Knowns and Unknowns about e-Cigarettes and Teens

 Photo ©istock/ kitiara65

The recent Monitoring the Future survey of students’ drug use and attitudes revealed that adolescents have taken to e-cigarettes in a big way. When asked in early 2014, 17.1 percent of high school seniors and 16.2 percent of 10th graders reported using e-cigarettes in the previous month (see infographic, bottom). We are still wrestling with whether or not e-cigarettes pose a danger, but their popularity among youth combined with society’s past experiences with tobacco and other addictive substances demands that we urge caution around these products.

E-cigarettes are being aggressively marketed as glamorous devices that empower users—such as by giving them the freedom to “vape” in public places where cigarette smoking is banned or taboo. And even though sellers are often careful not to make explicit health claims, another part of the “freedom” being sold is, implicitly, the freedom to enjoy the smoking experience without fear of long-term health consequences such as death from cancer or heart disease.

Those who know the history of cigarette marketing in America will experience a sense of déjà vu. Freedom was the concept used in the 1920s and 1930s to market cigarettes to women, a vast then-untapped market for what had previously been only a male pleasure. Cigarette smoking was sold to women as an image to help them feel liberated and empowered.

Although the vapor produced by e-cigarettes contains no tar—the main cause of lung cancer—it may contain other potentially harmful chemicals. There are currently no regulatory controls over these products, most are made in China, and testing of some products’ vapor has shown toxic metals, possibly produced by the vaporizing mechanism itself. And that is to say nothing of the risks of nicotine exposure. Whether or not e-cigarettes turn out to have fewer physical health harms than traditional cigarettes, it is still ridiculous to describe any product containing an addictive substance as “freeing.”

E-cigarette fluids vary widely in their nicotine concentrations, and the amount a user is exposed to probably depends on a range of factors (like how many puffs they take, how deeply they inhale, and how long they hold it), but there is clearly a potential for these products to promote addiction—especially when users start in their teens. Recent research in rodents suggests nicotine may even promote addictive behavior by altering gene expression: A 2011 study by Eric R. Kandel and colleagues at Columbia University found that nicotine exposure increased mice’s sensitivity to cocaine’s rewarding effects via an epigenetic pathway; if the same holds true in humans, nicotine could serve as a gateway to abuse of other substances.

Apart from the possible dangers of nicotine, e-cigarette use is normalizing and even glamorizing smoking behavior, which had been successfully stigmatized through public-health campaigns of the past decades. The MTF survey found that many kids who are using e-cigarettes are also smoking traditional cigarettes. It would be tragic if e-cigarettes re-opened the door to teen tobacco use, which has been slowly but surely declining since the late 1990s.

As scientists, we should be cautious and not sound alarm bells prematurely. It will be good if future research shows e-cigarettes are indeed helpful aids for smokers who have trouble quitting otherwise. But if vaping is hooking new users on nicotine—young people and those of any age who had never smoked before—then that could pose a serious problem. We should not allow e-cigarettes, with their promised “freedoms,” to rewind public health to the 1920s.

Past month use, 8th grade – Cigarettes: 4.0%, e-Cigarettes: 8.7%; 10th grade – Cigarettes: 7.2%, e-Cigarettes: 16.2%; 12th grade – Cigarettes: 13.6%, e-Cigarettes: 17.1% (Only 14.2% of 12th graders view e-cigarette use as harmful, which is less than 5 students in the average class)