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Teen vaping can be a conduit to future smoking

Teen vaping acts as a 'one way bridge' to future smoking among those who have never smoked before, and may not stop those who have smoked before from returning to it, concludes a small US study.

The researchers from the Institute for Social Research, University of Michigan, Ann Arbor, Michigan, base their findings on a follow up sample of 347 out of 822 originally targeted 12th graders (17-18 year-olds), who had been randomly selected from a representative (Monitoring the Future) survey of more than 13,000 12th graders from 122 schools, in 2014.

The 2014 survey and its follow up one year later in 2015 asked the teens about substance use, including vaping and conventional cigarette smoking. Analysis of the responses showed that e-cigarettes were one of the most popular substances that the teens said they used, and the prevalence of recent vaping (within the past 30 days) was around 50% higher than it was for conventional smoking.

Most of the respondents thought that cigarette smoking was harmful, with 80% in both the 2014 and follow up surveys feeling that one or more packs daily posed a “great risk.” Teens who had never smoked a cigarette before reaching 12th grade, but who had used an e-cigarette at least once within the past 30 days, were more than four times as likely to say that they had smoked a cigarette by the follow up survey (31%) as those who hadn't vaped (7%).

But all the new smokers who were also recent vapers said they had smoked only “once or twice” during the preceding 12 months.

This difference between vapers and non-vapers held true even after accounting for potentially influential factors, such as sex, ethnicity, and their parents' educational attainment.

For those who had ever smoked by the time of the 2014 survey, the prevalence of smoking during the preceding 12 months was more than twice as high among teens who were also vapers in 2014 (80%) than it was among those who weren't (37%).

Vaping also significantly predicted cigarette smoking in the preceding 12 months at the follow up survey among teens who had smoked at some point previously, but not recently (63% vs 27%), even among those who felt that smoking was very harmful.

And among teens who said they had never smoked by the time of the 2014 survey, recent vapers were four times as likely to move away from the belief that cigarette smoking poses a great risk as those who hadn't vaped, possibly because they become de-sensitised to the harms of smoking, suggest the researchers.

This is an observational study so no firm conclusions can be drawn about cause and effect, added to which the researchers point to several caveats.

The analysis did not take account of the substances in the e-cigarettes the teens vaped, nor the different frequencies of vaping at the time of the 2014 survey. The number of responses to the follow up survey was relatively small, which may have introduced some element of bias, while other factors associated with susceptibility to smoking take-up among teens, such as rebelliousness and the influence of friends, were not included.

But the researchers say the results contribute to the growing body of evidence for vaping as a "one way bridge" to cigarette smoking teens. "These results bolster findings for vaping as a one-way bridge to cigarette smoking among adolescents," they write.

"The results support a de-sensitisation process, whereby youth who vape lower their perceived risk of cigarette smoking," they add.

Abstract
Objective: To prospectively examine vaping as a predictor of future cigarette smoking among youth with and without previous cigarette smoking experience. A secondary aim is to investigate whether vaping may desensitise youth to the dangers of smoking.
Methods: Analysis of prospective longitudinal panel data from the nationally representative Monitoring the Future study. The analysis is based on 347 12th grade students who were part of a randomly selected subsample that completed in-school surveys in 2014 and were resurveyed 1-year later.
Results: Among youth who had never smoked a cigarette by 12th grade, baseline, recent vapers were more than 4 times (relative risk (RR)=4.78) more likely to report past-year cigarette smoking at follow-up, even among youth who reported the highest possible level of perceived risk for cigarette smoking at baseline. Among 12th grade students who had smoked in the past but had not recently smoked at baseline, recent vapers were twice (RR=2.15) as likely to report smoking in the past 12 months at the follow-up. Vaping did not predict cessation of smoking among recent smokers at baseline. Among never-smokers at baseline, recent vapers were more than 4 times (RR=4.73) more likely to move away from the perception of cigarettes as posing a ‘great risk’ of harm, a finding consistent with a desensitisation process.
Conclusions: These results contribute to the growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Vaping as a risk factor for future smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes.

Authors
Richard Miech, Megan E Patrick, Patrick M O'Malley, Lloyd D Johnston

[link url="https://www.sciencedaily.com/releases/2017/02/170207191935.htm"]BMJ material[/link]
[link url="http://tobaccocontrol.bmj.com/content/early/2017/01/04/tobaccocontrol-2016-053291"]Tobacco Control abstract[/link]

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