Young people who use e-cigarettes are more likely to take up tobacco cigarettes, according to an international review of research into vaping.
People under 20 who used vapes were more than three times as likely to have ever smoked tobacco cigarettes, and more than twice as likely to have smoked cigarettes in the previous month, according to a review of 25 studies globally.
The review, published in the journal Plos One, was led by Australian researchers and funded by the World Health Organization. It analysed vaping studies in several countries, including the US, UK and Germany.
The researchers concluded there was “an urgent need for governments internationally to take action to regulate the availability and marketing of [e-cigarette] products to children and adolescents”.
Serene Yoong, an associate professor at Swinburne University of Technology in Melbourne and the study’s lead author, said the findings pointed to the need for youth prevention programs and better regulation of e-cigarette products.
“Every single study showed an association between [e-cigarette] use among non-smokers and increased use of cigarettes at follow-up,” she said.
The researchers found “strong evidence to support the causal relationship”, and the link was consistent even when they adjusted for other factors including susceptibility to smoking, influence by friends and family, and exposure to advertising.
“Experimenting is not as benign as people might think in terms leading to later cigarette use,” Yoong said.
The review’s findings are similar to previous e-cigarette smoking research in the broader population. The study’s authors point out that young people who vape have a different psychological profile to cigarette smokers, and would “otherwise have been at low risk of [tobacco] smoking”.
“The experience of global efforts to combat the use of conventional cigarettes and other tobacco products suggests that such efforts are inadequate to sufficiently avert the projected harms, if the current trajectory continues,” the researchers concluded.
The sale of nicotine vapes is prohibited in Australia, but there are widespread reports of tobacconists illegally selling them to young people.
A loophole also allows people to buy nicotine e-cigarette products from overseas websites. From the beginning of next month, buying such products online without a doctor’s prescription will be outlawed.
Two of the reviewed studies looked at links between the use of nicotine-free vapes and subsequent cigarette use, with mixed findings. “The jury’s still out,” Yoong said.
One hypothesis, said Yoong, is that nicotine-teen free vaping could lead to subsequent cigarette smoking not as a result of nicotine addiction, but because simulating the act of smoking might make cigarette smoking seem inherently appealing to young people.
Though the findings were inconclusive, the researchers suggest “precautionary principles should be in place when considering the regulation for all forms of e-cigarettes, including those that do and do not contain nicotine.”