Are Hollywood starlets glamorizing smoking by using e-cigarettes?

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Article Highlights

  • The electronic cigarette also had its close-up at the recent Golden Globe Awards

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  • What do we know about the notion that e-cigarettes will serve a "gateway" function to smoking itself?

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  • The rate of youth smoking continues to decline.

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At the recent Golden Globe Awards, the Hollywood glitterati were not the only ones under the hot lights. The electronic cigarette, battery-operated devices that release water vapor and nicotine, also had its close-up as several stars were seen puffing away. Some U.S. Senators were not amused.

In a letter to Hollywood Foreign Press Association and NBCUniversal, which broadcasts the Golden Globes, Senators Edward J. Markey, Richard Blumenthal, Sherrod Brown and Richard J. Durbin, expressed concern that e-cigarettes will “glamorize smoking” and urged them not to allow e-cigarette use to appear at future shows.

“Unfortunately,” the senators wrote, “many young viewers saw notable displays of e-cigarette use throughout the awards show, including the opening monologue and repeated shots of celebrities smoking e-cigarettes.” The worry, of course, is that young people will be inspired by celebrities to do the same. The hard won gains in reducing teen smoking to its current low of 18 percent would soon go up in smoke.

Separately, Henry Waxman and Frank A. Pallone wrote to NBC: “The popularity of e-cigarettes has increased rapidly among adolescents.  This trend is particularly alarming since youth e-cigarette use serves as a gateway to a lifetime of nicotine addiction…”

To be sure, the fact that electronic cigarettes release nicotine is a good reason that their sales and marketing to minors should be banned, as cities such as New York and Chicago have done.  Presumably, the Food and Drug Administration will soon issue regulations that, at the very least, restrict advertising and sales to minors.

But the more worrisome aspect of youth “vaping,” as the use of electronic cigarettes is called, is that young people will move on to conventional smoking.  Indeed, the prospect of a “gateway” phenomenon has sparked so much anxiety among public health advocates that they are pressing for aggressive constraints on marketing to committed adult smokers too.

This would be a classic instance of tossing the vaping baby out with the smoky bath water.   After all, inveterate smokers could benefit enormously from switching to the electronic version because e-cigarettes don’t burn tobacco to release tar – thus, they do not cause smoking-related lung cancer, or respiratory or cardiovascular disease.

Some evidence regarding the relationship between youth smoking and vaping e-cigarettes should add perspective as localities, and soon the FDA, formulate regulations on these smokeless devices.

So what do we know about youth use of e-cigarettes and the notion that these new devices will serve a “gateway” function to smoking itself?

According to a 2012 report from the Centers for Disease Control (relying upon the National Youth Tobacco Survey) the use of e-cigarettes among those in high school more than doubled, from 1.5 percent in 2011 to 2.8 percent in 2012.  More precisely, these percentages refer to teens who tried an e-cigarette (as little as a single puff) within thirty days of answering the survey.

What’s more, among all middle and high school e-cigarette users, the vast majority were not naive to tobacco products.  In all, 89.2 percent also used other forms of tobacco: over three fourths smoked traditional cigarettes and the rest used chewing tobacco, cigars, pipes, hookah, snus, or dissolvable tobacco.

This leaves only 11 percent of e-cigarette trying youth who were completely new to tobacco products (note:  the nicotine delivered through electronic cigarettes is derived from tobacco).

Note, too, that the rate of youth smoking (defined by the CDC as “ever tried” within the past month) continues to decline. In 2011, the last year for which there were data, 18.1% had tried a cigarette within the last month. Combined with trends in e-cigarette experimentation/use, these data suggest that electronic cigarettes may even be aiding teens in reducing smoking. At the very least, it shows no correlation between increased exposure to vaping and increased rates of smoking – which is the pattern you’d expect if electronic cigarettes were serving a gateway function.

Another survey from the University of Oklahoma Health Sciences Center confirms these findings. Of 1,300 college students only 43 said their first nicotine product was an e-cigarette. Only one of them went on to initiate regular smoking. “It didn’t seem as though it really proved to be a gateway to anything,” said the study director Theodore Wagener, who presented his findings at a meeting of the American Association for Cancer Research last September.

Based on these data, Brad Rodu, Professor of Medicine at the University of Louisville, concludes that worries about e-cigarette use as a stepping stone to smoking is overblown. “Federal authorities should restrict youth access to all tobacco products,” he says, “but it is unacceptable for them to characterize e-cigarettes as gateway products when they are, in fact, helping to eliminate the smoking plague.”

Electronic cigarettes are relatively new so continued observation of how many young people take up vaping and smoking is important.  It is also important to keep in mind that even if e-cigarette users progress to smoking, we will never know whether these kids would have eventually smoked cigarettes anyway. After all, it makes sense that people dabble in less risky activities before they upgrade. That is just the nature of behavioral progression.

In the end, if youth smoking goes up as a direct result of e-cigarette popularity, then we have a problem.  But the existing data should allay fears that this is happening now.  My guess is the numbers of adult and youthful smokers switching to electronic cigarettes would dwarf the volume of young vapers who go on to become committed smokers. 

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