Monday, June 5, 2023
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
Irvine, California
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The goal of this activity is for learners to be better able to evaluate the relationship between e-cigarette use during adolescence and later established cigarette smoking.
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Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
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Health Sciences Clinical Professor of Family Medicine
University of California, Irvine School of Medicine
Irvine, California
This activity has been peer reviewed and the reviewer has no relevant financial relationships.
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CME / ABIM MOC / CE Released: 5/5/2023
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The use of electronic cigarettes (e-cigarettes) continues to be a major public health concern among adolescents, and a study by Cooper and colleagues evaluated the epidemiology of e-cigarette use in this age group in 2022. Their study evaluated data from the National Youth Tobacco Survey, and it was published in the October 7, 2022 issue of Morbidity and Mortality Weekly Report.[1]
A total of 14.1% of high school students and 3.3% of middle school students reported current e-cigarette use. This represented a decrease after peak use of e-cigarettes by adolescents in 2019; 27.6% of e-cigarette users reported daily use of e-cigarettes. Disposable e-cigarettes remained the most popular device, and there were a wider variety of e-cigarette brands used than in previous years. More than three-quarters (84.9%) of e-cigarette users bought flavored products.
One of the principal concerns regarding e-cigarette use is the potential transition to traditional cigarettes. The current study by Sun and colleagues examines the prevalence of this transition and chronic cigarette use.
Rachel Boykan, MD, clinical professor of pediatrics and attending physician at Stony Brook Children's Hospital, in Stony Brook, New York, said that despite the findings, the overall messaging to patients remains the same: Vaping is linked to smoking.
"There is still a risk of initiation smoking among e-cigarette users -- that is the take-home message," Boykan, who was not affiliated with the study, said. "No risk of smoking initiation is acceptable. And of course, as we are learning, there are significant health risks with e-cigarette use alone."
Among the entire group of teens, approximately 4% of the adolescents began smoking cigarettes; only 2.5% continued to smoke in the subsequent 3 years, the researchers found.
"Based on our odds ratio result, e-cigarette users are more likely to report continued cigarette smoking," said Sun. "However, the risk differences were not significant."
The low numbers of teens who continued to smoke also suggests that adolescents are more likely to quit than become long-term smokers.
Nicotine dependence may adversely affect the ability of adolescents to learn, remember, and maintain attention. Early research[2] has suggested that long-term e-cigarette smokers may be at increased risk of developing some of the same conditions as tobacco smokers, such as chronic lung disease.
Brian Jenssen, MD, a pediatrician at Children's Hospital of Philadelphia and assistant professor in the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, said that the analysis is limited in part because it does not include changes in smoking and vaping trends since the pandemic started, "which seems to have increased the risk of smoking and vaping use."
Data from the 2022 National Youth Tobacco survey[3] found that although the rate of middle school and high school students who begin to use e-cigarettes has steadily decreased during the past 2 decades, students who vape report using the devices more frequently.
Subsequent use of cigarettes is also only one measure of risk from vapes.
"The goal isn't just about cigarettes," said Jenssen, who was not affiliated with the new study. "The goal is about helping children live tobacco- and nicotine-free lives, and there seems to be an increasing intensity of use, which is causing its own health risks."
The current study findings do not change how clinicians should counsel their patients, and they should continue to advise teens to abstain from vaping, he added.
Sun said it's common for youths to experiment with multiple tobacco products.
"Clinicians should continue to monitor youth tobacco-use behaviors, but with their concern being focused on youthful patients who sustain smoking instead of just trying cigarettes," she said
Some of the study authors received support from the National Cancer Institute of the National Institutes of Health and the FDA's Center for Tobacco Products.
