ENDS Youth & Young Adults: Difference between revisions

=Gateway=

===2020: Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study===

In conclusion, this matched control analysis of NYTS data from 2014 to 2017 suggests that for adolescents initiation with e-cigarettes is associated with a reduced risk of subsequent cigarette smoking compared with initiators with other combustible and non-combustible tobacco products use, and propensity score matched adolescents without initial e-cigarette use. This suggests that, over the time period considered, e-cigarettes were unlikely to have acted as an important gateway towards cigarette smoking and may, in fact, have acted as a gateway away from smoking for vulnerable adolescents; this is consistent with the decrease in youth cigarette smoking prevalence over the same time period that youth e-cigarette use increased between 2014 and 2017.

===2019 The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications===

In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analyzed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking. We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking. We further found that e-cigarettes are highly effective in helping people stop smoking cigarettes.

Finally, we analyzed the impact of the sharp increase in e-cigarette use and the accelerating decline in cigarette smoking on healthcare costs and economic productivity. We found that while e-cigarette users incur lower healthcare costs than cigarette smokers or ex-smokers, the longer lifespans of e-cigarette users and ex-smokers who used e-cigarettes to quit smoking result in higher lifetime healthcare costs. However, we also found that the value of the additional years of life associated with using e-cigarettes instead of smoking is much greater than the additional healthcare costs. Lastly, we found that the increase in e-cigarette use and the associated reduction in smoking rates results in large productivity benefits, mainly from lower rates of illness.

===2015: [https://academic.oup.com/ntr/article-abstract/17/10/1255/1028251?redirectedFrom=fulltext The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes]===  

*Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333

*Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission.

=Youth Use / Risky Behaviors / ACE’s=

===2020: Up in Smoke: Exploring the Relationship between Bullying Victimization and E-Cigarette Use in Sexual Minority Youths===

Conclusions/Importance: These findings suggest that sexual minority students who report cyberbullying victimization may use cigarette and e-cigarette products more than their non-cyberbullied peers.  

===2020: Changes from 2017 to 2018 in e-cigarette use and in ever marijuana use with e-cigarettes among US adolescents: analysis of the National Youth Tobacco Survey===

Frequent and daily e-cigarette use was by far lower in never-smokers compared with ever-smokers.

===2020: 'Vaping and fidget-spinners': A qualitative, longitudinal study of e-cigarettes in adolescence===

Drivers out of vaping were changes in peer-group perceptions, diminished novelty and lack of addiction as the youth vaped non-nicotine-containing e-liquids.

In this study I have found evidence that e-cigarettes or vaping devices can represent fashionable experimentation rather than steady user patterns.  

===2019:  Epidemic of Youth Nicotine Addiction?  What does the National Youth Tobacco Survey reveal about high school e-cigarette use in the USA?===  

Shows the relation of youth usage to youth that had a previous addiction to cigarettes

Blog: The 2018 American Teen Vaping Epidemic, Recalculated  

===2016: E-Cigarette Uptake Amongst UK Youth: Experimentation, but Little or No Regular Use in Nonsmokers===  

Letter  

===2016: Survey on the use of electronic cigarettes and tobacco among children in middle and high school===  

RESULTS: Among the students, 56% had tried an electronic cigarette at least once (boys: 59.9%, girls: 49.3%; ranging from 31.3% for the 8th grade students to 66.1% for the 12th grades). However, only 3.4% reported that they used electronic cigarettes every day. Initiation of e-cigarette use in these teenagers was principally due to use by friends or triggered by curiosity and they usually choose fruit or sweet flavours initially. The majority could not give the concentration of nicotine in e-cigarettes that they used. Moreover, 61.5% of the students had ever tried tobacco and 22.3% were daily smokers. Our study found a strong link between vaping and smoking. 80% of the students who had ever tried conventional cigarettes (94% for the daily smokers) had also tried an electronic cigarette, versus 16% of the students who have never smoked. Few students (6.2%) used electronic cigarettes without smoking tobacco too. Usually, they have tried tobacco before trying an electronic cigarette. Only tobacco smokers seem to smoke electronic cigarettes with nicotine.

CONCLUSION: Although our study shows that teenagers frequently try electronic cigarettes, it does not prove, for the moment, that vaping itself usually leads to nicotine addiction. However, as most of the teenagers are unable to tell if the electronic cigarette they are testing contains nicotine, it raises the possibility that they could be vulnerable to manipulation by the tobacco industry.

===2016: Nicotine concentration of e-cigarettes used by adolescents===

Adolescents reported using nicotine-free e-liquid (28.5%), nicotine e-liquid (37.4%), or not knowing their e-liquid nicotine concentration (34.1%).  

Nicotine users comprised more smokers and heavier e-cigarette users compared to nicotine-free e-liquid users and those who did not know their nicotine concentration.  

===2015: Associations between e-cigarette access and smoking and drinking behaviours (behaviors) in teenagers===

Results: “One in five participants reported having accessed e-cigarettes (19.2%). Prevalence was highest among smokers (rising to 75.8% in those smoking >5 per day), although 15.8% of teenagers that had accessed e-cigarettes had never smoked conventional cigarettes (v.13.6% being ex-smokers). E-cigarette access was independently associated with male gender, having parents/guardians that smoke and students’ alcohol use. Compared with non-drinkers, teenagers that drank alcohol at least weekly and binge drank were more likely to have accessed e-cigarettes (adjusted odds ratio [AOR] 1.89, P < 0.001), with this association particularly strong among never-smokers (AOR 4.59, P < 0.001). Among drinkers, e-cigarette access was related to: drinking to get drunk, alcohol-related violence, consumption of spirits; self-purchase of alcohol from shops or supermarkets; and accessing alcohol by recruiting adult proxy purchasers outside shops.”

===2014: Parent, Peer, and Executive Function Relationships to Early Adolescent E-Cigarette Use: A Substance Use Pathway?===

Lifetime use prevalence was 11.0% for e-cigarettes, 6.8% for cigarettes, and 38.1% for alcohol. Free lunch and age were marginally related to e-cigarette use (p<.10). Parent e-cigarette ownership was associated with the use of all substances, while peer use was associated with gateway drug use (p’s<.05-.001). EF (Executive Function) deficits were associated with the use of all substances five times more likely than others to use e-cigarettes and over twice as likely to use gateway drugs.

E-cigarette and gateway drug use may have common underlying risk factors in early adolescence, including parent and peer modeling of substance use, as well as EF deficits. Future research is needed to examine longitudinal relationships of demographics, parent and peer modeling, and EF deficits to e-cigarette use in larger samples, trajectories of e-cigarette use compared to use of other substances, and the potential of EF skills training programs to prevent e-cigarette use.

===2013: [https://www.sciencedirect.com/science/article/abs/pii/S1054139X12004090 Adolescent Males' Awareness of and Willingness to Try Electronic Cigarettes]===

*Citation: Pepper, J. K., Reiter, P. L., McRee, A.-L., Cameron, L. D., Gilkey, M. B., & Brewer, N. T. (2013). Adolescent Males’ Awareness of and Willingness to Try Electronic Cigarettes. Journal of Adolescent Health, 52(2), 144–150. doi:10.1016/j.jadohealth.2012.09.014  

*Acknowledgement: : Support for this study was provided by the American Cancer Society (MSRG-06-259-01-CPPB), the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center (R25 CA57726), the National Institutes of Health (P50CA105632 and P30CA016058), and a NRSA in Primary Medical Care at the University of Minnesota (T32HP22239).

=Youth and Regulations=

===2020: Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”===

Teenagers under 18 could legally purchase e-cigarettes until states passed minimum legal sale age laws. These laws may have curtailed teenagers' use of e-cigarettes for smoking cessation.  

These results suggest that the laws reduced cigarette smoking cessation during pregnancy rather than causing new cigarette smoking initiation. Our results may indicate an unmet need for assistance with smoking cessation among pregnant teenagers.

===2016: Study The influence of electronic cigarette age purchasing restrictions on adolescent tobacco and marijuana use===

Conclusion: “We document a concerning trend of cigarette smoking among adolescents increasing when ENDS become more difficult to purchase.”

===2015: Study: How does electronic cigarette access affect adolescent smoking?===   

=Young Adults=

===2020: Adverse Childhood Experiences (ACE) and Health Indicators in a Young Adult, College Student Sample: Differences by Gender===

We observed graded relationships between levels of ACE exposure and physical, mental, and behavioral health indicators including cigarette use, e-cigarette use, drinking and driving, obesity, lifetime depression, suicide ideation and attempt, non-suicidal self-injury, and lack of restful sleep.

ACE-exposed females reported worse mental health status than ACE-exposed males while males reported more substance use than females. Most outcomes did not vary significantly by sex.

===2016: A Randomized Trial Comparing the Effect of Nicotine Versus Placebo Electronic Cigarettes on Smoking Reduction Among Young Adult Smokers===

Study subjects (n = 99) were young adult (21–35), current smokers

A diverse young adult sample of current everyday smokers, who were not ready to quit, was able to reduce smoking with the help of ECs.

===2015: Risky behaviors, e-cigarette use and susceptibility of use among college students===  

Conclusion: “More e-cigarette users report use of another nicotine product besides e-cigarettes as the first nicotine product used; this should be considered when examining whether e-cigarette use is related to cigarette susceptibility. Involvement in risky behaviors is related to e-cigarette use and susceptibility to e-cigarette use. Among college students, e-cigarette use is more likely to occur in those who have also used other tobacco products, marijuana, and/or alcohol.”

===2015: Changes in use of cigarettes and non-cigarette alternative products among college students===

RESULTS: The most prevalent products used by the entire sample at Wave 1 were cigarettes, followed by hookah, cigars/cigarillos/little cigars, and electronic cigarettes (e-cigarettes). At Wave 2, prevalence of e-cigarette use surpassed use of cigars/cigarillos/little cigars. Snus and chew/snuff/dip were relatively uncommon at both waves. Examination of change in use indicated that e-cigarette use increased across time among both current cigarette smokers and non-cigarette smokers. Prevalence of current e-cigarette use doubled across the 14-month period to 25% among current smokers and tripled to 3% among non-cigarette smokers. Hookah use also increased across time, but only among non-cigarette smokers, whereas it decreased among current cigarette smokers. Use of all other non-cigarette alternatives remained unchanged across time. Logistic regression analysis was used to examine the socio-demographic predictors of Wave 2 e-cigarette use, the only product that increased in use among both current cigarette smokers and non-cigarette smokers. Results indicated that Wave 1 current cigarette use and Wave 1 current e-cigarette use, but not gender, age, or race/ethnicity, were significantly associated with Wave 2 e-cigarette use.

===2015: Electronic Cigarette Trial and Use among Young Adults: Reasons for Trial and Cessation of Vaping===

Conclusion: …”We also see that about one third of former smokers and over 7% of never smokers report having tried e-cigarettes, and current use is 10% and 2% in these groups, respectively. Similar findings have led others to raise concerns that e-cigarette use is a threat to public health because it can lead to combustible tobacco use, presumably among those who otherwise would not have become smokers [2]. However, it is extremely rare for e-cigarette use to be the first exposure to nicotine in young adults. It was reported by fewer than 0.4% of the never smokers, and none of the current and former smokers. This may be a cohort effect, and e-cigarette use as the initial exposure to nicotine may become more common as younger cohorts, who are experimenting with vaping at higher and higher rates, mature [19]. Nevertheless, in this cohort, 99.6% of young adult never-smokers who tried e-cigarettes had previously used or experimented with another form of tobacco, suggesting that in these young adults tobacco is a gateway to e-cigarettes, rather than the reverse.”...

===2016 [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808446 Adolescent caffeine consumption increases adulthood anxiety-related behavior and modifies neuroendocrine signaling] and 2015 [https://pubmed.ncbi.nlm.nih.gov/24726984/ Caffeine triggers behavioral and neurochemical alterations in adolescent rats]===

===While some rodent studies suggest impaired cognitive development from nicotine administration in adolescence (2016 [https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/index.htm Surgeon General’s Report]) similar rodent studies exist for caffeine.===

* See above 2016 Adolescent caffeine consumption increases adulthood anxiety-related behavior and modifies neuroendocrine signaling and 2015 Caffeine triggers behavioral and neurochemical alterations in adolescent rats. This finds similar impairments in adolescent rats, when fed caffeine. It may well be that there is greater sensitivity in rats to stimulants, either way since no such impairments have been found in humans we must question the usefulness of the rat model. Rats are not little people!

===2015 [http://www.tweelingenregister.org/nederlands/verslaggeving/NTR-publicaties_2015/Treur_BP_2015.pdf Smoking During Adolescence as a Risk Factor for Attention Problems]===

*"Educational achievement did not differ within twin pairs discordant for smoking, in adults and adolescents." Treur et al. "Smoking during adolescence as a risk factor for attention problems." (2015) Biol. psychiatry

===2010 [https://www.gwern.net/docs/iq/2010-wennerstad.pdf Associations between IQ and cigarette smoking among Swedish male twins]===

*“The (inverse) IQ–smoking association disappeared after adjustments for shared environment and genetics.” Wennerstad, Karin Modig, et al. "Associations between IQ and cigarette smoking among Swedish male twins." Social science & medicine

===2010 [https://www.research.ed.ac.uk/portal/files/16310520/Corley_2012_Smoking_childhood_IQ_and_cognitive_function.pdf Smoking, childhood IQ and cognitive function in old age]===