantitatively similar to the results of the US studies.  These are big effects.
They also found evidence, consistent with the earlier cross-sectional study that Lauren Dutra and I published in 2014 that kids who used e-cigarettes and cigarettes at baseline were more likely to be smoking more cigarettes a year later.  (Correcting for covariates reduced the magnitude of the association, but the direction did not change.)
At this point, one would hope that the e-cigarette enthusiasts would accept the very consistent findings that e-cigarettes are recruiting new kids to nicotine and conventional cigarettes. 
Here is the abstract:
BACKGROUND:  In cross-sectional surveys, increasing numbers of adolescents report using both electronic cigarettes (e-cigarettes) and cigarettes. This study assessed whether adolescent e-cigarette use was associated prospectively with initiation or escalation of cigarette use.
METHODS:  Data were from 2836 adolescents (aged 13-14 years at baseline) in 20 schools in England. At baseline, breath carbon monoxide levels, self-reported e-cigarette and cigarette use, sex, age, friends and family smoking, beliefs about cigarette use and percentage receiving free school meals (measure of socioeconomic status) were assessed. At 12-month follow-up, self-reported cigarette use was assessed and validated by breath carbon monoxide levels.
RESULTS:  At baseline, 34.2% of adolescents reported ever using e-cigarettes (16.0% used only e-cigarettes). Baseline ever use of e-cigarettes was strongly associated with subsequent initiation (n=1726; OR 5.38, 95% CI 4.02 to 7.22; controlling for covariates, OR 4.06, 95% CI 2.94 to 5.60) and escalation (n=318; OR 1.91, 95% CI 1.14 to 3.21; controlling for covariates, this effect became non-significant, OR 1.39, 95% CI 0.97 to 1.82) of cigarette use.
CONCLUSIONS: This is the first study to report prospective relationships between ever use of e-cigarettes and initiation and escalation of cigarette use among UK adolescents. Ever use of e-cigarettes was robustly associated with initiation but more modestly related to escalation of cigarette use. Further research with longer follow-up in a broader age range of adolescents is required.
The full citation is:  Conner M, Grogan S, Simms-Ellis R, Flett K, Sykes-Muskett B, Cowap L, Lawton R, Armitage CJ, Meads D, Torgerson C, West R, Siddiqi K.  Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study.  Tob Control. 2017 Aug 17. pii: tobaccocontrol-2016-053539. doi: 10.1136/tobaccocontrol-2016-053539. [Epub ahead of print]

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