Cassandra A. Stanton, PhD, on the Transition Between Vaping and Cigarettes in Teens
Over the past few years, e-cigarette use has grown in the United States, and is a potentially dangerous trend among US adolescents. Vapor flavorings like gummy bear and cotton candy have often attracted adolescents to try e-cigarettes, exposing them to nicotine and other toxic chemicals in the process.
Amid increasing evidence that e-cigarette use may later lead to traditional cigarette use, new research suggests the relationship between these products may actually be bidirectional. In an analysis of data on 11,996 youth participants from the Population Assessment of Tobacco and Health (PATH) Study, researchers found that ever-use of e-cigarettes predicted future cigarette use, and that subsequent cigarette smoking uptake or reduction is also likely affected by the frequency of e-cigarette use.
Consultant360 spoke with lead study author Cassandra A. Stanton, PhD, about these findings and their implications for future tobacco prevention efforts among youth.
Cassandra A. Stanton, PhD, is a Senior Epidemiologist in the Behavioral Health and Health Policy Practice at Westat in Rockville, Maryland.
Consultant360: Could you discuss the significance of the potentially bidirectional patterns of traditional cigarette and e-cigarette use among youth observed in your study?
Dr Stanton: In a study of US youth aged 12 to 17 years, unadjusted findings showed that ever e-cigarette use at baseline (wave 1) was associated with subsequent new cigarette smoking 1 year later (wave 2). The study also found the converse relationship to be true: that wave 1, ever-cigarette use was similarly likely to be associated with wave 2, ever-e-cigarette use 1 year later. In other words, if adolescents start using one of these tobacco products, they are about 4 times more likely to use the other product 1 year later.
This finding is important because it highlights the strong connection between the use of different tobacco products and the need for targeted communication to encourage youth to avoid all tobacco products.
C360: Ample evidence and reports have surfaced saying individuals who smoke traditional cigarettes often transition to e-cigarettes as a means of cessation. Is this practice common among adolescents, and has this practice had the intended effect?
Dr Stanton: In this 2013-2015 study of US youth, we did not specifically examine cessation of any tobacco products, but we did observe new ever-cigarette smoking among adolescents who had used e-cigarettes 1 year earlier. In addition, although our study did not specifically examine the effects of e-cigarette use on tobacco cessation, it did find that the frequency of e-cigarette use made a difference in the number of days adolescents smoked cigarettes a year later.
Among youth who smoked cigarettes at the baseline wave, those who simultaneously used e-cigarettes for 1 to 5 days out of the previous 30 days were more likely to smoke fewer cigarettes a year later compared with adolescents who did not use e-cigarettes within the previous 30 days at baseline. However, youth who had smoked cigarettes and used e-cigarettes for more than 6 days out of the previous 30 days at baseline did not show a change in frequency of cigarettes smoked 1 year later. These results are difficult to interpret, and it should be noted that the number of youth in this age range who used e-cigarettes for at least 6 days within the previous 30 days was low. It is also important to remember that ever-use of e-cigarettes at the baseline wave was associated with subsequent ever-cigarette smoking 1 year later.
C360: How have devices like JUUL affected cigarette/e-cigarette use among youth, especially with products and flavorings like gummy bear flavoring that seem somewhat targeted towards youth?
Dr Stanton: Although this analysis did not specifically examine electronic device type or flavors that youth have been using, previous analyses of the PATH Study found that flavor was a primary reason among youth for using any given tobacco product. It has also been reported that the prevalence of current tobacco use is 13% higher among adolescents whose first tobacco product was flavored.
C360: In your view, how might the findings from your study affect clinical practice?
Dr Stanton: This study showed important associations between e-cigarette use and cigarette smoking among US adolescents and suggests that health care professionals should assess the use of both cigarettes and e-cigarettes in these patients. Early tobacco prevention efforts for youth should target all tobacco products.
—Christina Vogt
Reference:
Stanton CA, Bansal-Travers M, Johnson AL, et al. Longitudinal e-cigarette and cigarette use among US youth in the PATH Study (2013-2015) [Published online January 25, 2019]. J Natl Cancer Inst. doi:10.1093/jnci/djz006.