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More than one-third of teens and young adults who tried the battery-powered devices wound up smoking tobacco within one year, even though they had said they would never be interested in smoking, according to the results of a nationwide survey.
The results line up with a study released in August, in which Los Angeles-area teens were three to four times more likely to try smoking after they'd experimented with an e-cigarette, said Dr. James Sargent, senior author of the current study. Sargent is a professor of pediatrics and community & family medicine at Dartmouth University's Geisel School of Medicine in Hanover, N.H.
"The real concern is that if it does indeed move these adolescents in the direction of smoking cigarettes, it's going to turn around the two-decade-long decline in teen smoking that we've seen," Sargent said. "The government needs to get off the pot on this. They need to act."
The survey involved a national sample of nearly 700 teens and young adults, aged 16 to 26. Participants filled out a baseline survey and a follow-up survey one year later.
All participants were considered "non-susceptible" to becoming smokers because they had responded "definitely no" when asked if they would try a cigarette offered by a friend or if they would smoke a cigarette within the next year.
The first set of surveys took place in 2012 and 2013, before e-cigarette use boomed among teenagers, Sargent said. E-cigarette use among high schoolers tripled between 2013 and 2014, leaping from 4.5 percent to 13.4 percent, according to the U.S. Centers for Disease Control and Prevention.
As a result, only 16 of the 694 participants had tried an e-cigarette at the time of the first survey.
Gregory Conley, president of the American Vaping Association, a nonprofit group dedicated to education about e-cigarettes and vapor products, scoffed at the notion of basing any findings on such a small national sample.
But lead author Dr. Brian Primack said that findings were statistically significant, even after controlling for other risk factors for smoking.
By the next year, 38 percent of the baseline e-cigarette users had started smoking traditional tobacco cigarettes.
"It clearly raises concern about the effect of e-cigarettes as a gateway for youth and young adults to transition into traditional cigarettes," said Cliff Douglas, director of the American Cancer Society Tobacco Control Center. "It's one more bit of evidence in emerging data in this area. It's not conclusive, but it certainly is cautionary, and points toward the need for an effective regulatory structure in this country for these new products."
E-cigarettes help prepare young people to start smoking by providing a training-wheels version of the habit, Sargent said.
"They're practicing all of the parts of the behavior except lighting up that they would need to use a cigarette," he said.
E-cigarette users are also being exposed to nicotine, just at lower levels than with regular cigarettes. As young people become more heavily addicted, they are likely to turn to tobacco, said Primack, an associate professor of medicine and pediatrics at the University of Pittsburgh School of Medicine.
"When they need a higher dose of nicotine or a faster rush, then they transition to traditional cigarettes," he said.
The authors urged the U.S. Food and Drug Administration to regulate the e-cigarette industry. At this time, there is no regulation of e-cigarettes, although the FDA has issued proposed rules that would grant it that authority.
But Conley said that teen tobacco smoking rates have continued to decline, and argued that e-cigarettes will help keep people from smoking.
"No one should be surprised to find an association between e-cigarette experimentation and smoking experimentation," Conley said. "It makes sense that youth who are willing to try a vapor product will be more willing to try a cigarette than someone who will not try vaping."
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