A recent study concludes that teen e-cigarette use leads to nicotine addiction and then cigarette smoking.
This finding is a concern because it goes against CDC data, which has instead found that as teenagers have experimented with e-cigarettes in the last few years actual smoking rates have plummeted to the lowest levels ever recorded.
The issue may be a flaw in understanding correlation and epidemiology. In a longitudinal cohort study, 694 young people (ages 16 to 26) were surveyed, and then re-surveyed a year later. Sixteen participants used e-cigarettes.On follow-up, 11 of those 16 had progressed to real cigarettes, so the authors concluded that e-cigarettes led to 68 percent of users smoking. However, 16 young people -- youth is an experimental time -- are not a valid data set, and what is more of a concern is that 128 of 678 of those who had never used e-cigarettes took up smoking.
So while the data continues to be accrued on e-cigarettes, what should be alarming to us all is that 10 times as many young people who have never used e-cigarettes took up the noxious combustible time proved to be a killer.
Yet instead of noting the obvious, an editorial by Dr. Jonathan Klein makes much out of the 1.5% who went from e-cigarettes to smoking while dismissing the 18% who just took up smoking without having a "gateway" to blame. Dr. Klein concedes that e-cigarettes have far fewer toxins than smoking (95% less) but then invokes animal fetuses to suggest harm anyway. From a public health point of view, e-cigarettes are relatively new so the long-term data are not available yet, and we have advocated for getting rid of aldehydes in vapor altogether, because they have some risk. But to claim that anyone who used an e-cigarette, and then took so much as a puff of a cigarette within the next year (the survey had no way to know how much "use" there was) makes e-cigarettes a cause of smoking, seems like too much of a stretch. What is known is that e-cigarettes are a valid smoking cessation device, and they should be in the tool chest for cessation and harm reduction, along with gums and patches and whatever else works.
Everyone knows smoking cigarettes is bad by now. For everyone except the truly addicted, to smoke vs. not to smoke is something of an IQ test, really. But not all youngsters are dumb, some are downright creative - because they have figured out how to use vaping devices for marijuana.