New US research has found that vaping e-cigarettes with higher concentrations of nicotine may increase how often teenagers use them and make them more likely to also start smoking traditional cigarettes.
Carried out by Keck School of Medicine of USC, the study is the first to look at a potential association between nicotine concentration in e-cigarettes and future smoking and vaping behavior in young people.
The team surveyed 181 students at 10 high schools in Los Angeles on their vaping and smoking habits, collecting the initial set of data in the 10th grade and carrying out follow-up surveys six months later when the students had moved into the 11th grade.
Nicotine concentration of e-cigarettes were defined in the survey as none, low (1-5 mg/mL), medium (6-17mg/mL) and high (18 or more mg/mL).
The responses showed that 43 percent of students who used high-nicotine e-cigarettes at the start of the study were found to be "frequent smokers" at the follow-up six months later, meaning they smoked traditional cigarettes at least three times in the past month.
In contrast, only 10 percent of those who used low-strength e-cigarettes (1-5mg/mL of nicotine) and 6 percent of those who used nicotine-free e-cigarettes were frequent smokers at the follow-up.
Those who vaped high-nicotine e-cigarettes also smoked more cigarettes per day compared to those who vaped nicotine-free e-cigarettes.
"We know that smoking is one of the most dangerous things that you can do for your health, especially if you begin during adolescence," said Adam Leventhal, director of the USC Health, Emotion and Addiction Laboratory at the Keck School of Medicine. "Because nicotine has mood-elevating and addictive effects, teens who use e-cigarettes with stronger nicotine concentrations may be less willing to stop vaping and be more inclined to use other nicotine products, like conventional cigarettes."
The results are also worrying as nicotine is highly addictive and may harm the developing teenage brain by increasing the risk of attention problems and depression warned Leventhal.
Previous research by Keck School of Medicine has also found that teens who were unlikely to have smoked traditional cigarettes if e-cigarettes didn't exist are now vaping, and that teens who vape are at higher risk of going on to smoke tobacco cigarettes.
Leventhal now believes the studies raise concern whether e-cigarettes may actually be slowing the decline of tobacco use.
"It's feasible that youths who vape go on to smoke conventional cigarettes because they get used to the act of inhaling something and the sensation they get in their lungs even if they vape nicotine-free e-cigarettes," explains Leventhal, "This study suggests that nicotine may be integral to transitioning from vaping to smoking in teens."
Further research is now needed with a larger sample size to confirm the results, which can be found published online in JAMA Pediatrics.
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