More evidence that the US permissive policy environment for e-cigs is expanding the tobacco epidemic

Hong-Jun Cho, Lauren Dutra, and I recently published “Differences in adolescent e-cigarette and cigarette prevalence in two policy environments: South Korea and the United States” in Nicotine and Tobacco Research.  This paper compares changes in e-cigarette and cigarette use in South Korea and the United States between 2011 and 2015.  Korea has maintained restrictive policies on e-cigarettes whereas the US has left them essentially unregulated (a situation that the FDA will continue until at least 2022). 
 
We found that In Korea adolescent e-cigarette use remained stable at a low level, whereas in the United States e-cigarette use increased.  Most important, combined e-cigarette plus cigarette use declined in Korea whereas it increased in the US. The restrictive policies in Korea likely contributed to lower overall tobacco product use.  These results are evidence against the claims that the availability of e-cigarettes is preventing youth from taking up cigarettes.  They also add to the case that a permissive e-cigarette policy environment is making the overall nicotine/tobacco epidemic worse.  It is also
 
Here is the abstract:
 
Background:  In the context of different regulatory environments, different patterns of e-cigarette use have emerged among adolescents worldwide. One example is the United States and South Korea, the latter of which has maintained much more extensive regulation of e-cigarettes.
Methods: This analysis compares the prevalence of e-cigarette and conventional cigarette use between 2011 and 2015 from the Korean Youth Risk Behavior Web-based Survey and the U.S. National Youth Tobacco Survey, both nationally representative samples of middle and high school students that use similar questions.
Results: E-cigarette prevalence (past 30 day) among Korean adolescents decreased from 4.7% in 2011 (95% confidence interval [CI]: 4.4–5.0) to 4.0% in 2015; (3.7–4.3) but increased dramatically among U.S. adolescents from 0.9% (0.7–1.2) to 11.2% (9.9–12.7). Cigarette prevalence (past 30 day) decreased in Korea from 12.1% (11.6–12.7) to 7.8% (CI: 7.3–8.3) and in the United States from 11.1% (9.5–12.6) to 6.1% (5.1–7.3). Combined prevalence of cigarette and e-cigarette use (adjusting for dual users) decreased in Korea from 13.2% (12.7–13.8) to 8.5% (8.0–9.1) but increased in the United States from 11.3% (9.7–12.9) to 14.0% (12.4–15.7).
Conclusions:  In Korea, where e-cigarettes are extensively regulated, adolescent e-cigarette use remained stable at a low level, whereas in the United States, where e-cigarette regulation has been limited, e-cigarette use increased. Combined e-cigarette plus cigarette use declined in Korea whereas it increased in the US. The restrictive policies in Korea likely contributed to lower overall tobacco product use.
 
The full citation is: Hong-Jun Cho, Lauren M Dutra, Stanton A Glantz.  Differences in adolescent e-cigarette and cigarette prevalence in two policy environments: South Korea and the United States  Nicotine & Tobacco Research, ntx198, https://doi.org/10.1093/ntr/ntx198.  The paper is available here.