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The future of electronic cigarette growth depends on youth uptake

Simon Chapman
Med J Aust 2015; 202 (9): 467-468. || doi: 10.5694/mja15.00304

Simon Chapman discusses the phenomenon of “e-cigarettes” and the potential risks associated with their use

The New South Wales Government recently announced that it will outlaw the sale of electronic cigarettes (ECs) to minors. For the unfamiliar, ECs are battery-powered vaporisers that produce an aerosol or vapour containing nicotine and other substances, rather than cigarette smoke, which the user inhales. Parallel laws banning sales of tobacco products to children have existed in Australian states since 1900.1 These laws have long been ignored by many retailers2 and are poorly enforced. Prosecutions are rare, with the laws being largely symbolic gestures.

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  • Simon Chapman

  • University of Sydney, Sydney, NSW.


Competing interests:

No relevant disclosures.

  • 1. Tyrrell I. Deadly enemies. Tobacco and its opponents in Australia. Sydney: UNSW Press, 1999.
  • 2. Tofler A, Chapman S. “Some convincing arguments to pass back to nervous customers”: the role of the tobacco retailer in the Australian tobacco industry's smoker reassurance campaign 1950-1978. Tob Control 2003; 12 Suppl 3: iii7-iii12.
  • 3. Hung S. Smoking and health meeting. Philip Morris. [Memo of meeting minutes, dated 14 Feb 1973.] http://legacy.library.ucsf.edu/tid/owq24e00 (accessed Apr 2015).
  • 4. Australian Institute of Health and Welfare. National Drugs Strategy Household Surveys (NDSHS). Highlights from the 2013 survey. Canberra: AIHW, 2014. http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/ (accessed Apr 2015).
  • 5. Chapman S. E-cigarettes: the best and the worst case scenarios for public health — an essay by Simon Chapman. BMJ 2014; 349: g5512.
  • 6. Australian Institute of Health and Welfare. Online tables. Table 3.10. In: National Drug Strategy Household Survey. Detailed report: 2013. Canberra: AIHW, 2014. http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs-2013/tables/ (accessed Apr 2015).
  • 7. University of Michigan. E-cigarettes surpass tobacco cigarettes among teens [media release]. Michigan News 16 Dec 2014. http://www.monitoringthefuture.org/pressreleases/14cigpr_complete.pdf (accessed Apr 2015).
  • 8. Action on Smoking and Health. Young people and smoking. Fact sheet. London: ASH, Jul 2014. http://www.ash.org.uk/files/documents/ASH_108.pdf (accessed Apr 2015).
  • 9. US Centers for Disease Control and Prevention. Cigarette smoking among US high school students at lowest level in 22 years [media release]. 12 Jun 2014. http://www.cdc.gov/media/releases/2014/p0612-YRBS.html (accessed Apr 2015).
  • 10. Scollo M, Winstanley M. Prevalence of smoking — secondary students. In: Tobacco in Australia: Facts and issues. 4th ed. Melbourne: Cancer Council Victoria, 2012. http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-secondary-students (accessed Apr 2015).
  • 11. Goniewicz ML, Gawron M, Nadolska J, et al. Rise in electronic cigarette use among adolescents in Poland. J Adolesc Health 2014; 55: 713-715.
  • 12. Grana RA, Ling PM. “Smoking revolution”: a content analysis of electronic cigarette retail websites. Am J Prev Med 2014; 46: 395-403.
  • 13. Zhu SH, Sun JY, Bonnevie E, et al. Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Tob Control 2014; 23 Suppl 3: iii3-iii9.
  • 14. Glantz S; University of California, San Francisco: Center for Tobacco Control Research and Education. Lorillard admits flavored e-cigarettes attract youth; FDA should prohibit flavors as part of the current rulemaking. 31 May 2014. http://www.tobacco.ucsf.edu/lorillard-admits-flavored-e-cigarettes-attract-youth-fda-should-prohibit-flavors-part-current-rulema (accessed Apr 2015).
  • 15. Flavor and Extract Manufacturers Association of the United States. The safety assessment and regulatory authority to use flavors — focus on e-cigarettes. Revised. Washington, DC: FEMA, 3 Mar 2015. http://tobacco.ucsf.edu/sites/tobacco.ucsf.edu/files/u9/FEMAGRAS Ecig 030315.pdf (accessed Apr 2015).
  • 16. Etter JF, Bullen C. A longitudinal study of electronic cigarette users. Addict Behav 2014; 39: 491-494.
  • 17. Tverdal A, Bjartveit K. Health consequences of reduced daily cigarette consumption. Tob Control 2006; 15: 472-480.
  • 18. Hart C, Gruer L, Bauld L. Does smoking reduction in midlife reduce mortality risk? Results of 2 long-term prospective cohort studies of men and women in Scotland. Am J Epidemiol 2013; 178: 770-779.
  • 19. Song YM, Sung J, Cho HJ. Reduction and cessation of cigarette smoking and risk of cancer: a cohort study of Korean men. J Clin Oncol 2008; 26: 5101-5106.
  • 20. Grana R, Benowitz N, Glantz SA. E-cigarettes: a scientific review. Circulation 2014; 129: 1972-1986.
  • 21. Pisinger C, Dossing M. A systematic review of health effects of electronic cigarettes. Prev Med 2014; 69: 248-260.
  • 22. Grando SA. Connections of nicotine to cancer. Nat Rev Cancer 2014; 14: 419-429.
  • 23. Straif K, Loomis D, Guyton K, et al. Future priorities for the IARC Monographs. Lancet Oncol 2014; 15: 683-684.

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access_time 03:08, 18 May 2015
Attila Danko

Simon Chapman cites a cross sectional study from Poland as evidence for electronic cigarettes having a harmful effect on youth smoking rates. Without going into the flaws of this study I would think that the much more comprehensive and repeated data we have on youth EC and smoking rates in the UK and the US with more similar culture, smoking rates and tobacco controls have more relevance to Australia than an isolated Polish study.

Given that 30-day prevalence data will capture a large amount of youth experimentation (a youth who has one puff on an EC or cigarette in the last 30 days is counted as a smoker or vaper) we need to look at daily smoking data to get a good idea about how the increased use of EC's is affecting smoking prevalence.

This is seldom measured compared to monthly prevalence but when it is the results call into question Australia's place as a world leader in reducing tobacco use in youth.

AIHW data shows that daily smoking rates amongst youth aged 12-17 have stubbornly refused to go down for the last 6 years. In contrast, data from some US jurisdictions show a continued decline over the same period to the point where daily smoking rates in youth are now below Australia's.

A recent study on high school students in Hawaii (mean age 14.6) showed that although past 30-day EC use was measured at 29%, in Table 2 of this study (1) it showed that daily use of EC's was at the same level as daily use of marijuana at 2% and daily cigarette smoking rates were below 1%. This is perhaps another type of “canary in the coalmine” showing that high levels of EC experimentation, which may or may not have been with nicotine, (the question was not asked), is perhaps a powerful diversion from cigarette experimentation that does not lead to sustained use and is certainly worthy of more study with an open mind.

1. Wills TA, Knight R, Williams RJ, et al. Risk Factors for Exclusive E-Cigarette Use and Dual E-Cigarette Use and Tobacco Use in Adolescents. Pediatrics. doi:10.1542/peds.2014-0760



Competing Interests: No relevant disclosures

Dr Attila Danko
None

access_time 12:51, 1 June 2015
Simon Chapman

Atilla Danko refers to selected AIHW data (1) in writing that “daily smoking rates amongst youth aged 12-17 have stubbornly refused to go down for the last 6 years” in Australia.

Danko selects the years 2007 to 2013 where daily rates changed from 3.2% to 3.4%, a tiny (0.2%) increase and a small relative increase of 6.25% in 12-17 year olds. But had he selected 2004-2013, the change was from 5.2% to 3.4%, a relative decline of 34.6%. The declines in daily smoking in the next 18-24 age group were equally dramatic: from 20.2% in 2004 to 13.4% in 2013 (a relative decline of a third).

Parallel data from the Australian National Drug Strategy surveys of secondary school students (2) include measures of smoking in the past week. In 1999, 30% of Australian 16-17 year olds smoked in the past week, and 15% of 12-15 years olds. By 2011, this had fallen to 13% and 4% respectively.

Against this spectacular success, e-cigarette advocates would have us believe that the benefits of unleashing their products on the youth market would be a “powerful diversion” from smoking, rather than a means of re-socialising the richly semiotic smoking performance among a generation rapidly abandoning it, and exposing the teenage brain to worrying neurobiological effects (3) and everything the commercial e-cigarette industry can do to ensure many years of lucrative addiction.

Two studies of teenagers from the USA and England show that non-trivial proportions of those vaping have never smoked tobacco products. In the USA, “A fifth of senior high school [students who had vaped in the past month] and nearly a third of tenth graders using e-cigarettes had no lifetime cigarette or smokeless tobacco use” (4) and in England 15.8% had never smoked cigarettes (5). In the USA today, more teenagers have vaped in the last month than smoked (6). Most teenagers who vape are vaping as well as smoking, not instead of it, a fact that would delight the tobacco transnationals who have all invested in this important key to their future.

References.

1. AIHW. National Drug Strategy Household Survey detailed report: 2013 25 Nov 2014 updated: 12 Feb 2015 Table 3.4: Tobacco smoking status, people aged 12 years or older, by age, 2001 to 2013 (per cent) http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548784

2. Tobacco in Australia: Facts and Issues. 2015. Figure 1.6.1 http://www.tobaccoinaustralia.org.au/chapter-1-prevalence/1-6-prevalence-of-smoking-secondary-students#x15.

3. Schochet TL, Kelley AE, Landry CF. Differential expression of arc mRNA and other plasticity-related genes induced by nicotine in adolescent rat forebrain. Neuroscience 2005; 135(1):285-97.

4. Compton W. E-cigarettes and teens: how concerned should we be? BMC Series Blog 31 Mar 2015 http://blogs.biomedcentral.com/bmcseriesblog/2015/03/31/e-cigarettes-teens/?utm_campaign=BMC18155B7&utm_medium=BMCemail&utm_source=Teradata
5. Hughes K, Bellis MA, Hardcastle KA, McHale P, Bennett A, Ireland R, Pike K. Associations between e-cigarette access and smoking and drinking behaviours in teenagers. BMC Public Health 2015; 15:244 doi:10.1186/s12889-015-1618-4 http://www.biomedcentral.com/1471-2458/15/244
6. Michigan News. University of Michigan. E-cigarettes surpass tobacco cigarettes among teens Dec 16, 2014
http://monitoringthefuture.org/pressreleases/14cigpr.pdf

Competing Interests: No relevant disclosures

Prof Simon Chapman
School of Public Health, University of Sydney

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