Teenagers who use e-cigarettes are three times more likely to start smoking tobacco cigarettes within a year than those who do not use the electronic devices, new research at the University of Hawaii Cancer Center has found. And that might be the best-case scenario. The new findings mirror the results of a multitude of recent studies that have concluded that e-cigarettes are a gateway product to nicotine addiction. One of the earlier studies, done by scientists at the University of Pittsburgh School of Medicine, found that teenagers who used e-cigarettes were four times more likely to progress to traditional cigarettes, while scientists at UC San Francisco found that teens who “vaped” were six times more likely to try tobacco than their peers who had never tried an e-cigarette. “Whether e-cigarettes lead teenagers to tobacco cigarettes is the No. 1 public health question of our time,” Dr. Thomas Wills, a cancer-prevention expert at the University of Hawaii in Honolulu and lead author of the most recent study, told the Right Step. “There’s a huge experiment going on here. Teens are picking these things up hand over fist.” The data from Wills and his colleagues was based on surveys of more than 2,300 high school students, mostly ninth- and 10th-graders. The students were asked whether they had ever used e-cigarettes or tobacco cigarettes, whether they currently used them, and if so, how often they used them. A year later, the students were asked the same questions. Electronic cigarettes, promoted as a safer way for tobacco smokers to get their nicotine fix, work by heating a liquid called “e-juice” until it vaporizes. The devices came onto the market about a decade ago — not enough time for researchers to determine their health effects — and are skyrocketing in popularity among adolescents. Recent data published by the Centers for Disease Control and Prevention indicate that e-cigarette use among middle and high school students has tripled in just one year. Part of the reason teens are puffing on these devices is their perceived low risk: in all grades only 15% or less see a “great risk” of harm to their health if they regularly smoke e-cigarettes, one of the lowest levels of perceived risk for all drugs measured.
FDA Ruling Imminent
The studies come as the U.S. Food and Drug Administration is poised this year to assert control over e-cigarettes. The FDA’s final regulations, which have been sent to the White House for review, would require e-cigarette makers to submit applications detailing ingredients, health effects and how the products are manufactured. There are many FDA-approved smoking cessation aids, includingnicotine gum, skin patches and lozenges, and e-cigarette makers could have taken their products to the FDA for clearance at any time. “I do think that some people believe that these devices can help smokers cut back, but we have a process where they could take the product to the FDA and get approval as a cessation device and no one has done that,” said Cathy Callaway of the American Cancer Society Cancer Action Network. The FDA has not taken any action against companies that claim e-cigarettes are effective for quitting smoking. But is “vaping” really an effective way to quit smoking? The science is lining up against that theory. A new systematic review and meta-analysis of 38 studies looking at the link between e-cigarette use and smoking cessation found that smokers who try e-cigarettes are 28% less likely to give up tobacco than those who don’t. The study by UC San Francisco researchers is the largest to examine whether e-cigarettes help smokers quit tobacco cigarettes and concluded with this remark: “As currently being used, e-cigarettes are associated with significantly less quitting among smokers.” In 2015, the U.S. Preventive Services Task Force concluded that there was not enough evidence to recommend the devices to help adults quit smoking. Ironically, experts say e-cigarettes can interfere with efforts to quit smoking by keeping users hooked on nicotine. The University of Pittsburgh researchers found that e-cigarettes deliver nicotine more slowly than conventional cigarettes, which allows users to become accustomed to nicotine’s side effects and progress to tobacco. As with any highly addictive drug, as the body gets used to a substance, it needs more and more over time.
‘Goal Is to Keep People Smoking’
Wills says the teen brain is particularly sensitive to nicotine and more vulnerable to addiction. “Once adolescents get exposed to nicotine, the thought may come into their heads that tobacco cigarettes are something they will like even more.” “E-cigarettes help people keep smoking,” Wills said. “Most adults who smoke use both — the dominant pattern is for them to use both. We know e-cig companies are increasing the amount of nicotine [in their products]. My belief is that the goal is to keep people smoking. Five different studies in Europe and the U.S. show that people who use e-cigs are more likely to start smoking. People who say they use e-cigs to quit, well, all empirical evidence is against that working.” Callaway sees another motive. “They are using e-cigarettes partly to get around smoke-free laws,” Callaway told the Right Step. “And some of the devices can be used to conceal illicit drug use.” Such was the finding of a study on Connecticut teenagers published in the journal Pediatrics in 2015 that found that 27% of high school students who had used both marijuana and e-cigarettes had tried to “vape” their marijuana. Callaway countered another argument put forward by vape supporters — that the devices are healthier than tobacco cigarettes because they do not contain all of the harmful chemicals associated with burning tobacco leaves. “To assume that all 450 [vaping] products are the same is dangerous at best,” Callaway said. “We don’t know the long-term effects of inhaling propylene glycol (a key ingredient of the vapor in e-cigarettes). It could be years before we determine the cancer risk associated with these products.”
Vapor Kills Lung Cells
Propylene glycol is a synthetic liquid added to foods, cosmetics and certain medicines to help them stay moist. It is considered safe to eat in foods in small amounts, but researchers at the UC San Diego School of Medicine and Veterans Affairs San Diego Healthcare System just completed a study on mice that showed that the vapors kill lung cells, weakening the immune system and boosting the capacity of the bacteria to cause disease. “We already knew that inhaling heated chemicals, including the e-liquid ingredients nicotine and propylene glycol, couldn’t possibly be good for you,” the study’s senior author, Dr. Laura E. Crotty Alexander, said in a statement. “This study shows that e-cigarette vapor is not benign — at high doses it can directly kill lung cells, which is frightening.” The Dow Chemical Company states that “inhalation exposure to [propylene glycol] mists should be avoided” and the American Chemistry Council has repeatedly issued warnings about inhaling theater fog (which contains propylene glycol) after reports of eye and respiratory infections from actors. In May 2005, a study by the School of Environment and Health at the University of British Columbia found that people working the closest to the fog machines had reduced lung function. But the devices continue to have high-profile backers, including Iowa Attorney General Tom Miller, who supports the idea that the devices help people quit tobacco cigarettes. Miller said in a statement that companies that make e-cigarettes and tobacco cigarettes are not “equally evil”, adding that “adults misleading kids to get them to do what we want has always been a failed strategy.” (There is no clear cut separation between manufacturers. Tobacco giant Reynolds American owns the prominent e-cigarette brand Vuse and Altria Group, formerly known as Philip Morris, in January said it plans to lay off workers and use the savings to invest in e-cigarettes.) Wills was not surprised by the criticism. “To those who think that e-cigs are the best thing that ever happened, people who try to restrict them are horrible villains,” the University of Hawaii researcher said. “That’s what they say about me.” By Laura Nott Sources: “Tobacco Use Among Middle and High School Students — United States, 2011–2014 Morbidity and Mortality Weekly Report (MMWR),” CDC, April 17, 2015 “Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents, A Cross-sectional Study,” JAMA Pediatrics, July 2014, Vol 168, No. 7 “E-cigarette use triples among middle and high school students in just one year,” CDC, April 16, 2015 “Electronic Cigarettes (e-Cigarettes),” FDA News & Events “Product Safety Assessment Propylene Glycol-Based Low Temperature Thermal Fluids Journal of Molecular Medicine,” pp 1-13 First online: 25 January 2016 “Effects of theatrical smokes and fogs on respiratory health in the entertainment industry,”American Journal of Industrial Medicine Volume 47, Issue 5, pages 411–418, May 2005 “Electronic cigarette inhalation alters innate immunity and airway cytokines while increasing the virulence of colonizing bacteria, A Longitudinal Analysis of Electronic Cigarette Use and Smoking Cessation,” Rachel A. Grana, PhD, MPH; Lucy Popova, PhD; Pamela M. Ling, MD, MPH
