High-schoolers who smoke e-cigarettes with high nicotine levels are more likely to smoke the same devices long term and have a higher chance of starting to smoke cigarettes-
By Laura Kelly | October 23rd, 2017
researchers concluded in a study published Monday in the Journal of the American Medical Association Pediatrics.
The new findings come as the Food and Drug Administration is evaluating implementing a standard level of nicotine in cigarettes, one that is shown to keep people from becoming addicted to smoking, especially young people, of which around 2,500 youth smoke their first cigarette each year.
“Unless we change course, 5.6 million young people alive today will die prematurely later in life from tobacco use,” FDA Commissioner Scott Gottlieb said in July when the initiative was announced.
The new study, led by University of Southern California researcher Adam Leventhal, explored how differing levels of nicotine in e-cigarettes and vaping devices, where a liquid containing nicotine is heated and the vapor inhaled, affect adolescents and their propensity to increase their vaping or move to smoking combustible cigarettes.
“Our study raises an important issue regarding how policymakers may regulate nicotine in e-cigarettes,” Mr. Leventhal, the director of the USC Health, Emotion and Addiction Laboratory at the Keck School of Medicine, wrote in an email to The Washington Times.
“On one hand, adult smokers who switch to a less harmful nicotine product may experience significant health benefits. On the other hand, our study indicates that teens who vape more nicotine may be at greater risk for critical adverse health effects like becoming a more frequent smoker of conventional cigarettes and becoming a regular user of e-cigarettes,” he wrote.
A typical cigarette has about 15.8 mg of nicotine per one gram of tobacco. E-cigarettes and popular electronic nicotine delivery systems (ENDS), however, can have varying levels of nicotine, that range from none to 18 mg.
In the study, researchers surveyed 181 high-school 10th graders across Los Angeles who reported smoking e-cigarettes. The nicotine concentration in their used products was recorded as a baseline and a six-month follow-up assessed whether they continued vaping, had increased nicotine levels in their vaping juice and if they smoked combustible cigarettes.
Nicotine concentration levels were assessed as none (0 mg/mL); low (1-5 mg/ML); medium (6-17 mg/mL); and high (greater than 18 mg/mL). Participants also answered questions on the number of days within the past month they smoked cigarettes and vaped, and the frequency with which they smoked cigarettes.
The demographics of the sample size were evenly distributed between boys and girls who were majority Hispanic with parents that had not graduated college, the researchers wrote.
The researchers said their sample size, although small, had a high rate of retention and a detailed assessment of smoking and vaping intensity.
The USC researchers found that, in the followup, teenagers who used e-cigarettes with higher concentration levels of nicotine were more likely to report an increased frequency of vaping and greater levels of smoking cigarettes.
“Use of electronic cigarettes with higher nicotine concentrations may contribute to the progression to smoking and vaping at higher levels of frequency and intensity among youths,” the authors wrote in their conclusion.
However, the researchers point out that other limitations of their study include that the data was self-reported and not objectively verified.
“The observational period in this study captures an important, but brief, window in adolescent development, and extension to longer periods of follow-up is warranted,” the authors wrote, adding that further research with a larger sample size can better determine how nicotine concentrations influence youth smoking.
There is little definitive research on the health effects of e-cigarette use among adults and even less on teenagers, just as their use is becoming increasingly popular among youth, Mr. Leventha wrote.
“Because nicotine may harm the developing adolescent brain and increases risk of attention problems and depression, continuous exposure to nicotine, even through e-cigarettes, is a concern,” he said. “While some previous research reported that most adolescents were using nicotine-free e-cigarettes, results from our survey and other soon-to-be-published studies show that many more teens are vaping e-cigarettes with nicotine than we originally thought.”
In an accompanying “patient page” in JAMA Pediatrics, Dr. Megan Moreno, the pediatric program director of the University of Washington Department of Pediatrics, advises parents to be aware of campaigns targeting youth with e-cigarettes, particularly as the “vape juice” is developed in flavors such as “bubble gum” and “peach,” she pointed out.
She advised parents to talk to their children about the dangers of vaping, including the risk of carcinogens from the nicotine-filled liquid; the addictive properties of nicotine; the unknown effects of “vape smoke” and its potential to harm an adolescent’s developing brain and lungs.