In a recent report on the use of tobacco and related products among high-school students, the CDC announced that students’ current (past-month) e-cigarette use increased from 1.5 percent to 13.4 percent between 2011 and 2014. That so many teens are using e-cigarettes is surprising, but it fits with the high levels of use we saw in last year’s Monitoring the Future (MTF) survey, released in December, which found that 17.1 percent of high school seniors and 16.2 percent of tenth graders were current e-cigarette users. The appeal of these new products to youth is thus no longer a matter of uncertainty: They are a major new drug trend.
The possibility that e-cigarettes could help wean smokers off of traditional cigarettes has been part of these devices’ appeal. But the MTF data also showed that many young users of these products were not previously cigarette smokers, indicating that we can set aside the notion that these devices are solely being used as aids to help smokers quit—at least in young people. This was also shown in a recent British study in BMC Public Health: Nearly one in five teens surveyed in North-West England in early 2013 had accessed (tried or purchased) these products, and of those, almost 16 percent had never smoked cigarettes. This suggests teens view e-cigarettes as a new experience to enjoy or experiment with, not a replacement or substitution for cigarettes. It may also be, for many kids, part of a larger pattern of risky behavior and drug use. In the British study, access to e-cigarettes was associated with other substance-related behaviors including binge drinking and drinking to get drunk.
There remains much debate over the harms of e-cigarettes. Even if they are not being used as quit aids, some people claim that the health risks are minor, given that e-cigarette aerosol (vapor) lacks the known carcinogenic combustion products of cigarette smoke (e.g., tar). But we still do not know enough about what harms there may be in e-cigarette aerosol, either from chemicals used in the flavorings or from residues produced by the vaporization mechanism itself.
More importantly, there is good reason to believe the nicotine in many e-cigarette liquids can have an adverse effect on the developing brain. For example, University of Wisconsin-Madison researchers found that, when administered to adolescent rats, nicotine upregulates the arc gene involved in synaptic plasticity in the forebrain, suggesting that nicotine exposure has enhanced ability to modify crucial aspects of brain development during this critical window of maturation. The planned Adolescent Brain and Cognitive Development study (ABCD) will be able to study this question in much greater detail in humans, of course, as well as examine the neurodevelopmental impact of other substances in isolation or in combination with nicotine.
There is no question that nicotine is a highly addictive substance. Research in animals shows it is especially rewarding during adolescence and even suggests it can act as a gateway to other substance use. For instance, at Columbia, Eric Kandel and his colleagues found that nicotine increases sensitivity to cocaine’s rewarding effects, via an epigenetic pathway. Thus, even if nicotine by itself does not cause the devastating physical health effects associated with cigarette smoke, such as lung cancer, e-cigarettes that deliver nicotine are likely to contribute to the disease of addiction. Because e-cigarette products have the potential to re-glamorize smoking-type behavior, there is cause to worry that these devices could act as gateways to regular cigarettes for some teens who would not otherwise have taken up smoking. This would be particularly unfortunate given the great advances made in reducing youth smoking since the late 1990s; smoking-reduction and prevention efforts have succeeded in part by stigmatizing the behavior.
As I wrote recently on my blog, the aggressive advertising of e-cigarettes as devices to restore former or would-be smokers’ “freedom” alarmingly calls to mind the marketing of cigarettes to women a century ago. In fact, there is nothing empowering or “freeing” about addiction to nicotine, nor anything glamorous in the brain’s dependency on powerfully rewarding chemicals. Thus, it is important that we apply lessons learned from the long effort to reduce teen cigarette smoking and do everything possible to prevent the marketing of e-cigarettes to youth.