Researchers from the University of Hawaii found that high school students who used e-cigarettes but not tobacco had, on the whole, nevertheless been exposed to higher risk factors for tobacco use than those who neither smoked nor vaped.
Their findings will be controversial, but will undoubtedly be presented by proponents of e-cigs as suggesting that – far from acting as a “gateway” into tobacco – vaping has actually provided an alternative to tobacco use for these children.
In other words, the implication of the vapers’ higher exposure to risk factors for tobacco use may be that, had e-cigarettes not existed or been unavailable, they would indeed have taken up tobacco. But instead, they opted for e-cigs.
Rebels or explorers?
The researchers wanted to explore whether teenagers aged roughly 13-15 (in grades 9 and 10) using e-cigarettes were motivated more by curiosity and exploration, or by rebellion through engagement in “problem behaviour” and affiliation with substance-using peers.
They found evidence supporting both models and – as is so often the case with e-cigarettes – have advised that more research is done before reaching definitive conclusions.
Their study, published in the journal Pediatrics, employed a different methodology from many other examinations of youth e-cigarette and conventional tobacco use.
Instead of asking the 1941 students surveyed in five high schools whether they ever had tried a product or whether they had used one in the past 30 days, two typical questions from e-cigarette usage surveys, the study asked them to place themselves on a range of use from “never” to “frequent”.
The researchers also analysed students on a range of demographic and psychosocial questions to assess risk factors for tobacco use.
The study found that, in almost all cases, those young people who only vaped e-cigs and didn’t smoke tobacco fell into an intermediate group between non-users on one side, and smokers and dual users only on the other.
“The e-cigarette only group was higher on risk status compared with non-users, but in almost all contrasts it was significantly lower than the dual-use group. Thus it represented an intermediate risk status,” the researchers wrote.
For example, the e-cigarette-only group had significantly lower levels of parental support and monitoring, academic involvement and grades, and behavioural and emotional self-control when compared to non-users. But the cigarette-only group was even lower on parental support and monitoring.
This – and the fact that 67% of those surveyed believe e-cigarettes could be a healthier alternative to conventional tobacco – may suggest that some could be using e-cigarettes as an alternative to tobacco.
It could also mean that e-cigarette usage among youth is, like smoking, driven more by an inclination toward rebellion and problem behaviour than simple exploration – a theory which would undermine the proposition that e-cigs act as a “gateway” into nicotine, and thereby tobacco, for young people who would not otherwise have sampled it.
The dark side
However, critics of e-cigarettes have used the same data to draw the opposite conclusion. Indeed, the University of Hawaii Cancer Center’s own press release announcing the findings said the study “raises a question about whether e-cigarettes are recruiting low-risk youth (who would otherwise not try smoking) to tobacco product use”.
The authors of the study say further research is needed, as their findings may be limited by geography, and by being “cross-sectional”, or conducted at only one point in time.
A geographical anomaly may be suggested by the discovery that e-cigarette use among youth is higher on the Hawaiian islands than other national U.S. studies have reported. “A possible reason for the higher rate is that cigarettes are highly taxed in Hawaii, so alternatives may be more attractive economically,” the study said.
The researchers would also like to see further research into dual use examining the same individuals over a period of time, known as a longitudinal study, to determine whether e-cigarettes do promote smoking, or whether dual users may be trying to use them to quit conventional tobacco.
“The fact that adolescents in the dual-use group had high rates of other substance use (e.g. alcohol and marijuana) and problem behaviour variables (e.g. sensation-seeking and rebelliousness) suggests that they may have difficulty quitting the use of cigarettes and other substances,” the study added.
What This Means: The study provides a fascinating glimpse into factors behind youth use of e-cigarettes and conventional tobacco, and it is to be hoped that more researchers will continue this work.
Again, however, here is a case of a reasonable, thoughtful and cautious study being undermined by its own institution’s press office seeking an attention-grabbing headline.
Most coverage of the research focused on Hawaiian teens being heavier users of e-cigarettes than their counterparts in the mainland U.S. But this was a minor point in a much larger picture (and many of the figures quoted in news articles come from a misreading of the data presented).
– Freddie Dawson ECigIntelligence staff