New Study on Electronic Cigarette Use Among Youth Fails to Find a Single Nonsmoking Youth Who Has Even Tried an Electronic Cigarette

In a newly published article in the Journal of Adolescent Health, Pepper et al. report the results of an online survey of 228 adolescent males, ages 11-19, to assess awareness, willingness to use, and actual use of electronic cigarettes.

The results were reported as follows: "Only two participants (< 1%) had previously tried e-cigarettes. Among those who had not tried e-cigarettes, most (67%) had heard of them. Awareness was higher among older and non-Hispanic adolescents. Nearly 1 in 5 (18%) participants were willing to try either a plain or flavored e-cigarette, but willingness to try plain versus flavored varieties did not differ. Smokers were more willing to try any e-cigarette than nonsmokers (74% vs. 13%; OR 10.25, 95% CI 2.88, 36.46). Nonsmokers who had more negative beliefs about the typical smoker were less willing to try e-cigarettes (OR .58, 95% CI .43, .79)."

The article concludes: "Given that even experimentation with e-cigarettes could lead to nicotine dependence and subsequent use of other tobacco products, regulatory and behavioral interventions are needed to prevent “gateway” use by adolescent nonsmokers."

In an accompanying commentary entitled "Electronic Cigarettes: A New Nicotine Gateway?" Dr. Rachel Grana of the Center for Tobacco Control Research and Education expresses alarm because "18% of the sample endorsed being susceptible to trying e-cigarettes." On this basis, she concludes that: "Additional action should be taken to ensure e-cigarettes are not sold to youth and their appeal to youth and nonsmokers is minimized, such as enacting restrictions on health claims, explicit celebrity endorsements, and the elimination of the flavors."

The Rest of the Story

These two articles are a perfect example of the profound disconnect between the scientific evidence and the policy agenda in the modern tobacco control movement.

Here we have two papers which sound the alarm about the terrible problem of youth use of electronic cigarettes and about the hazards of e-cigarettes serving as a gateway to nicotine addiction. But what did the study actually show?

It showed that not a single nonsmoking youth could be found, among a sample of 228 male adolescents, who actually uses or has ever even tried an electronic cigarette. And only two smoking youth could be found who have tried the product.

This is a striking finding which puts to bed the contention of many anti-smoking groups and advocates that electronic cigarettes appeal heavily to youths and serve as a gateway to nicotine addiction. The finding quite strongly answers the question posed by Dr. Grana, in the negative.

Yet instead of emphasize this important finding, the articles try to scare the public about the scourge of electronic cigarettes among our nation's youth, citing the rather meaningless finding that 18% of youths would be willing to try an electronic cigarette. Most adolescents are willing to try anything. This finding means nothing. The important finding is that in contrast to popular belief among anti-smoking advocates and researchers, the electronic cigarette is simply not popular among adolescents. In this particular sample, not a single nonsmoking youth could be found who has even so much as tried the product.

The first sentence of the paper's discussion reads as follows: "Although few adolescent males in our national sample had tried e-cigarettes, around two-thirds were aware of them." This is an odd way to summarize the results. I would have stated it in exactly the opposite way: "Although two-thirds of the adolescent males in our national sample were aware of electronic cigarettes, only two had ever tried them."

This is a striking finding. Adolescents are widely aware of these products, but they are not using them. And they are not even experimenting with them. Clearly, this is a product which is not particularly appealing to adolescents. They much prefer the real thing. Just as they prefer "real" jeans to imitation ones and "real" name-brand sneakers to imitation ones.

To be sure, public health practitioners and policy makers need to stay vigilant and monitor the use of electronic cigarettes. And measures to prohibit the sale of electronic cigarettes to minors are certainly justified. But the rest of the story is that there simply is no evidence to suggest that electronic cigarettes are appealing to, or popular among youth. Measures suggested by Dr. Grana - such as prohibiting flavors, outlawing celebrity endorsements, or banning truthful claims about the relative safety of these products - are not justified or warranted.

But I don't think most anti-smoking groups or advocates care about the actual evidence. They've already made up their minds. Vaping looks too much like smoking. So forget about the fact that not a single nonsmoking youth could be found who has even tried the product. The advocates must continue to follow the party line and warn about the danger of electronic cigarettes as a gateway to nicotine addiction. Never mind that the gateway just doesn't exist.