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Teenagers who use e-cigarettes are more likely to start smoking tobacco cigarettes, a new study by University of Hawaiʻi Cancer Center researchers has found. Adolescents who have never smoked cigarettes, but are using e-cigarettes, are more likely to become cigarette smokers one year later.

“Teenage use of electronic cigarettes is an emerging public health issue. There is still a significant amount of debate around how e-cigs are relevant for someone’s health,” said Thomas Wills, interim director of the UH Cancer Center’s Prevention and Control Program.

In the last four years there has been a dramatic increase in e-cigarette use by teenagers. Rates of high school students’ use of e-cigs have gone from 1 to 2 percent of students to rates now showing 20-30 percent, according to Wills.

“For several years people have asked if e-cigarettes make young people more inclined to smoke, whether there’s no effect, or if it does the opposite and helps teens who are smoking to quit,” said Wills. “However, there has been little knowledge about what this means for health-related behaviors, and almost no scientific evidence for an answer to this question until recently.”

E-cigarettes a risk for teens

Thomas Wills of the U H Cancer Center
Thomas Wills

The findings by Wills and collaborators published in Tobacco Control, provide evidence that e-cigarettes are serving as a risk for teens to begin smoking tobacco cigarettes. The data, collected since 2012, are based on school surveys of more than 2,300 high school students in Hawaiʻi, mostly 9th and 10th graders.

“The findings of the University of Hawaiʻi Cancer Center study confirm the importance of protecting our youth from initiating e-cigarette use,” said Lila Johnson, program manager for the Department of Health’s Tobacco Prevention and Education Program. “It also provides further evidence for the inclusion of e-cigarettes in Hawaiʻi’s clean air laws, and for restricting the sale of tobacco products (including e-cigarettes) to those under age 21.”

Results showed that Native Hawaiian and Filipino teens were more likely to start using e-cigarettes, compared with Asian-Americans (Japanese, Chinese or Koreans). The study also found that adolescents who perceived higher levels of emotional support and understanding from parents were less likely to start using e-cigarettes, and this was true for all ethnic groups.

“Research from Hawaiʻi is making a national impact. The findings are being included in the scientific database used by the Food and Drug Administration as they consider federal regulation of tobacco products including e-cigarettes,” Wills pointed out.

“For teens the findings mean that they cannot assume that e-cigarettes are harmless. Using e-cigarettes increases the likelihood of starting to smoke cigarettes, which are not good for you. For parents, you can’t assume that it doesn’t matter whether kids use e-cigarettes. It does matter.”

—By Nana Ohkawa

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