Researchers claim electronic cigarettes "gateway" to real smoking but experts unsure

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A new study may confirm some fears health officials had about electronic cigarettes. Researchers found teens who use e-cigarettes may be more likely to become addicted to actual cigarettes, doctors at the University of California San Francisco reported on March 6 in JAMA Pediatrics.

"E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco," Dr. Lauren M. Dutra, a postdoctoral scholar at UCSF School of Medicine, said in a university press release.

But, the study did not definitively prove that young e-cigarette smokers turned to tobacco after smoking the products, since it examined two large data pools of teens in 2011 and 2012 rather than tracking the same people for two years. Some experts have questioned the conclusions drawn by researchers.

Part of the findings suggest kids who used the products also experimented with conventional cigarettes and weren't any more likely to quit using them, as some proponents had suggested.

E-cigarettes are metallic tubes that allow liquid nicotine to be converted into an inhalable vapor without the use of combustion. The battery-powered devices look like pens or cigarettes, and can come in flavors including strawberry, licorice and chocolate.

Sales were estimated to reach over $1 billion in 2013.

Researchers looked at survey data collected from more than 17,000 middle and high school students in 2011 and more than 22,500 in 2012.

In 2011, 3.1 percent of adolescents said they tried an e-cig once and 1.1 percent were current users. By 2012, 6.5 percent of adolescents had tried the products and 2 percent were current users.

Ever using and current use of e-cigarettes increased odds of experimenting with conventional cigarettes, smoking at least 100 cigarettes (ever smoking), or smoking at least 100 cigarettes and smoking within the past 30 days (current smoking). Teens who smoked both conventional cigarettes and e-cigarettes smoked more cigarettes per day than non-e-cigarette users, they also found.

Teens who used e-cigarettes and conventional cigarettes were much less likely to have abstained from cigarettes in the past 30 days, 6 months or the last year, despite some proponents claiming it could be used to help people quit smoking, Dutra added.

"Our results suggest that e-cigarettes are not discouraging use of conventional cigarettes," she said.

Product users however were more likely to say they planned to quit smoking real cigarettes in the next year compared to smokers who did not also use e-cigs.

Previously, the Centers of Disease Control and Prevention had reported upticks in the number of adolescents and adults using electronic cigarettes in recent years. Nationally, cigarette-smoking rates have fallen in adults.

"This rapid rise has stimulated a vigorous debate in the tobacco control community over the potential public health impact of (e-cigarettes) and about how best to regulate them," wrote Dr. Frank J. Chaloupka, a professor of economics who directs the Health Policy Center at the University of Illinois at Chicago in an editorial published in the same issue.

The article highlights some of the concerns about the public health harms, he added, noting the doubling of ever use of e-cigarettes among teens between 2011 and 2012, and the reduced likelihood to stop smoking conventional cigarettes among the experimenters.

"While much remains to be learned about the public health benefits and/or consequences of (e-cigarettes) use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly," he wrote.

The Food and Drug Administration does not currently regulate e-cigarettes unless they claim health benefits, such as getting people to quit smoking.The FDA has previously announced intentions to tighten regulation of the products.

However, some experts questioned the conclusion drawn by the authors that e-cigs could be a gateway to smoking the real thing.

"The data in this study do not allow many of the broad conclusions that it draws," Thomas J. Glynn, a researcher at the American Cancer Society, told The New York Times.

"The authors seem to have an axe to grind," Dr. Michael Siegal, a professor of community health sciences at Boston University School of Public Health who has previously spoken in favor of e-cigarettes, told Reuters. "I could equally argue that what this study shows is that people who are heavy smokers are attracted to e-cigarettes because they are looking to quit."


Last September, 40 state attorneys general asked the federal government to tighten regulation, charging e-cigarettes are marketed to young people through its fruit and candy flavors and cartoon-like advertising.

New York City, Chicago and Los Angeles have banned e-cigarette uses in some public places, putting them in the same category of other tobacco products.



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