A large portion of young people using e-cigarettes are also smoking tobacco cigarettes, a cross-sectional study from Hawaii showed, raising concerns that the rise in the popularity of “vaping” may be renormalizing cigarette smoking.
Electronic cigarettes are a rising phenomenon in the United States, with projected sales in 2013 reaching $11.7 billion, Thomas A. Willis, Ph.D., and his associates at the University of Hawaii in Honolulu wrote in Pediatrics (2014 Feb. 15 [doi:10.1542/peds.2014-0760]).
There are two schools of thought on the use of e-cigarettes in adolescents, Dr. Willis and his colleagues wrote. One suggests that youth who try e-cigarettes are motivated by health values and concerns, making it unlikely that they also would try cigarettes or other substances.
However, the contrasting model argues that e-cigarettes appeal to young people wishing to rebel against conventional values, making it likely that they also would try tobacco and alcohol. “Although both formulations are plausible, there is little empirical evidence to support or reject either theory at this time,” the study authors wrote.
Conducting a school-based survey of 1,941 high school students living in Oahu, Hawaii, who were on average 14.6 years old, the researchers sought to determine what risk factors and conversely,which protective factors lead to a higher or lower likelihood of substance use. They found that 17% of respondents used e-cigarettes only, 12% used e-cigarettes and tobacco cigarettes (dual users), 3% used cigarettes only, and 68% were nonusers. The use of e-cigarettes in the student population was higher than seen in other data, although the authors noted that young people in Hawaii are particularly exposed to aggressive marketing.
According to the authors, some support for both schools of thought can be found in their data.
For example, people who used e-cigarettes only did not score high on rebelliousness and sensation seeking, compared with dual users. This finding supports the first model by showing that people who fall into this group are less prone to deviance, the investigators said. However, consistent with the model, dual users scored higher across several risk factors and lower on protective factors, compared with the other groups. “Dual users clearly represent people who are prone to problem behavior,” they wrote. “The fact that e-cigarette–only users were intermediate in risk status [between nonusers and dual users] raises the possibility that e-cigarettes are recruiting medium-risk adolescents who otherwise would be less susceptible to tobacco product use.”
Dr. Willis and his colleagues cited two limitations: The study was cross-sectional, and it was conducted in a single geographic area. “However, our findings on the association of e-cigarette use with current smoking status are consistent with those of other studies ... and our results on demographics are consistent with these and other studies,” the investigators wrote.
Attention should be given to the prominence of e-cigarette advertising and the perceived attractiveness of e-cigarettes, they added.
The study was funded by a grant from the National Cancer Institute. The authors said they had no relevant financial conflicts to disclose.