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E-cigs a gateway to smoking for young: study

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The AMA’s call for a cautious, evidence-based approach to the use of e-cigarettes has been underlined by research that ‘vaping’ can lead to heavy smoking among young users.

As debate rages over the effectiveness of e-cigarettes as an aid in avoiding or giving up smoking, a study published in the Journal of the American Medical Association has cast doubt on the idea that they can divert people from the deadly habit.

The longitudinal study involving 3084 public high school students in Los Angeles County found a “positive association” between the use of e-cigarettes and subsequent smoking, particularly when those taking up the vaping habit were non-smokers.

 “In this study of adolescents,” the researchers said, “vaping more frequently was associated with a higher risk of more frequent and heavy smoking six months later.”

Furthermore, the positive association between baseline vaping and follow-up smoking frequency was stronger among baseline non-smokers than infrequent or frequent smokers, the research found.

The findings follow a United States Centers for Disease Control and Prevention investigation that found a large number of non-smoking middle and high school students had used an e-cigarette, and were twice as likely as those who hadn’t to report that they intended to start smoking tobacco cigarettes.

The findings back AMA concerns that e-cigarettes are undermining tobacco control efforts and should be subject to the same restrictions as on cigarettes, including a ban on sales to children and adolescents, and tight restrictions on their marketing and promotion.

In a Position Statement released late last year, the Association warned that many e-cigarettes were being marketed to appeal to young people, including through the use of flavourings, and voiced fears that they could act as a gateway for young people to progress to become smokers – a concern borne out by the JAMA study.

The AMA said the evidence that using e-cigarettes helped people to give up smoking was “mixed and low-level”, and the risk they posed meant governments should take a precautionary approach.

“Currently, there is no medical reason to start using an e-cigarette,” the Association said. “There are legitimate concerns that e-cigarettes normalise the act of smoking.  This has the potential to undermine the significant efforts that have been dedicated to reducing the appeal of cigarettes to children, young people and the wider population.

“In fact, using an e-cigarette may significantly delay the decision to quit smoking,” the AMA warned, adding that the longer-term health implications of inhaling e-cigarette vapours produced by illegally imported and unregulated solutions were unclear.

The best approach, it said, was restrict their promotion and ban sales to young people until further evidence as to their safety and efficacy was available.

The AMA’s Position Statement, Tobacco Smoking and E-Cigarettes – 2015, can be downloaded at: position-statement/tobacco-smoking-and-e-cigarettes-2015

Adrian Rollins