University of California San Francisco study: E-Cigarettes are gateway to smoking

14 May

According to Tobacco Facts most teenage smoking starts early. Among the statistics cited at Tobacco Facts are the following:

Each day 3,000 children smoke their first cigarette.
Tobacco use primarily begins in early adolescence, typically by age 16.
At least 3 million adolescents are smokers.
20 percent of American teens smoke.
Almost all first use occurs before high school graduation.
Roughly 6 million teens in the US today smoke despite the knowledge that it is addictive and leads to disease.
Of the 3,000 teens who started smoking today, nearly 1,000 will eventually die as a result from smoking.
Of every 100,000 15 year old smokers, tobacco will prematurely kill at least 20,000 before the age of 70.
Adolescent girls who smoke and take oral birth control pills greatly increase their chances of having blood clots and strokes.
According to the Surgeon’s General, Teenagers who smoke were:
* Three times more likely to use alcohol.
* Eight times are likely to smoke marijuana.
* And 22 times more likely to use Cocaine.
Although only 5 percent of high school smokers said that they would definitely be smoking five years later, close to 75 percent were still smoking 7 to 9 years later.
Kids who smoke experience changes in the lungs and reduced lung growth, and they risk not achieving normal lung function as an adult.
A person who starts smoking at age 13 will have a more difficult time quitting, has more health-related problems and probably will die earlier than a person who begins to smoke at age 21.
Kids who smoke have significant health problems, including cough and phlegm production, decreased physical fitness and unfavorable lipid profile.
If your child’s best friends smoke, then your youngster is 13 times more likely to smoke than if his or her friends did not smoke.
Adolescents who have two parents who smoke are more than twice as likely as youth without smoking parents to become smokers.
More than 90 percent of adult smokers started when they were teens.

It is important to prevent teens from beginning to smoke because of health issues and the difficulty many smokers have in quitting the habit. See, E-Cigarette Teen Popularity Prompts Concerns

Anna Almendrala reported in the Huffington Post article, 5 Important Lessons From The Biggest E-Cigarette Study:

E-cigarettes as we know them today were invented by a Chinese pharmacist, Hon Lik in the early 2000s as a smoking cessation aid. They are handheld nicotine vaporizers that deliver an aerosol made up of nicotine, flavorings and other chemicals to users. It’s the chemicals in those vapors that are moving municipalities like Los Angeles, New York City, Washington D.C., Chicago and Boston to restrict “vaping” in some way.
Formaldehyde, for instance, is a carcinogen that also irritates the eyes, nose and throat. Propylene glycol can also cause eye and respiratory irritation, and prolonged exposure can affect the nervous system and the spleen. Acetaldehyde, also known as the “hangover chemical,” is also a possible carcinogen.
The secondhand vapor finding is just one of several that UCSF researchers highlighted in the broadest review to date of peer-reviewed e-cigarette studies. The findings, which were published Monday in the American Heart Association’s journal Circulation, include:
1. Some youth have their first taste of nicotine via e-cigarettes. Twenty percent of middle schoolers and 7.2 percent of high schooler e-cigarette users in the U.S. report never smoking cigarettes.
2. Nicotine absorption varies too much between brands. Early 2010 studies found that users got much lower levels of nicotine from e-cigarettes than from conventional cigarettes, but more recent studies show that experienced e-cigarette users can draw levels of nicotine from an e-cigarette that are similar to conventional cigarettes….
3. Just because particulate matter from e-cigarettes isn’t well studied, doesn’t mean it’s safe. To deliver nicotine, e-cigarettes create a spray of very fine particles that have yet to be studied in depth. “It is not clear whether the ultra-fine particles delivered by e-cigarettes have health effects and toxicity similar to the ambient fine particles generated by conventional cigarette smoke or secondhand smoke,” wrote the researchers….
4. So far, e-cigarette use is not associated with the successful quitting of conventional cigarettes. One clinical trial found that e-cigarettes was no more effective than the nicotine patch at helping people quit, and both cessation methods “produced very modest quit rates without counseling.”
5. Major tobacco companies have acquired or produced their own e-cigarette products. They’re promoting the products as “harm reduction” for smokers, which allows them to protect their cigarette market while promoting a new product. Companies also using “grassroots” tactics to form seemingly independent smokers’ rights groups, just like they did for cigarettes in the 1980s.
Based on the weight of the combined research, UCSF researchers end with several policy recommendations, which include banning e-cigarettes wherever cigarettes are banned, subjecting e-cigarettes to the same advertising restrictions that constrict cigarette marketing and banning fruit, candy and alcohol flavors, which are attractive to younger customers.


A Scientific Review
1. Rachel Grana, PhD, MPH;
2. Neal Benowitz, MD;
3. Stanton A. Glantz, PhD
+ Author Affiliations
1. From the Center for Tobacco Control Research and Education (R.G., N.B., S.A.G.) and Department of Medicine and Cardiovascular Research Institute (N.B., S.A.G.), University of California, San Francisco.
1. Correspondence to Stanton A. Glantz, PhD, Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, No. 366, San Francisco, CA 94143-1390. E-mail
Key Words:
particulate matter
public policy
Electronic cigarettes (e-cigarettes) are products that deliver a nicotine-containing aerosol (commonly called vapor) to users by heating a solution typically made up of propylene glycol or glycerol (glycerin), nicotine, and flavoring agents (Figure 1) invented in their current form by Chinese pharmacist Hon Lik in the early 2000s.1 The US patent application describes the e-cigarette device as “an electronic atomization cigarette that functions as substitutes [sic] for quitting smoking and cigarette substitutes” (patent No. 8,490,628 B2). By 2013, the major multinational tobacco companies had entered the e-cigarette market. E-cigarettes are marketed via television, the Internet, and print advertisements (that often feature celebrities)2 as healthier alternatives to tobacco smoking, as useful for quitting smoking and reducing cigarette consumption, and as a way to circumvent smoke-free laws by enabling users to “smoke anywhere.”3
Figure 1.
Examples of different electronic cigarette (e-cigarette) products. Reproduced from Grana et al.1
There has been rapid market penetration of e-cigarettes despite many unanswered questions about their safety, efficacy for harm reduction and cessation, and total impact on public health. E-cigarette products are changing quickly, and many of the findings from studies of older products may not be relevant to the assessment of newer products that could be safer and more effective as nicotine delivery devices. In addition, marketing and other environmental influences may vary from country to country, so patterns of use and the ultimate impact on public health may differ. The individual risks and benefits and the total impact of these products occur …
[Full Text of this Article]

Here is the press release from the UCSF:

E-Cigarettes Expose People to More than ‘Harmless’ Water Vapor and Should be Regulated, UCSF Scientists Find
First Comprehensive Analysis Shows that Industry Health Claims are Unsupported by Data
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By Elizabeth Fernandez on May 13, 2014
In a major scientific review of research on e-cigarettes, UC San Francisco scientists found that industry claims about the devices are unsupported by the evidence to date, including claims that e-cigarettes help smokers quit.
The review marks the first comprehensive assessment of peer-reviewed published research into the relatively new phenomenon of electronic cigarettes.
The devices, which are rapidly gaining a foothold in popular culture particularly among youth, are marketed as a healthier alternative to tobacco smoking, as an effective tool to stop smoking, and as a way to circumvent smoke-free laws by allowing users to “smoke anywhere.” Often the ads stress that e-cigarettes produce only “harmless water vapor.”
But in their analysis of the marketing, health and behavioral effects of the products, which are unregulated, the UCSF scientists found that e-cigarette use is associated with significantly lower odds of quitting cigarettes. They also found that while the data are still limited, e-cigarette emissions “are not merely ‘harmless water vapor,’ as is frequently claimed, and can be a source of indoor air pollution.
The long-term biological effects of use are still unknown, the authors said.
In tackling the question of whether e-cigarette use is helping or harming the nation’s tobacco control efforts, the authors analyzed 84 research studies on e-cigarettes and other related scientific materials.
They concluded that e-cigarettes should be prohibited wherever tobacco cigarettes are prohibited and should be subject to the same marketing restrictions as conventional cigarettes.
The paper is published May 12, 2014 in the American Heart Association’s journal Circulation.
E-cigarettes deliver a nicotine-containing aerosol popularly called “vapor” to users by heating a solution commonly consisting of glycerin, nicotine and flavoring agents. E-liquids are flavored, including tobacco, menthol, coffee, candy, fruit and alcohol flavorings.
Despite many unanswered questions about e-cigarette safety, the impact on public health, and whether the products are effective at reducing tobacco smoking, e-cigarettes have swiftly penetrated the marketplace in the United States and abroad in both awareness and use. Sold by the major multinational tobacco and other companies, the devices are aggressively marketed in print, television and the Internet with messages similar to cigarette marketing in the 1950s and 1960s, even in the U.S. and other countries that have long banned advertising for cigarettes and other tobacco products.
In one indication of the swiftness by which the devices have been embraced, in the U.S. youth “ever use” of the devices rose from 3.3 percent in 2011 to 6.8 percent the following year; in Korea, youth “ever use” of e-cigarettes rose from .5 percent in 2008 to 9.4 percent in 2011. “Ever use” means whether one has smoked the product even just once.
Furthermore, most adults and youths who use e-cigarettes are engaging in “dual use” – smoking both e-cigarettes and conventional cigarettes.
While most youth using e-cigarettes are dual users, up to a third of adolescent e-cigarette users have never smoked a conventional cigarette, indicating that some youth are starting use of the addictive drug nicotine with e-cigarettes.
The report also tackles secondhand exposure.
“E-cigarettes do not burn or smolder the way conventional cigarettes do, so they do not emit side-stream smoke; however, bystanders are exposed to aerosol exhaled by the user,” said the authors. Toxins and nicotine have been measured in that aerosol, such as formaldehyde, acetaldehyde, acetic acid and other toxins emitted into the air, though at lower levels compared to conventional cigarette emissions.
One study of e-cigarettes was conducted to resemble a smoky bar: the researchers found that markers of nicotine in nonsmokers who sat nearby was similar for both cigarette smoke and e-cigarette aerosol exposure. Short-term exposure studies of e-cigarette use show a negative impact on lung function and bystanders absorb nicotine from passive exposure to e-cigarette aerosol, the authors report.
While early research found that e-cigarettes resulted in lower levels of plasma nicotine than conventional cigarettes, more recent research demonstrated that experienced users can attain nicotine absorption similar to that with conventional cigarettes.
When UCSF scientists pooled the results of five population-based studies of smokers, they found that smokers who used e-cigarettes were about a third less likely to quit smoking than those who did not use e-cigarettes. Whether e-cigarette use prevents attempts to quit or whether people who choose to use e-cigarettes are more highly dependent and therefore have a harder time quitting remains to be determined.
The scientists said their research illustrates the need for product regulation.
“While it is reasonable to assume that, if existing smokers switched completely from conventional cigarettes (with no other changes in use patterns) to e-cigarettes, there would be a lower disease burden caused by nicotine addiction, the evidence available at this time, although limited, points to high levels of dual use of e-cigarettes with conventional cigarettes, no proven cessation benefits, and rapidly increasing youth initiation with e-cigarettes,” the authors wrote.
“Furthermore, high rates of dual use may result in greater total public health burden and possibly increased individual risk if a smoker maintains an even low-level tobacco cigarette addiction for many years instead of quitting.”
The authors are Rachel Grana, PhD, MPH, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education (CTCRE); Neal Benowitz, MD, a UCSF professor of medicine and bioengineering and therapeutic sciences and chief of the division of clinical pharmacology at San Francisco General Hospital and Trauma Center; and Stanton Glantz, PhD, professor of medicine at UCSF, director of the CTCRE and the American Legacy Foundation Distinguished Professor in Tobacco Control.
The same authors have previously published general information on e-cigarettes.
The paper is a condensed and updated version of a longer report by Grana, Benowitz and Glantz with the support of the World Health Organization. Additional support came from the University of California Tobacco Related Disease Research Program and the National Cancer Institute and Food and Drug Administration Center for Tobacco Products.
Benowitz is a consultant to several pharmaceutical companies that market smoking cessation medications and has been a paid expert witness in litigation against tobacco companies.
UC San Francisco (UCSF), now celebrating the 150th anniversary of its founding, is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.

Science Daily reported about a Swedish Study which showed that parents are influential in their child’s decision whether to smoke.

Teenagers are more positive today towards their parents’ attempts to discourage them from smoking, regardless of whether or not they smoked, than in the past. The most effective actions parents could take include dissuading their children from smoking, not smoking themselves and not allowing their children to smoke at home. Younger children were more positive about these approaches than older children. Levels of smoking amongst participants were stable at 8% in 1987 and 1994, but halved in 2003. The decrease in the proportion of teenagers smoking is thought to result from a number of factors, including changes in legislation and the decreasing social acceptability of smoking….

Another study reported by Reuters came to a similar conclusion that parents influence the decision whether to smoke The Mayo Clinic has some excellent tips on preventing your teen from smoking

As with a lot of issues adolescents face, it is important for parents and guardians to know what is going on in their children’s lives. You should know who your children’s friends are and how these friends feel about smoking, drugs, and issues like sex. You should also know how the parents of your children’s friends feel about these issues. Do they smoke, for example, or are they permissive in allowing their children to use alcohol and/or other drugs. Are these values in accord with your values?

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One Response to “University of California San Francisco study: E-Cigarettes are gateway to smoking”


  1. University of California San Francisco study: E-Cigarettes are gateway to smoking - Pull My Index Finger - September 5, 2014

    […] University of California San Francisco study: E-Cigarettes are gateway to smoking […]

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