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E-Cigarettes – a Wolf in Sheep’s Clothing

Those who know me well will know that ‘vaping’, or the smoking of e-cigarettes, is one of my bête noir’s. I make no excuse for taking the stance that I do against it. Of course, I acknowledge that the use of e-cigarettes is a potentially safer alternative to smoking, but we must remember that it is not safe! I find it concerning when I see some in the medical profession advocating its use - and of course, there are many within the profession who don’t and hold similar views to my own.

To reinforce the somewhat insidious nature of vaping, it now appears that vaping is potentially a gateway drug to cigarettes for teenagers. It has been known for years that just as many teens as ever have, despite health education, been taking up smoking, with an increasing number starting to vape. Social pressure and looking cool are just some of the potential reasons why they do it - not forgetting the rebellion factor either (we all remember what it was like to be a teenager…).

Following a survey carried out in South Carolina of around 300 high school eleventh and twelfth graders who had never smoked tobacco, it was found that half of them had used e-cigarettes. For those of us who don’t understand the American educational system, these are teenagers with an average age of 17. At the start of the study a questionnaire was filled out that was designed to evaluate whether the teens had ever smoked tobacco or used e-cigarettes.

The researchers restricted their analyses to those who had never smoked cigarettes.

They also assessed for susceptibility to smoke cigarettes, which was defined as the "absence of a firm commitment not to smoke". When questioned about intention to smoke in the future, students who answered "definitely not" were considered "not susceptible".

The researchers also looked at the social acceptability of smoking within the teenagers' social environment and took sociodemographic factors into consideration too.

The researchers then invited the e-cigarette users and the non-e-cigarette users to complete a follow-up questionnaire 16 months later, matching by gender, ethnicity, and grade. In the final count, the study presented findings from 152 non-e-cigarette users and 146 e-cigarette users.

What they found was interesting and potentially disturbing. They reported that e-cigarette users were 6.17 times more likely to start smoking cigarettes than those who never smoked e-cigarettes. They also noted that around 10 percent of those who never smoked were found to have started smoking cigarettes too. It was also found that e-cigarette users were more likely to start using any combustible product, such as hookahs, cigars and pipes.

The researchers concluded that e-cigarette use in teenagers who never smoked may increase the risk of them subsequently starting smoking cigarettes and other combustible products.

And finally, I want to mention another disturbing trend, one that is not mentioned in the report, but one that I have been made aware of. And that is that e-cigarettes themselves are now being used to smoke recreational drugs. Canabinoid extracts and designer highs have all found favour in the underground e-cigarette market. What the implications are of this for the health of users remains to be seen.

For those who want to read the original research:

Barrington-Trimis, J. L., Urman, R., Berhane, K., Unger, J. B., Cruz, T. B., Pentz, M. A., Samet JM, Leventhal AM & McConnell, R. (2016). E-Cigarettes and Future Cigarette Use. Pediatrics, 138(1), e20160379.

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