Kids who use ecigs to quit quit less

The discussion of whether or not e-cigarettes help smokers quit has been focused on adults. All the discussion of e-cigarettes and kids has focused on the massive success of e-cigarettes in expanding the nicotine epidemic by attracting kids. There has also been some focus on the well-documented “gateway effect” in which kids who start nicotine with e-cigarettes go on to cigarettes. People haven’t paid much attention to the effect that e-cigarettes have on youth cigarette cessation.

But kids hear the e-cigarette advocates’ (and the FDA’s) claims that e-cigarettes are a way to quit cigarettes and some try.

I used 7 years of the CDC’s National Youth Tobacco Surveys to look at how successful kids were at using e-cigarettes to stop smoking among kids who specifically reported using e-cigarettes to stop using other tobacco products.

Kids who specifically used e-cigarettes to quit had significantly lower odds of having stopped smoking cigarettes (odds ratio, 0.62; 95% confidence interval, 0.45–0.85), controlling for nicotine dependence and demographics compared to kids who used e-cigarettes for other reasons or not at all. In other words, e-cigarettes kept kids smoking cigarettes.

(And, yes, I focused on kids who started the e-cigs after cigarettes.)

In addition, the results were stable over the 7 years that I studied, showing that changes to the e-cigarettes didn’t make a detectable difference.

Thus, it is not only misleading adults to suggest that e-cigarettes as consumer products are a way to quit smoking, but it is even more harmful for kids who are trying to quit cigarettes.

My new paper “e-Cigarettes Used by Adolescents to Try to Quit Smoking Are Associated With Less Quitting: A Cross-Sectional Analysis of the National Youth Tobacco Survey” published in Journal of Adolescent Health is a companion paper to “Nicotine addiction and intensity of e-cigarette use by adolescents in the US, 2014-2021” that also used the NYTS and showed that And since Juul pioneered protonated nicotine, kids were getting addicted to nicotine faster and using e-cigs more heavily.

These two papers add to the scientific evidence that e-cigarettes are even worse for kids than we thought. It is time for FDA to stop suggesting that e-cigarettes are a way to quit smoking on the fantasy that they somehow reduce harm for adults.

Instead, public health education programs should tell people, “Don’t use e-cigarettes to try and quit smoking; they make it harder to become smokefree.

Here is the abstract:

Purpose: This paper determines the association between youth e-cigarette use “to try to quit using other tobacco products, such as cigarettes” and having stopped smoking cigarettes (defined as an ever cigarette smoker who did not smoke in the past 30 days).

Methods: This study uses data from the NYTS from 2015 through 2021, focusing on youth who started smoking cigarettes before they started using e-cigarettes. Associations between using e-cigarettes to quit and having stopped smoking were computed using logistic regression accounting for the complex survey design and adjusting for level of nicotine dependence, year, age, gender, and race/ethnicity. Sensitivity analyses allowed for having started cigarettes and e-cigarettes in the same year and without regard for starting sequence.

Results: The primary analytic subsample included 6435 United States middle and high school students (mean age 15.9 years, 55.4% male). Using e-cigarettes to quit was associated with significantly lower odds of having stopped smoking cigarettes (odds ratio, 0.62; 95% confidence interval, 0.45–0.85), controlling for nicotine dependence and demographics. Youth with higher levels of nicotine dependence also had lower odds of having stopped smoking. The results were stable over time. Sensitivity analyses produced similar results.

Discussion: Ever-smoking youth who used e-cigarettes “to try to quit using other tobacco products, such as cigarettes” had lower odds of having stopped smoking cigarettes than those who did not use e-cigarettes as to try to quit. Physicians, regulators, and educators should discourage youth from attempting to use e-cigarettes as a way to stop smoking cigarettes.

Implications and Contribution: In an analysis of 7 years of national data, youth using e-cigarettes to quit other tobacco products was associated with significantly lower odds of having stopped smoking cigarettes, controlling for nicotine dependence and demographics. Adolescents should be discouraged from using e-cigarettes to try to quit other tobacco products.

The full citation is: Glantz SA. e-Cigarettes Used by Adolescents to Try to Quit Smoking Are Associated With Less Quitting: A Cross-Sectional Analysis of the National Youth Tobacco Survey. Journal of Adolescent Health 2022; https://doi.org/10.1016/j.jadohealth.2022.10.011. It is available here.

Published by Stanton Glantz

Stanton Glantz is a retired Professor of Medicine who served on the University of California San Francisco faculty for 45 years. He conducts research on tobacco and cannabis control and cardiovascular disease/

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