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Teens more likely to start smoking after using e-cigarettes, study finds

Teenagers who try e-cigarettes are more likely to start smoking cigarettes, according to a new study.

Teenagers who had tried e-cigarettes were more likely to have started using cigarettes a year later, and this was still the case when the results were controlled for various other predictors of smoking.

The prospective study, led by a team of UK researchers, looked at data from just over 2,800 13 and 14 year olds. The teenagers were asked about their e-cigarette and cigarette use, their socioeconomic background, their beliefs about smoking and whether they had friends and family who smoked.

In those who had tried e-cigarettes but not cigarettes at the beginning of the study, 34% said that they had tried cigarettes when they were followed up 12 months later, compared with 9% in those who had not tried e-cigarettes at baseline.

When controlling for other influential factors, such as having friends and family members who smoked, teenagers who used e-cigarettes were still four times as likely as non-users to start smoking cigarettes.

The team cautioned that their study lacked clarity regarding the mechanism by which e-cigarette use predisposed teenagers to cigarette use.

They said in the paper: ‘It is… plausible that the use of e-cigarettes might lead to initiation and escalation in cigarette use by normalising any kind of nicotine use, by developing nicotine addiction (if the e-cigarettes contain nicotine) or by developing friendship networks with smokers and decreasing the perceived risks of smoking.’

They also said that the research highlights the need for tight regulation of the e-cigarette market.

They wrote: ‘We acknowledge that since our survey, UK legislation has been put in place, including bans on marketing and selling e-cigarettes to minors.

‘Nevertheless, our findings emphasise the value of regulating the marketing and sale of e-cigarettes to minors in countries without such measures, particularly given that e-cigarette advertising has been shown to reduce perceived harm of occasional smoking.’

The findings come as more and more research suggests that e-cigarettes are an important tool in helping smokers to quit successfully.

BMJ 2017; available online 17th August


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