Kids who vape or JUUL or use e-cigarettes smoke about as much as teen smokers who never used the devices, according to a USC study in the Nov. 5 journal Pediatrics.

“The findings show that e-cigs do nothing to deter the amount of combustible smoking in youth,” said Jessica Barrington-Trimis, an assistant professor of preventive medicine at the Keck School of Medicine of USC and the study’s lead author. “On the contrary, they increase the likelihood that vaping teens will start smoking.”

The study is likely to add heft to a growing chorus seeking changes in regulation or industry practice for the nicotine delivery devices. Their popularity has surged while government and health officials warn of unintended consequences. The e-cigarette market is expected to reach $44.6 billion worldwide in five years.

Policies needed to provide deterrent to teen smoking

Earlier this year, the Food and Drug Administration commissioner declared e-cigs and vaping an “epidemic” that threatens to undo gains in decreasing smoking rates, and ordered e-cigarette manufacturers to submit plans on reducing teen use.

“This study shows that tobacco control policies are needed to reduce adolescent use of e-cigs and prevent progression to more frequent tobacco use,” Barrington-Trimis said.

The USC researcher and her colleagues surveyed 6,258 high schoolers from three studies — the Children’s Health Study and Happiness and Health Study in Southern California and the Yale Adolescent Survey study in Connecticut — about their vaping and smoking usage. Participants were surveyed again about a year later. The researchers found:

• Seven percent of never-smokers started smoking.
• Twenty-one percent of e-cig users began smoking regular cigarettes.
• The number of days that teens smoked in the past 30 days was similar for those who began smoking after using e-cigarettes or who began smoking without e-cigarettes.
• Teens who were using both combustible and e-cigarettes were more likely to continue using both than to switch to vaping only.

‘E-cigarettes are not benign’

Previously, researchers found that many of the kids who vaped started smoking cigarettes later.

“Pediatricians need to find a way to address this matter because e-cigarettes are not benign, and it’s unlikely to stop there,” Barrington-Trimis said.

“A lot of people like to compare cigarette smoking to vaping and say, ‘Oh, vaping is safer.’ When you’re talking about kids, and especially kids who might never have started smoking without vaping, it’s definitely not safer than not using any tobacco products at all.”

Barrington-Trimis said the study was unique because its large size allowed researchers to look beyond smoking initiation, and see what patterns emerged after a year.

The study’s other authors are Adam Leventhal, Feifei Liu, Tess Boley Cruz and Rob McConnell of the Keck School of Medicine and Grace Kong, Margaret Mayer and Suchitra Krishnan-Sarin of the Yale University School of Medicine.

The study was funded by grants from the National Cancer Institute and the FDA Center for Tobacco Products (P50CA180905), and the National Institute on Drug Abuse (K01DA042950, R01DA033296 andP50DA036151).

— Leigh Hopper