Flavored e-cigarette use associated with higher smoking risks in youth

1. In a nationally representative study of in-school youth, use of flavored e-cigarettes was associated with higher odds of intention to start cigarette smoking among never-smoking youth, and lower odds of intending to quit among current-smoking youth, compared to those who did not use e-cigarettes in the past month.

2. Among all responders, those using flavored e-cigarettes had lower perception of tobacco-associated danger than those not using e-cigarettes.

Study Rundown: While the number of young people using traditional cigarettes has decreased significantly in recent years, e-cigarette use in the United States has increased dramatically to over 3 million in 2015. E-cigarettes are available in a multitude of youth-appealing flavors (e.g., candy and fruit flavors), leading to the concern that these flavors may increase the use of e-cigarettes and normalize smoking behaviors in this population. This study addresses knowledge gaps regarding the effect of flavored e-cigarette use on youth smoking behavior. A nationally-representative survey database was used to explore both e-cigarette and traditional cigarette use and smoking attitudes among middle and high school students. Among never-smokers, the use of flavored e-cigarettes was associated with higher intention to initiate cigarette smoking, compared to those not using e-cigarettes in the past month. Those who used flavored e-cigarettes were the least likely to perceive tobacco’s danger, compared to unflavored e-cigarette users, and non-users. Current smokers who also used flavored e-cigarettes were less likely to intend on quitting tobacco compared to non-users. Non-flavored e-cigarette use among current smokers was not significantly associated with decreased likelihood of intending to quit smoking. This study highlights the need for policy to reflect the increased danger of flavored e-cigarettes, specifically by considering limitations on availability or access of flavored e-cigarettes to young people. While the study highlights important distinctions, it is limited by sampling bias of in-school children.

Click to read the study published today in Pediatrics

Relevant Reading: Preferred flavors and reasons for e-cigarette use and discontinued use among never, current, and former smokers

Study Author, Dr. Hongying Dai, PhD, talks to 2 Minute Medicine: Division of Health Services and Outcomes Research, Children’s Mercy Hospital, and Departments of Biomedical and Health Informatics and Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri

“Flavored e-cigarettes are not prohibited in the United States and e-cigarette flavors proliferate on the market. This study sought to examine flavored e-cigarette use and its association with smoking among youth. Due to a proliferation of e-cigarette flavors on the market, flavored e-cigarette use among youth in the US has increased significantly. The majority of youth who have ever used e-cigarettes started with a flavored product. Flavored e-cigarette use among youth might serve as a gateway for future smoking and was associated with decreased odds of quitting smoking. Flavored e-cigarette use was also associated with decreased perception of tobacco’s danger among youth.

We found that compared with not using e-cigarettes in the past 30 days, flavored e-cigarette use was associated with higher odds of intention to initiate cigarette use among never-smoking youth, lower odds of intention to quit tobacco use among current-smoking youth, and a lower prevalence of perception of tobacco’s danger among users of flavored e-cigarettes. Comprehensive tobacco control and prevention strategies that address flavored e-cigarette products are critically needed to reduce tobacco use among youth. This study is based on the 2014 National Youth Tobacco Survey [NYTS], a cross-sectional and school-based survey that supports estimation of the tobacco-related knowledge, attitudes, and behaviors of students in middle school (grades 6–8) and high school (grades 9–12) from all 50 states and the District of Columbia. The NYTS uses a nationally representative sample. Weighted estimate has been applied for sampling weight and the complex survey design.”

In-Depth [cross-sectional study]: This study included 21 491 6-12th graders participating in the 2014 National Youth Tobacco Survey. Students were asked how often they used e-cigarettes and tobacco products, as well as what kinds, and their intention to take up or quit traditional smoking. Among those reporting use of e-cigarettes, 60.9% used flavored e-cigarettes, and 68.4% of current smokers used flavored e-cigarettes. The prevalence of intention to initiate cigarette smoking was significantly higher among non-smokers using flavored e-cigarettes compared with non-users (58.3% vs 20.1%). Flavored e-cigarette users among smokers were the least likely to intend to quit compared with non-flavored users and non-users (24.1% vs 33.5% and 32.7%, respectively). Using flavored e-cigarettes was associated with greater odds of initiating cigarette use, compared to both no e-cigarette use (aOR 5.7, p < .0001) and non-flavored e-cigarette use (aOR 1.7, p = .02). Use of flavored e-cigarettes among current smokers was associated with lower odds of intention to quit tobacco use, compared to those not using e-cigarettes (aOR 0.6; p = .006). Finally, those who reported using flavored e-cigarettes had lower odds of perceiving the danger of tobacco, compared to non-users (aOR 0.5, p < .0001). In addition, boys had lower prevalence of perceiving tobacco’s danger compared to girls (aOR 0.9, p = .01), as well as former and current smokers (aOR 0.4, p < .0001 and aOR 0.3, p < .0001, respectively).

Image: CC/Wiki/LindsayFox

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