Analyzing data from the National Youth Tobacco Survey, a new study published in JAMA Pediatrics debates whether e-cigarettes could be encouraging the use of conventional cigarettes in adolescents.
Recently, Medical News Today ran a feature examining the boom in popularity of e-cigarettes, which some experts believe will become more widely used than conventional cigarettes by the next decade.
In that feature, we also debated the conflicting data on e-cigarettes from scientific studies and looked at how these - currently unregulated - products might be controlled in the future.
Many observers have commented that e-cigarettes are sold and promoted in a way that is similar to how cigarettes were aggressively marketed in the 1950s and 1960s, before cigarette advertising was banned from television and radio.
But in addition to these traditional media, e-cigarettes have a strong advertising presence on the internet, where they can be purchased.
This raises concerns over the accessibility of these devices to children. E-cigarettes are also sold in strawberry, licorice and chocolate flavors. These kind of flavorings are banned in conventional cigarettes in the US because they appeal to children.
The National Youth Tobacco Survey 2011-12
The new study analyzed National Youth Tobacco Survey (NYTS) data from 2011 and 2012 to see what the relationship is between e-cigarette use and conventional cigarette smoking in American adolescents.
It is difficult to say whether adolescents are beginning to smoke with conventional cigarettes and then moving on to e-cigarettes, or whether it is the other way around.
The NYTS shows that e-cigarette use doubled among adolescents in grades 6 through 12 between 2011 and 2012, from 3.3% of adolescents to 6.8%. The survey also reported that 76.3% of e-cigarette users also smoke conventional cigarettes.
The researchers found that adolescents who had ever used an e-cigarette were more likely to have smoked at least 100 conventional cigarettes and be current smokers than adolescents who had never used an e-cigarette.
Adolescents who use e-cigarettes were also less likely to abstain from using conventional cigarettes over 30-day, 6-month and 1-year periods.
This challenges the assumption that e-cigarettes are effective as tools for quitting smoking - which has been a major claim attributed to these products. The researchers found there was no significant association between using e-cigarettes and attempting to quit smoking.
It is difficult to say whether adolescents are beginning to smoke with conventional cigarettes and then moving on to e-cigarettes, or whether it is the other way round. This study can only report a link between conventional cigarette and e-cigarette use. But the authors do conclude that "e-cigarettes are not discouraging use of conventional cigarettes."
E-cigarettes may also contribute to nicotine addiction, according to the researchers, who consider that the still-developing adolescent brain may be more at risk from the adverse effects of nicotine than adults.
In an editorial linked to the study, Frank J. Chaloupka PhD of the University of Illinois at Chicago, says:
"While much remains to be learned about the public health benefits and/or consequences of electronic nicotine delivery systems use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly.
Adopting the right mix of policies will be critical to minimizing potential risks to public health while maximizing the potential benefits."