Cigarette smoking among teens has been on a steady decline since the mid-1990s.
But e-cigarettes could send all the gains made in reducing teen use of tobacco products up in a cloud of smoke — or make that vapor.
A new study suggests that many high school students who may have never smoked cigarettes are now using e-cigarettes.
“A whole bunch of kids who probably wouldn’t have used anything are now being exposed to nicotine plus whatever other chemicals are in the e-cigarettes,” Jessica Barrington-Trimis, Ph.D., lead author of the study, and a postdoctoral scholar research associate in the Department of Preventive Medicine at the Keck School of Medicine of the University of Southern California, told Healthline.
Teens starting out on e-cigarettes
The study of 5,490 high school juniors and seniors shows that the use of tobacco products — specifically cigarettes and e-cigarettes — among teens in Southern California is on the rise.
In 2014, 13 percent of 12th graders surveyed said they had either smoked cigarettes or vaped in the previous month. About half of those students — almost 8 percent — were cigarette smokers, with some also using e-cigarettes.
E-cigarettes didn’t enter the U.S. market until 2007, so the researchers compared the 2014 combined level to levels of cigarette smoking, by itself, in earlier years. Levels were 9 percent in 2004, and 14 percent in 2001.
So while vaping is on the rise among teens, smoking is on the decline.
The researchers say, though, that the change in smoking levels from 2004 to 2014 is so small that statistically it’s more of a plateau.
Different smoking trends nationally
The study only looked at 12 schools in Southern California, so the results may not apply to all areas of the United States.
“Data from California is not comparable to the overall U.S. because the youth smoking trends in California are vastly different than in the rest of the nation,” Dr. Michael Siegel, M.P.H., a professor at Boston University School of Public Health, told Healthline in an email.
The Monitoring the Future Study, an annual survey of a total of 50,000 students in 8th, 10th, and 12th grades, supports the finding.
The national survey found much higher levels of cigarette smoking among high school students. Twenty-five percent had smoked during the month before the 2004 survey. Thirteen percent said they’d smoked during the month before the 2014 survey.
Like the USC study, Monitoring the Future found that vaping levels in 2014 were higher than smoking. Seventeen percent of 12th graders had used an e-cigarette during the month before the survey.
Comparing the overall impact of cigarettes and e-cigarettes on the health of teens is difficult because these products are not identical.
Smoke from regular cigarettes contains more toxins and carcinogens that e-cigarette vapor.
The nicotine levels may also not be the same in the two products. Some liquids used in e-cigarettes contain no nicotine at all, only flavorings.
This may mean that a rise in e-cigarette use may be less harmful overall, at least in some ways.
“Nationally, overall nicotine use has remained about the same, but the profile of that use has changed,” said Siegel, “with a shift from combustible tobacco products to electronic.”
Smoke vs. vapor
That doesn’t mean e-cigarettes aren’t harmful.
Ingredients in the e-cigarette liquid vary among manufacturers, but can contain chemicals like the carcinogen formaldehyde. Inhaling vapor may also harm the lungs.
Plus, there is highly addictive nicotine in some e-cigarette liquids.
“Kids who are still in high school, their brains are still developing,” said Barrington-Trimis. “So use of nicotine products at that time is harmful, even if we’re just thinking about the nicotine.”
Some research also suggests that use of e-cigarettes may lead to cigarette smoking.
The continuing national decline in teen cigarette smoking, though, suggests that vaping may be keeping some teens from smoking.
For some experts, the increase in vaping may not be that concerning when you look at the big picture.
“This study does not change my overall assessment that nationally, the benefits from the huge observed decline in cigarette smoking among youth far outweigh the minor risks associated with youth vaping,” said Siegel.
Of course, the effect of vaping on your health depends on whether you are switching from smoking or starting fresh.
“E-cigarettes may be less harmful than cigarettes, but we don’t know a lot about what’s in them,” said Barrington-Trimis. “I think using e-cigarettes is more dangerous than not using anything at all.”