It is a well-known fact that cigarette smoking carries with it significant health risks, but the younger a person starts smoking, the more problems it can cause. Now, a new study suggests flavored tobacco products may be the main culprit in attracting young people to start smoking.
The study, published in JAMA, is led by Bridget K. Ambrose, of the Center for Tobacco Products - part of the US Food and Drug Administration (FDA).
She and her colleagues note that most tobacco use starts during youth and young adulthood. According to the Centers for Disease Control and Prevention (CDC), preventing tobacco use among young people is crucial for stopping the "tobacco epidemic" in the US.
In fact, nearly 9 out of 10 cigarette smokers in the US first tried smoking by the age of 18.
Some promising statistics have come in recent years; according to 2013 results, cigarette smoking rates among high school students dropped to the lowest levels since 1991, with a teen cigarette smoking rate of 15.7%.
Though this means that the US has met its national Healthy People 2020 objective of reducing teen smoking to 16% or less, the CDC note that if youth smoking continues at the current rate, 5.6 million of today's under-18s will die early from a smoking-related illness.
And though cigarette smoking rates among youths have dropped, this has coincided with increased use of e-cigarettes and hookahs.
To further investigate how young people start smoking in the first place, the researchers used data from the Population Assessment of Tobacco and Health study, which is a household-based, nationally representative study of 45,971 adults and youths (aged 12-17 years) in the US.
Majority of first-time users tried flavored products
As part of the survey, young people answered questions regarding past 30-day use of tobacco products, as well as any history of use. Tobacco products included cigarettes, e-cigarettes, hookahs, cigars, pipe tobacco, smokeless tobacco, dissolvable tobacco, bidis (small, hand-rolled cigarettes) and kreteks (cigarettes made with a blend of tobacco, cloves and other flavors).
- Each day, more than 3,800 people under 18 years of age smoke their first cigarette
- An additional 2,100 young adults become daily cigarette smokers each day
- 99% of cigarette smokers first tried smoking by the age of 26.
If any of the products were ever used, the young people answered whether the first product they used was flavored - for example, to taste like menthol, mint, clove, spice, candy, fruit, chocolate or other sweets.
There were a total of 13,651 young people whose responses were used for this study. Of these, 51% were male, and the average age was 14.5 years.
Results show that the majority of young people used a flavored product for their first time: 89% of hookah users, 81% of e-cigarette users, 65% of cigar users and 50% of cigarette smokers.
Among young study subjects who used tobacco within the past 30 days, overall flavored product use was 80% of any-product users, 89% of hookah users, 85% of e-cigarette users, 72% of cigar smokers and 60% of cigarette smokers.
What is more, the young people routinely cited product flavoring as a reason for use of all product types, including e-cigarettes, hookahs, cigars, smokeless tobacco and snus pouches.
Commenting on their findings, the authors write:
"Consistent with national school-based estimates, this study confirms widespread appeal of flavored products among youth tobacco users. In addition to continued proven tobacco control and prevention strategies, efforts to decrease use of flavored tobacco products among youth should be considered."
Though the study had many strengths, including a large sample size, there were some limitations. One involves potential recall bias, as the young people often experimented with many products.
Additionally, the analysis does not "allow direct estimation of flavoring's role in initiation of tobacco use among youth." The authors also note that there are "mode differences" in household versus school-based youth tobacco surveys.
In the US, flavors other than menthol are prohibited in cigarettes, but the researchers note that flavored non-cigarette tobacco products are widely available, potentially appealing to young people.
Because young people who do not start using tobacco by the age of 18 will most likely never start, initiatives aimed at reducing teen smoking are a major public health priority.
Medical News Today recently reported on a study that revealed marijuana use has doubled in the US since 2001.