Researchers have today (20 August) shown there is strong evidence that e-cigarette use may act as a gateway to cigarette smoking and other health issues in future for young people.
While previous studies have shown links between e-cigarette use and asthma, coughing and airway irritation, a new review has revealed a consistent link between e-cigarette use and later cigarette smoking, as well as potential links between vaping and a range of health issues, including mental health concerns and drug use.
Researchers from the University of York and the London School of Hygiene and Tropical Medicine (LSHTM) argue that more research is needed to determine whether there is a direct cause and effect, but the consistency of the findings between the studies conducted so far provide a strong case for precautionary policies, such as restricting youth access to e-cigarettes and strengthening public education efforts.
Su Golder, Associate Professor in Health Science at the University of York (right), said: “Our previous reviews have shown that commonly used marketing strategies for e-cigarettes on social media networks resulted in more young people vaping, and this new review looks at what happens when vaping is a regular practice.
“The consistency in the evidence is striking. Across multiple studies, young people who use e-cigarettes are more likely to smoke in the future. These findings support stronger public health measures to protect teens from the risks associated with vaping.”
“Across multiple studies, young people who use e-cigarettes are more likely to smoke in the future…”
Researchers not only showed an increased smoking risk, but that young people who once vaped, may go on to smoke more frequently and intensely. The review also found that vaping in young people often is followed by alcohol and marijuana use.
The new research is to be published in the journal Tobacco Control.
A number of studies showed links between e-cigarette use and asthma, coughing and airway irritation, and experts highlighted that the associated risk of depression and suicidal thoughts in teens needed more research to better inform on the mental health risks of vaping.
Many young people report signs of nicotine dependence, including cravings and difficulty quitting, but despite concerns about nicotine’s effects on the adolescent brain, very few reviews have examined this issue.
Dr Greg Hartwell, Clinical Assistant Professor at LSHTM (left), said: “Our review provides the most comprehensive picture to date on the range of risks vaping poses to young people. In particular, we found consistent evidence around transitions to smoking which of course, in turn, opens the door to the multitude of harms that conventional cigarettes bring.”
Researchers are also calling for urgent, longitudinal research into e-cigarettes and areas such as brain development, cardiovascular impacts, oral health, and dual use of e-cigarettes and tobacco.
In a response, Jamie Strachan (below left), operations director at vape distributors VPZ, said: “Protecting young people from access to vaping products has always been, and continues to be, a top priority for us.
“Vaping is intended solely for existing adult smokers as a less harmful alternative to combustible tobacco. It should never be marketed to, sold to, or used by children and non-smokers.
“VPZ supports strict regulation that prevents under-18s from obtaining vaping products. We’ve long operated under a Challenge 25 policy in all our stores, require valid photographic ID and have consistently called for stronger enforcement against irresponsible retailers who sell to minors.”
Strachan added that while the report raised significant issues, they shouldn’t be confused with the broader benefits vaping can offer public health. “While the review highlights concern about young people experimenting with e-cigarettes, it’s equally important to separate this from the wider role vaping plays in harm reduction.
“In the UK alone, vaping has been shown by independent bodies such as Public Health England and the NHS to be significantly less harmful than smoking and the most effective tool available to help adults quit cigarettes.
“We echo the call for robust enforcement to ensure that all retailers uphold the law. There must be a clear distinction between legitimate, regulated businesses who support smoking cessation, and those who act irresponsibly by targeting underage customers.”
Not all groups concerned with vaping were as convinced by the study, however. Mark Oates, founder of campaign group We Vape, said: “This study, as the researchers admit, shows no causal link between youth vaping - which is already prohibited - and risky adult behaviours.
“Kids should never vape. But vaping is proven far less harmful than smoking and has helped millions of UK smokers quit. That’s why the NHS distributed a million devices through the Swap to Stop scheme.
“Fear-mongering about this vital, life-saving harm reduction tool is irresponsible and undermines efforts to end smoking. We urge everyone to research the facts, and call on the Government to launch mass awareness campaigns to counter misinformation.
”Currently, 57% of smokers in England wrongly believe vaping is as harmful or worse than smoking, when vaping is a far safer way to consume nicotine. This has to change if we are serious about making the UK smoke free and saving lives.”
We Vape said it took issue with the methodology of the study, citing the low number of case studies (56) and reliability of many of these. It also quoted Prof Kevin McConway, Emeritus Professor of Applied Statistics at The Open University, who said: “A major issue, and one that the researchers acknowledge, is that it’s pretty well impossible to conclude that the associations between vaping and various health and behavioural outcomes are causal.
“We don’t know whether those outcomes are actually caused by the vaping because the original studies are observational. There will be other differences between the young people who vape, and the young people who do not. And those other differences could be the cause of bad outcomes that are correlated with vaping, and not the vaping itself.”
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