Are teen users of electronic cigarettes at increased risk for substance use?

Teenagers who smoke electronic cigarettes (e-cigarettes) are less likely to use substances than adolescents who use both cigarettes and e-cigarettes (dual users) but are more likely to use them than teenagers who have never used either product (nonusers). This was one of the primary findings of a school-based survey of 1941 high school students (mean age, 14.6 years) in Hawaii. In addition to addressing the prevalence of smoking e-cigarettes and cigarettes, the survey assessed psychosocial and demographic variables as well as perceived health effects of e-cigarettes.

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A full 96% of participants were aware of e-cigarettes; 67% considered them healthier than cigarettes. Of students surveyed, 68% were nonsmokers; 17% used e-cigarettes alone; 12% used both cigarettes and e-cigarettes; and 3% used cigarettes only. Dual users and cigarette-only users had the highest risk status for substance use compared with e-cigarette users and nonusers.

For example, compared with dual users, e-cigarette-only smokers had fewer known risk factors for substance use (such as conflicts with parents, sensation seeking, and rebelliousness) and more protective factors (such as parental support and emotional self-control). However, compared with nonusers, e-cigarette-only smokers had more risk factors and fewer protective factors. In other words, the risk status-levels of risk and protective factors--of e-cigarette-only smokers was in between those of nonusers and dual users (Wills TA, et al. Pediatrics. 2015;135[1]:e43-e51).

Commentary: In this survey of ninth and tenth graders, 29% of students have used either e-cigarettes or e-cigarettes and traditional cigarettes. Other studies have confirmed a rapid increase of “vaping,” often in children. I find it alarming that so many young people are adopting this practice. We need to know more about the long-term effects of vaping and we need the US Food and Drug Administration to regulate this $11.7 billion industry while we await answers.  -Michael G Burke, MD 

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.