Cigarette smoking is the leading cause of preventable disease and death in the U.S. Even though youth cigarette smoking is at its lowest levels since 1991, there is concern for the emerging popularity of alternative tobacco products, such as electronic vapor products (EVPs). EVPs include e-cigarettes, electronic cigars, electronic pipes, vape pens, and electronic hookahs. Even though overall amounts of tobacco use have not increased, reported e-cigarette use has increased from 1.5% to 16% in high school students from 2011-2015. These electronic products still contain nicotine and other additives that are harmful and can become addictive.
While it is clear that the use of EVPs increases the risk of adolescents becoming dependent and initiating cigarette use, there has not been much study into what other types of health-risk behaviors are associated with EVPs. The researchers in this study examined data from the 2015 national Youth Risk Behavior Survey (YRBS) to answer this question. The YRBS is a self-reported survey administered at high schools in the U.S. every two years. It monitors 6 high priority health-risk behavior categories: unintentional injury & violence, risky sexual behaviors, alcohol & substance use, tobacco use, unhealthy dietary behaviors, and inadequate physical activity.
For their analysis of cigarette and EVP use, the researchers sorted the YRBS participants into four distinct categories based on their past 30-day tobacco use. About 73.5% of the students fell into the nonuse category. The rest were split between cigarettes only (3.2%), EVPs only (15.8%), and dual users (7.5%). There were significant differences in use based on sex, race/ethnicity, and grade level. Males were more likely to use than females; white and Hispanic students more than black students; and older students more than younger students.
There was also variability in how frequently students smoked. EVP only users tended to smoke less frequently, with the most common answer being 1-2 times in the past 30 days. Cigarette only smokers most commonly reported infrequent cigarette use, but almost 20% also reported using everyday in the past 30 days. The dual users still had the largest percentage that reported relatively infrequent use, but had a much more even spread compared to the other two usage groups when looking at a range from 1-2 days all the way up to everyday use.
To varying amounts, all 3 categories of tobacco users were significantly more likely than nonusers to engage in other risky behaviors. These high risk behaviors included engaging in a physical fight, attempting suicide, drinking alcohol, using marijuana, usage of other illicit drugs, nonmedical usage of prescription drugs, being currently sexually active, having more that 3 lifetime sexual partners, not eating many vegetables, and drinking large amounts of soda per day. However, it appears that dual users are generally at higher risk for these types of behaviors compared to either EVP-only users or cigarette-only users.
There do not appear to be many major differences between the amount of risks taken by cigarette-only users and EVP-only users, indicating that both of these groups tend to have closely associated behaviors. While the study does not provide any evidence or suggestion that tobacco use is the cause of these other risky behaviors, it does suggest that any form of tobacco use could be a useful marker for youth engaged in high-risk acts.
Reasons for the rise in EVP use could come from a large number of factors including increased advertising, the introduction of flavored vapors, social acceptability, and ease of access. There are many efforts ongoing to counteract the rise of EVP use in adolescents. One of these includes efforts by the USDA to extend its authority in regulating the minimum age of EVP sales. This study highlights the continued need to study cigarette and tobacco use in youth and to implement more prevention strategies and educational efforts about the associated harms.
Original article can be found here: http://pediatrics.aappublications.org/content/early/2017/01/19/peds.2016-2921
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