1. Among adolescents, the prevalence of electronic cigarette (e-cigarette) use was 17% and the prevalence of dual cigarette and e-cigarette use was 12%. Both groups perceived e-cigarettes as a healthier alternative to regular cigarettes.
2. E-cigarette only users had higher social cognitive and problem behavior risk factors associated with smoking compared to non-users, but lower risk factors compared to dual users.
Evidence Rating Level: 2 (Good)
Study Rundown: Since emerging in the U.S. market, e-cigarettes have enjoyed increasing popularity with ever-use rates among adults climbing from <1% in 2009 to 7% in 2010. There are concerns that e-cigarettes may lead to renormalization of cigarette smoking and increased use among adolescents. Two models of teen e-cigarette use have emerged. One describes teens’ use of e-cigarettes as motivated by health concerns and suggests that teens normally at low risk for smoking conventional cigarettes might turn to e-cigarettes as an alternative. The other model suggests that e-cigarettes provide another form of rebellion among pleasure-seeking, at-risk teens. This study tested the two competing models and found that overall, e-cigarette only users had intermediate-level risk factors predisposing to cigarette, alcohol, and marijuana use. That is, e-cigarette only users were at higher risk compared to non-users. but at lower risk compared to dual cigarette and e-cigarette users. Unlike non-users, e-cigarette only and dual users considered e-cigarettes healthier than conventional cigarettes. Although this study raises an important question about whether low-risk youth are being recruited to tobacco use, its generalizability is limited by an ethnically and geographically distinct and isolated sample. These findings suggest a need to broaden prevention and education policies to include moderately at-risk adolescents.
Relevant Reading: E-cigarettes: a scientific review
Study Author, Dr. Thomas A. Wills, PhD, talks to 2 Minute Medicine: Professor and Interim Director, Cancer Prevention and Control Program, University of Hawaii Cancer Center.
“First, there has been an explosion of e-cigarette use among adolescents, with rates of use doubling or tripling every year; this phenomenon is occurring all over the US but its consequences for adolescents’ health are not known and research in this area should be a high priority. Second, there is a debate going on in the public health community, with some researchers viewing e-cigarettes as likely to replace tobacco and hence be good for public health, but research is beginning to show that there may be risks to e-cigarette use by adolescents, so physicians should keep themselves up to date on research in this area.”
In-Depth [cross sectional study]: This study recruited 1941 students from 5 high schools in Hawaii, with a mean age of 14.6 years. Twenty-one percent were Asian American, 17% Caucasian, 32% Filipino, 20% Native Hawaiian/other Pacific Islander and 10% other. Participants were administered a survey assessing demographics, outcome, and predictor variables. Ninety-six percent of participants were aware of e-cigarettes, 17% exclusively used e-cigarettes, and 12% used both e-cigarettes and conventional cigarettes (dual use). Sixty-seven percent of participants considered e-cigarettes healthier than conventional cigarettes Predictor variables included social cognitive risk factors (e.g. emotional and behavioral dysregulation), problem behavior factors (e.g. rebelliousness and sensation seeking), as well as protective factors (e.g. self-control, and parental support). All but 1 assessed risk factor correlated significantly (P<.001) with cigarette, alcohol, and marijuana use. The dual use group had significantly higher risk factors and lower protective factors compared to the e-cigarette only group. Dual users were significantly more likely to use alcohol and marijuana than the e-cigarette group.
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