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ENDS Youth & Young Adults: Difference between revisions

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=Addiction / Dependence= <!--T:3-->
=Addiction / Dependence=  


===Please see this page for addiction/dependence information===
*[https://safernicotine.wiki/mediawiki/index.php/Nicotine_-_Addiction/Dependence Nicotine - Addiction/Dependence]


=Marketing/Advertising/Packaging=


===2021: [https://onlinelibrary.wiley.com/doi/10.1111/add.15403 Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use]=== <!--T:4-->
===2024: [https://www.tandfonline.com/doi/full/10.1080/10826084.2024.2374973 Associations Between Noticing E-Cigarette Advertising Features and E-Cigarette Appeal and Switching Interest Among Young Adult Dual Users]===
*Results: "Noticing fruit flavors (AOR = 1.67 and 1.28) and fruit images (AOR = 1.53 and 1.21) was positively associated with having any e-cigarette product appeal and switching interest. Noticing price promotions (AOR = 1.23) was positively associated with product appeal. In contrast, noticing nicotine warnings (AOR = 0.74 and 0.86), smoker-targeted claims (AOR = 0.78 and 0.89), and tobacco flavors (AOR = 0.92 and 0.90) was negatively associated with product appeal and switching interest."


<!--T:5-->
=Flavors=
*Use of e-cigarettes increased dramatically, use of cigarettes declined, and use of combustible (non-cigarette) and smokeless tobacco was relatively stable. Whether the overall increase in product use has been mirrored by an increase in nicotine dependence was unclear.
*We found that different tobacco products were associated with differing levels of nicotine dependence, with cigarettes characterised by highest dependence and e-cigarettes in otherwise tobacco-naïve students by low dependence.
[[File:Youth_Dependence.jpg|Youth Dependence on Nicotine Products]]
*The increase in population use of tobacco products between 2012 and 2019 (from 23.2% to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence (craving: 10.9% to 9.5%; wanting to use within 30min: 4.7% to 5.4%).
*Among US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e‐cigarettes (on which users are least dependent).
*PDF version behind a paywall
*Citation: Jackson, S. E., Brown, J., and Jarvis, M. J. (2021) Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use. Addiction, https://doi.org/10.1111/add.15403.


===Please see this page for flavor (flavour) information===
*[https://safernicotine.wiki/mediawiki/index.php/ENDS_Flavors ENDS Flavors]


=Gateway= <!--T:6-->
=Gateway= <!--T:6-->


 
===Please see this page for gateway information:===
 
*[https://safernicotine.wiki/mediawiki/index.php/Myth:_Alternative_nicotine_products_are_a_gateway_to_smoking Myth: Alternative nicotine products are a gateway to smoking]
===2021: [https://academic.oup.com/ntr/advance-article-abstract/doi/10.1093/ntr/ntab102/6276227 High School Seniors Who Used E-Cigarettes May Have Otherwise Been Cigarette Smokers: Evidence From Monitoring the Future (United States, 2009–2018)]=== <!--T:7-->
 
<!--T:8-->
*
 
 
 
===2021: [https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003555 Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study]=== <!--T:9-->
 
<!--T:10-->
*
 
 
 
===2021: [https://pubmed.ncbi.nlm.nih.gov/33394529/ Trends in electronic cigarette use and conventional smoking: quantifying a possible 'diversion' effect among US adolescents]=== <!--T:11-->
 
<!--T:12-->
*
 
 
 
===2021: [https://tobaccocontrol.bmj.com/content/30/2/212 Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study]=== <!--T:13-->
 
<!--T:14-->
*
 
 
 
===2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: [https://www.clivebates.com/documents/NLFlavoursResponseJan2021.pdf Regulation of e-cigarette flavours – a response]=== <!--T:15-->
 
<!--T:16-->
*Signed by 24 experts from around the world
*Covers 12 key points including the theory of a gateway effect
 
 
 
===2020: Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study=== <!--T:17-->
 
<!--T:18-->
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.
 
 
===2020: [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773464 Trends in Tobacco Use Among Adolescents by Grade, Sex, and Race, 1991-2019]===
*This cross-sectional study suggests that, despite the increase in the prevalence of e-cigarette use among adolescents between 2011 and 2019, the prevalence of cigarette and smokeless tobacco use has decreased more rapidly during the same period compared with earlier years.
*Link to PDF on study page
*Citation: Meza R, Jimenez-Mendoza E, Levy DT. Trends in Tobacco Use Among Adolescents by Grade, Sex, and Race, 1991-2019. JAMA Netw Open. 2020;3(12):e2027465. doi:10.1001/jamanetworkopen.2020.27465
*Acknowledgement: Research reported in this publication was supported by award U54CA229974 from the National Cancer Institute of the National Institutes of Health and the US Food and Drug Administration Center for Tobacco Products.
 
 
 
===2020: [https://onlinelibrary.wiley.com/doi/abs/10.1111/add.15099 Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018]=== <!--T:19-->
 
<!--T:20-->
*
 
 
 
===2020: [https://www.sciencedirect.com/science/article/pii/S0376871620300181 Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?]=== <!--T:21-->
 
<!--T:22-->
*
 
 
 
===2019: [https://tobaccocontrol.bmj.com/content/28/6/629 Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check]=== <!--T:23-->
 
<!--T:24-->
*
 
 
 
===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291806/ The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors]=== <!--T:25-->
 
<!--T:26-->
*
 
 
 
===2019 The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications=== <!--T:27-->
 
<!--T:28-->
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]=== <!--T:29-->
 
<!--T:30-->
*Nonsmoking teens’ interest in e-cigarettes was very low.
*Adult smokers’ interest was significantly higher overall and for each flavor.
*Teen interest did not vary by flavor, but adult interest did.
*Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavor.
*'''Nonsmoking teens who had never tried e-cigarettes had the lowest interest in flavors''', followed by adults who had never tried e-cigarettes
*[https://www.casaa.org/wp-content/uploads/Shiffman-on-flavors-1255-62.pdf PDF Version]
*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= <!--T:31-->
=Youth Use / Risky Behaviors / ACE’s= <!--T:31-->
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=Youth and Regulations / Preventing Youth Use= <!--T:56-->
=Youth and Regulations / Preventing Youth Use= <!--T:56-->


=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37409355/ How do you solve a problem like youth vaping?] ===
* Gartner C. Drug Alcohol Rev. 2023 Jul;42(5):1298-1300. doi: 10.1111/dar.13666. Epub 2023 May 9. PMID: 37409355 No abstract available.
* But the first step to "solve a problem like youth vaping" is to ''define'' the problem. The opening statement "concerns about youth vaping are rising globally" isn't really enough for a scientific discussion, unless it's a discussion about media/political perceptions. In my view, the problem of youth vaping is primarily an ''aesthetic or'' political problem (and I agree, no one wants to see this), rather than a public health risk that should really justify strong interventions that will likely harm adults.  This is because there are really two types of youth vaping: (1) frivolous experience, faddish, transitory and of little current or lasting consequence; (2) the uptake of vaping by young people who would otherwise smoke or have a high propensity to use nicotine. For these adolescents, vaping is likely beneficial - a harm-reduction diversion from smoking. So youth vaping, in public health terms, is a mix of inconsequential and beneficial. We've already seen how that played out in the US in a [https://rodutobaccotruth.blogspot.com/2023/07/astounding-smoking-vaping-statistics-in.html recent blog] by Brad Rodu.  So from a scientific and public health perspective, we need a clear-eyed public understanding of the (non-)problem, before we make trade-offs to solve this problem that may cause actual harm to adults. See Mendelsohn and Hall: [https://www.sciencedirect.com/science/article/abs/pii/S0955395923001123?via%3Dihub What are the harms of vaping in young people who have never smoked?]
* "''Frequent vaping of nicotine by young people who have never smoked is uncommon and there is limited evidence so far that vaping has caused significant harms in this population. At a population level, the net benefits of vaping to adult and youth who smoke are likely to outweigh the feared harms of vaping to youth."''
** Gartner provides a good discussion of the costs and ineffectiveness of addressing non-compliance with Australia's Byzantine system for accessing vapes legally, and draws out the important point that people will often comply with laws without extensive enforcement if they think the laws are just and proportionate. Laws that allow cigarettes to be available everywhere, but greatly restrict access to far safer alternatives for people who want to use them to quit smoking using their own money ''may not meet this test''.
** Gartner dismisses a 'responsible retailer' initiative (from BAT), not on its merits but because it is "unlikely to reassure public health advocates", as if public health advocate reassurance is some sort of goal of policy.  In Australia, the public health community is unlikely to be satisfied by much short of outright prohibition, but governments are elected to find working proportionate solutions to actual problems.  However, she immediately notes that ''irresponsible'' retailing provides illicit under-the-counter sales, including to children - but concludes that regularising the consumer trade would not reduce youth uptake.
** She notes the pronounced anomaly in the availability of cigarettes and vaping products and recommends finding "new models of controlled supply for harmful products like cigarettes and NVPs" that will command enough public support to be self-enforcing. But what is the evidence that controlled supply doesn't have massive unintended consequences?  Or that the use of coercive supply-side measures and enforcement are ever an effective and respectful way for the state to address demands for a substance? In this case, an almost benign and innocuous substance?
** Worth noting the FOIA release of internal papers of the Australian National Advisory Council on Alcohol and Other Drugs (ANACAD) assessing the Australian government's quasi-prohibition policies. Like a voice of sanity.  See Colin Mendelson's blog summarising: [https://colinmendelsohn.com.au/anacad/ Expert committee’s advice on vaping is dynamite to Butler’s prohibition model]
* "''Further restrictions will likely only make the problem worse and we’ll end up criminalising more people. Regulation that is too severe risks making smoking more attractive"''


=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37364525/ An experimental evaluation of the effects of banning the sale of flavored tobacco products on adolescents' and young adults' future nicotine vaping intentions.] ===
* Dunbar M, Setoji CM, Martino SC, Jensen D, Li R, Bialas A, Shadel WG. Addict Behav. 2023 Jun 19;145:107784. doi: 10.1016/j.addbeh.2023.107784. Online ahead of print. PMID: 37364525
* An experimental purchasing study of youth (11-20 years old) in a mock convenience store, examining different conditions with different flavor availabilities:
** ''Methods: The display of flavored tobacco products in the store was manipulated with these conditions: 1) tobacco, sweet, and menthol/mint flavors displayed; 2) only tobacco and menthol/mint displayed; and 3) only tobacco flavors displayed.co flavors displayed.''
** Results: Study condition was not associated with intentions to use menthol/mint- sweet-flavored, or any flavor. Compared to the condition in which all flavored products were displayed, removing menthol/mint- and sweet-flavored products significantly increased future intentions to use tobacco-flavored vaping products (OR = 3.97, 95 % CI [1.01, 15.58], p < .05). This effect was only observed among adolescents with history of vaping (OR = 11.30, 95 % CI [1.42, 89.96], p = .02).
* The assumption behind flavor bans is that flavor availability will causally deter use among youth (especially non-using youth), which stems from the unproven assumption that because youth often use flavors, that flavors caused youth use. However, there is no evidence for this causation – youth might otherwise use tobacco flavor, as evidenced by youth using no-added-flavors cigarettes for decades previously. This is one of the first studies that evaluates the causality of flavor availability on youth use (another one was a Pinney paper finding that youth interest did not vary across flavor descriptors).
* The results are notable in their lack of causal associations, except in increasing the intention to use tobacco-flavored products among youth who already use e-cigarettes if there are no flavors available (i.e., migrating to the remaining available products). Especially notable is that flavor restrictions did not change intentions to use among non-users (which were already low), which calls into question the fundamental motivation behind flavor bans.


===2021: [https://www.tandfonline.com/doi/full/10.1080/17538068.2020.1860671 Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign]=== <!--T:57-->
===2021: [https://www.tandfonline.com/doi/full/10.1080/17538068.2020.1860671 Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign]=== <!--T:57-->
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*[https://www.tandfonline.com/doi/pdf/10.1080/17538068.2020.1860671?needAccess=true PDF Version]
*[https://www.tandfonline.com/doi/pdf/10.1080/17538068.2020.1860671?needAccess=true PDF Version]
*Citation: Ziming Xuan & Jasmin N. Choi (2021) Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign, Journal of Communication in Healthcare, DOI: 10.1080/17538068.2020.1860671
*Citation: Ziming Xuan & Jasmin N. Choi (2021) Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign, Journal of Communication in Healthcare, DOI: 10.1080/17538068.2020.1860671


===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789942/ Rescuing Vapers Versus Rescuing Smokers: The Ethics]=== <!--T:59-->
===2020: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789942/ Rescuing Vapers Versus Rescuing Smokers: The Ethics]=== <!--T:59-->
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*Acknowledgement: The author is grateful to the National Institutes of Health for a grant supplement (to parent grant R01CA190444-04; PI: Delnevo) that supported this work.
*Acknowledgement: The author is grateful to the National Institutes of Health for a grant supplement (to parent grant R01CA190444-04; PI: Delnevo) that supported this work.


 
===2020: [https://cei.org/studies/perverse-psychology/ Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”]=== <!--T:61-->
 
===2020: Perverse Psychology How Anti-Vaping Campaigners Created the Youth Vaping “Epidemic”=== <!--T:61-->


<!--T:62-->
<!--T:62-->
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Teen vaping did not escalate despite the increased anti-vaping messaging. Adolescents’ curiosity and subsequent experimentation with vaping rose because of anti-vaping messaging.
Teen vaping did not escalate despite the increased anti-vaping messaging. Adolescents’ curiosity and subsequent experimentation with vaping rose because of anti-vaping messaging.


=Age Restrictions=


===2023: [https://isfe.uky.edu/sites/ISFE/files/research-pdfs/Effects%20of%20E-Cigarette%20Minimum%20Legal%20Sales%20Ages%20on%20Youth%20Tobacco%20Use%20in%20the%20US_Working%20Paper_0.pdf Effects of E-Cigarette Minimum Legal Sales Ages on Youth Tobacco Use in the United States]===
*"Using an estimator designed to correct for dynamic heterogeneity in treatment effects, e-cigarette MLSAs are estimated to reduce lifetime e-cigarette use by approximately 25% and increase daily cigarette use and daily cigar use by approximately 35%. Therefore, these MLSAs operate as intended in reducing e-cigarette use, although at the expense of more dangerous combustible tobacco use. The Food and Drug Administration should consider the impact of e-cigarette availability in reducing youth combustible tobacco use as an important public health benefit of e-cigarettes in their regulatory activity."
**Citation: Michael F. Pesko, 2023. "Effects of e-cigarette minimum legal sales ages on youth tobacco use in the United States," Journal of Risk and Uncertainty, Springer, vol. 66(3), pages 261-277, June. DOI: 10.1007/s11166-022-09402-y
***Acknowledgment: Dr. Pesko was supported by R01DA045016 from the National Institute on Drug Abuse of the National Institutes of Health and by a grant from the Institute for the Study of Free Enterprise at the University of Kentucky.


===2019: E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers=== <!--T:63-->
===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051858/ E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers]===
 
*"This paper suggests that increases in teen prenatal cigarette smoking may be an unintended consequence of ENDS MLSAs among rural teens. Increases in prenatal smoking were entirely accounted for by pre-pregnancy smokers, suggesting that the mechanism through which ENDS MLSAs affected prenatal smoking was by reducing smoking cessation rather than by causing new initiation of cigarette smoking during pregnancy."
<!--T:64-->
**Citation: Pesko MF, Currie JM. E-cigarette minimum legal sale age laws and traditional cigarette use among rural pregnant teenagers. J Health Econ. 2019 Jul;66:71-90. doi: 10.1016/j.jhealeco.2019.05.003. Epub 2019 May 13. PMID: 31121389; PMCID: PMC7051858.
E-cigarette Regulations Increase Prenatal Cigarette Use Among Teen Smokers, Study Shows (Article)
***Acknowledgment: We appreciate helpful comments from Michael French and participants at the 2016 American Society for Health Economists conference. We thank Joanna Seirup for excellent data management. Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA045016 (PI: Michael Pesko), P30DA040500 (PI: Bruce Schackman), and R01DA039968 (PI: Dhaval Dave). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health
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.
*See also: [https://news.gsu.edu/2019/07/11/e-cigartte-legal-age-regulation-teen-smokers/ E-cigarette Regulations Increase Prenatal Cigarette Use Among Teen Smokers, Study Shows]
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=== <!--T:65-->
===2019: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377803/ The Effects of E-Cigarette Minimum Legal Sale Age Laws on Youth Substance Use]===
*"Taken together, our findings suggest a possible unintended effect of e-cigarette MLSA laws—rising cigarette use in the short term while youth are restricted from purchasing e-cigarettes."
**Citation: Dave D, Feng B, Pesko MF. The effects of e-cigarette minimum legal sale age laws on youth substance use. Health Econ. 2019 Mar;28(3):419-436. doi: 10.1002/hec.3854. Epub 2019 Jan 15. PMID: 30648308; PMCID: PMC6377803.
***Acknowledgment: We gratefully appreciate comments from Abigail Friedman, Rahi Abouk, and others at the 2017 International Society for Health Economists (iHEA) conference. We also gratefully acknowledge Amanda Shawky for editorial assistance.
***Funding: Research reported in this publication was supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number R01DA039968 (PI: Dhaval Dave) and R01DA045016 (PI: Michael Pesko)


<!--T:66-->
===2016: [https://pubmed.ncbi.nlm.nih.gov/26971853/ 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.”
*Conclusion: “We document a concerning trend of cigarette smoking among adolescents increasing when ENDS become more difficult to purchase.”
**Pesko MF, Hughes JM, Faisal FS. The influence of electronic cigarette age purchasing restrictions on adolescent tobacco and marijuana use. Prev Med. 2016 Jun;87:207-212. doi: 10.1016/j.ypmed.2016.02.001. Epub 2016 Mar 10. PMID: 26971853.
***(Full study behind paywall, can't see information on study funding)


 
===2015: [https://conference.nber.org/confer/2015/SI2015/HE/Friedman.pdf How does electronic cigarette access affect adolescent smoking?]===
 
*Abstract: “Understanding electronic cigarettes’ effect on tobacco smoking is a central economic and policy issue. This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks. This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking for a given two-year period.”
===2015: Study: How does electronic cigarette access affect adolescent smoking?=== <!--T:67-->
**Citation: Friedman AS. How does electronic cigarette access affect adolescent smoking? J Health Econ. 2015 Dec;44:300-8. doi: 10.1016/j.jhealeco.2015.10.003. Epub 2015 Oct 19. PMID: 26583343.
 
***Acknowledgement: I am grateful to David Cutler, Richard Frank, Claudia Goldin, Frank Sloan, Jody Sindelar, Martin Anderson, Sebastian Bauhoff, Shivaani Prakash, Mark Schlesinger, and Sam Richardson for helpful comments and discussion, and to the Radcliffe Institute for Advanced Study, for fellowship funding that helped support this research.
 
<!--T:68-->
Abstract: “Understanding electronic cigarettes’ effect on tobacco smoking is a central economic and policy issue. This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks. This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking for a given two-year period.”
<br>


=Young Adults= <!--T:69-->
=Young Adults= <!--T:69-->
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=Youth - Nicotine Use=
=Youth - Nicotine Use=


=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37263111/ What are the harms of vaping in young people who have never smoked?] ===
* A comprehensive rebuttal of the concerns about youth vaping from Drs. Mendelsohn and Hall, covering several different angles.
* How common is frequent vaping in never-smokers?
** Frequent vaping by young people who have never smoked is uncommon in western countries with a prevalence mostly under 2%.
** Measures of lifetime vaping (“even a puff”) or current vaping (at least once in the past 30-days) overestimate the prevalence of frequent vaping by those who have never-smoked because they include experimental and infrequent vaping which is the most common pattern of use in this group.
* Does vaping increase the risk of taking up smoking?
** Increases in youth vaping have been accompanied by an accelerated decline in smoking since vaping became popular in the US, UK, and New Zealand, suggesting either no overall gateway effect or at most, a small gateway effect that is outweighed by the much larger number moving from smoking to vaping.
* What are the known health effects of vaping by never-smokers?
** Nicotine itself represents minimal risk of serious harm in the doses commonly used in vaping. Nicotine does not cause cancer or lung disease and it has only a minor role in cardiovascular disease.
* Do never-smokers who vape become dependent on nicotine?
** Vaping can cause nicotine dependence in some young people who have never smoked. The evidence suggests, however, that this is a minority of cases, not, as the media often claim, “a new generation addicted to nicotine.”
* What about the risks for young smokers who take up vaping?
** Modelling studies suggest a net benefit from vaping to population health under all plausible scenarios. These models take into account harms from vaping (uptake by never-smoking youth and adults, the potential to increase smoking, inhibit smoking cessation and promote relapse) and benefits (cessation of smoking and diversion of those who would have otherwise taken up smoking).
* Policy measures to reduce youth vaping
** We need to recognize that overly restrictive policies intended to reduce youth vaping can have counterproductive results.
* Mendelsohn CP, Hall W. Int J Drug Policy. 2023 May 30;117:104064. doi: 10.1016/j.drugpo.2023.104064. Online ahead of print. PMID: 37263111 (No abstract available)
=== 2020: [https://onlinelibrary.wiley.com/doi/10.1111/add.15099 Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018] ===
* Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk.


===2020: [https://onlinelibrary.wiley.com/doi/10.1111/add.15099 Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018]===
*Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk.




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<!--T:93-->
: [[File:PeterHajek1.jpg|Hajek quote]]
: [[File:PeterHajek1.jpg|Hajek quote]]
:
<gallery widths="300" caption="US Vaping and smoking trends (youth and adult)">
File:Vaping and smoking trends.png|US nicotine vaping and smoking trends
</gallery><gallery widths="300" perrow="2" caption="Vaping trend data 2011 to 2023">
File:Past 30 day e-cig use.png|vaping trend data
File:Past e-cig use frequent and infrequent.png|'''Past e-cig use frequent and infrequent'''
File:Past 30 day e-cig and any tobacco use.png|'''Past 30 day e-cig and any tobacco use'''
File:Past 30 day e-cig and any combustable tobacco use.png|alt=Shows an increase in the linear combustible trend decline since the onset of the "youth vaping epidemic" in 2018. (Note that the expected trend would be more likely to have geometric characteristics, so this is impressive)|'''Past 30 day e-cig and any combustable tobacco use'''
</gallery>


=Suggested studies to add to this page= <!--T:94-->
=Suggested studies to add to this page= <!--T:94-->
=== 2023: [https://www.mdpi.com/1660-4601/20/19/6866 Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes] ===
* These findings suggest dramatic successes in reducing youth smoking since the late 1990s, with more rapid declines in prevalence in the past decade.
* Healthy People’s 2030 goal for youth cigarette smoking, which uses the NYTS as its benchmark, has already been achieved and exceeded, years ahead of schedule.
* Concerns about a potential rise in adolescent cigarette use following the introduction of e-cigarettes to the U.S. market in the early 2010s are not supported by the data. In fact, the emergence of e-cigarettes has coincided with the most rapid declines in cigarette use over the past thirty years.
* Importantly, an emerging body of evidence suggesting that initiation of cigarette smoking is shifting from adolescence to young adulthood. However, the prevalence of cigarette smoking has also dramatically declined among young adults aged 18–24 from 26.8% in 2000 to 7.4% in 2020
* Cristine D. Delnevo, Andrea C. Villanti Int. J. Environ. Res. Public Health 2023, 20(19), 6866; <nowiki>https://doi.org/10.3390/ijerph20196866</nowiki>
* Funding: C.D.D. and A.C.V. were supported in part by a grant from the National Cancer Institute of the National Institutes of Health and the FDA Center for Tobacco Products (U54CA229973 and U01CA278695. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, NCI or FDA.
===2022: [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796834 Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use]===




===2022: [https://pubmed.ncbi.nlm.nih.gov/35862070/ Correlates of vaping among adolescents in Canada]===
===2022: [https://pubmed.ncbi.nlm.nih.gov/35862070/ Correlates of vaping among adolescents in Canada]===
===2022: [https://pubmed.ncbi.nlm.nih.gov/35852452/ Young Adult Responses to Taxes on Cigarettes and Electronic Nicotine Delivery Systems]===
===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287473/ Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas]===




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