Smoking kills many South Africans as a result of tobacco-related diseases such as tuberculosis, lung cancer, stroke, throat and mouth cancer, as well as various lung and heart diseases.
Teens and young adults who use electronic cigarettes – also known as vaping – are almost four times as likely as their non-vaping counterparts to begin smoking traditional cigarettes, a new review suggests.
The study was published in JAMA Pediatrics.
Increased risk for youth
"E-cigarette use increases the risk of subsequent cigarette smoking, even for teens and young adults who might not be at the highest risk for smoking," said study lead author Samir Soneji.
"This increased risk may counter the successful tobacco control efforts that have produced a steady decline in smoking since 1998," he said.
Soneji is an assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire.
Are e-cigarettes the healthier option?
Battery-powered e-cigarettes deliver nicotine through vapour instead of smoke. Their effect on public health is still being debated. Some say they may help adults wean themselves off tobacco cigarettes, while others feel they may introduce kids to smoking, according to background information in the study.
Debates have been triggered on the use of e-cigarettes increasing the possibility of escalating nicotine addiction and encourage people to start smoking, as previously reported by Health24.
Dr Michael Siegel, a professor of community health sciences at Boston University School of Public Health, isn't convinced that e-cigarettes are to blame for kids starting to smoke tobacco cigarettes.
"These are kids who likely would have smoked anyway. There is no evidence that the e-cigarette experimentation is contributing towards an increased risk for smoking," said Siegel, who wasn't involved with the review.
Public health awareness
Teens also seem to be picking up on public health messages themselves, and all types of smoking may be losing a bit of their "cool".
A report from the US Centers for Disease Control and Prevention found that fewer teens are vaping. The report said that an estimated 3 million teens smoked e-cigarettes in 2015. By 2016, that number had fallen to 2.2 million. Fewer teens are using tobacco, too. An estimated 4.7 million teens used tobacco in 2015 compared to 3.9 million in 2016, the report found.
The new review looked at the results of nine studies. The studies included more than 17 000 teens and young adults aged 14 to 30 when the studies began. 56% of the study volunteers were female.
When the studies were combined, the researchers found that an estimated 30% of teens who had ever used an e-cigarette went on to use traditional cigarettes. Only about 8% of those who never used e-cigarettes went on to smoke tobacco cigarettes.
When the researchers looked at the past 30 days, 21.5% of those who'd smoked e-cigarettes went on to smoke regular cigarettes. Less than 5% of those who hadn't smoked e-cigarettes tried regular cigarettes.
The new report didn't observe if people kept smoking over long periods. It also didn't examine whether smoking affected their health.
From e-cigarettes to traditional cigarettes
Soneji pointed to three possible reasons why e-cigarette users may be drawn to smoke traditional cigarettes:
- They may become addicted to nicotine and seek a greater fix.
- They may learn to enjoy smoking and spend more time with friends who light up.
- E-cigarettes may make it easier for users to transition to cigarette smoking because they've already learned how to do it.
Soneji called for the US Food and Drug Administration to target teen and young adult use of e-cigarettes by banning fruit- and candy-flavoured e-cigarettes and requiring accurate labels regarding the levels of nicotine in the liquids used in e-cigarettes.
"It failed to examine whether non-smoking youth who are regular vapers are more likely to progress to established smoking," Siegel said.
"What these studies show is simply that youth who tend to experiment with substances – like try e-cigarettes – are also more likely to try real cigarettes and of course, some of them will become smokers since cigarettes are so addictive," he said.
"The proper question is whether non-smokers who experiment with e-cigarettes are likely to progress to regular vaping and then, whether this increases their likelihood of progressing to smoking," Siegel said.