Higher e-cig nicotine levels linked to more teen smoking, vaping

Contributing Writer
AMA Wire
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If your teen patients or their parents think electronic cigarettes may be a better option for high-school students than traditional combustible cigarettes, new evidence suggests they need to think again.

A study published online in JAMA Pediatrics showed that the higher the nicotine concentration in the e-cigarettes high school students used, the greater the chance those teens increased the frequency and intensity of combustible cigarettes or vaping in the future. The uptick can begin in just a six-month period.

Researchers’ findings are based on the results of following 181 students, split almost evenly between boys and girls, from 10 high schools in the Los Angeles area. The students were surveyed during the spring of 10th grade and participated in a follow-up in the fall of 11th grade.

At the baseline evaluation, students reported using e-cigarettes within the past month and they reported the nicotine concentration levels they used as being none, low (1–5 mg/mL), medium (6–17 mg/mL) or high (equal to or greater than 18 mg/mL). Students also reported how frequently they used combustible cigarettes and e-cigarettes in the past month, and reported the daily intensity of the smoking and vaping, including the number of cigarettes per day, as well as the number of vaping episodes per day and the number of puffs per vaping episode.

When investigators queried the students at the six-month follow-up, they discovered teens who vaped e-cigarettes with higher nicotine concentrations at the baseline survey were more likely to progress to higher frequency and intensity levels of vaping and smoking. For example, the odds of participants’ reporting frequent smoking in the past month (versus no smoking) at the follow-up were 2.26 times greater for each one-level increase of nicotine concentration—none to low, low to medium and medium to high—that students reported at the baseline assessment six months earlier.

“In the context of research demonstrating that youth who use e-cigarettes are more likely to initiate and progress to higher levels of combustible cigarette use, the present findings suggest that the overrepresentation of frequent and high-intensity smoking among youths who vape may be accounted for by nicotine concentration in e-cigarettes,” Adam M. Leventhal, PhD, of the University of Southern California Keck School of Medicine in Los Angeles, and his study co-authors wrote.

The authors concluded that the study results are preliminary evidence that “regulatory policies addressing nicotine concentration levels in e-cigarette products used by adolescents may affect progression of combustible cigarette and e-cigarette use among youths.”  

The findings come just months after the Food and Drug Administration (FDA) announced it would pursue a new public health education campaign to discourage children from using e-cigarettes and other electronic nicotine delivery systems (ENDS). A full-scale campaign is expected to launch in 2018. More than 2 million middle- and high-school students used e-cigarettes and other ENDS in 2016, according to the FDA.

The AMA has policy supporting raising the minimum tobacco-purchasing age to 21. AMA policy also supports increased taxation of all tobacco products, including electronic nicotine-delivery systems and FDA oversight of e-cigarettes and many other tobacco products. The AMA says physicians should educate themselves about e-cigarettes, only promote FDA-approved smoking-cessation tools and resources, and advise patients who use e-cigarettes about the potential danger to children of accidental ingestion of improperly stored e-cigarette liquid.

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Here are 5, 2017 US Govt funded, peer reviewed, published studies showing most of this article is false and misleading. The effect will be continued smoking, and death. #5 is most on point here. Vaping is the most common smoking cessation product in the USA and also most effective, per CDC data. 1. Switching to vaping would create major public health benefit - saving 6.6 million US lives. Georgetown University Lombardi Cancer Center – David Levy et al. Oct. 2017 https://gumc.georgetown.edu/news/Tobacco_Smokers_Could_Gain_86%20Million_Years_of_Life_if_they_Switch_to_Vaping_Study_Finds Funded by National Cancer Institute, NIDA “Tobacco smokers (in the US) could gain an additional 86.7 million years of life if they switch to vaping.” 2. Vaping does NOT lead to smoking among youth, and likely prevents it. Univ. of North Dakota, Dept. of Population Health – AS Selya et al. Addiction. 2017 Aug 25. Funded by National Cancer Institute, NIDA https://www.ncbi.nlm.nih.gov/labs/articles/28841780/ “E-cigarette use was not associated significantly with later conventional smoking, either directly or through nicotine dependence.” 3. E-cigarette Flavors prevent smoking – Flavor bans increase smoking. National Bureau of Economic Research (Yale Univ); J. Buckell et al. Sept. 2017 http://www.nber.org/papers/w23865 Funded by FDA, National Cancer Institute, NIDA “Our results indicate that banning flavors in e-cigarettes…. would result in the greatest increase in smoking of combustible cigarettes.” 4. Toxin and carcinogen levels about equal in patch, gum (NRT) & e-cigarettes. l. Shahab et.al., Annals of Internal Medicine, Feb. 2017 http://annals.org/aim/article-abstract/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement Funded by Cancer Research UK and NIH grants “Long-term NRT-only and e-cigarette–only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes.” 5. E-cigarettes cause more quit attempts, and are more successful than NRT. University of California- San Diego School of Public Health, Shu-Hong Zhu, et.al., BMJ; July 2017 http://www.bmj.com/content/358/bmj.j3262 Funded by NIH, National Cancer Institute “We found that e-cigarette use was associated with an increased smoking cessation rate at the level of subgroup analysis and at the overall population level. It is remarkable, considering that this is the kind of data pattern that has been predicted but not observed at the population level for cessation medication, such as nicotine replacement therapy and varenicline. E-cigarettes appear to have helped to increase smoking cessation at the population level ” Try to think more critically please.
I see the correlation but I don't see the causation. Here's what I do see, people (not only youth) that experiment with nicotine experiment with different sources, the same can be said with other drugs. If someone were to experiment with crack chances are they'd be more likely to experiment with other drugs would they not? Youth are much more aware of the dangers of combustible tobacco than my generation ever was and they understand that vapor products offer a substantially reduced harm source of nicotine over tobacco cigarettes. What are the effects vapor products having on society as a whole? By them simply being labelled what they are and that is a harm reduction strategy, by them being know to be "less hazardous than combustible tobacco" they actually reinforce just how bad smoking is for people. This study insinuates that vaping is leading to smoking but that's not what the data shows, instead it shows that people that experiment will experiment with different things.
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