Some experts concerned that vaping may be pathway to nicotine addiction, but others say it is less dangerous than smoking
More teenagers are trying or using e-cigarettes than tobacco products, according to a US study that has prompted fresh concerns among some scientists about a new generation of nicotine addicts. The report is the first to claim such high rates of e-cigarette use among 12- to 18-year-olds, though the study did not distinguish between those who had had one puff and never tried them again and more regular users.
"This is an early warning sign, not the final story," Wilson Compton, deputy director of the US National Institute on Drug Abuse, said at an American Association for the Advancement of Science meeting in San Jose.
Advocates believe that e-cigarettes - which do not contain tobacco - have an enormous potential to improve public health by replacing traditional cigarettes, which contain hundreds of harmful chemicals. But some critics fear that the products could draw more people into nicotine addiction and possibly act as a gateway to smoking tobacco.
Figures from an annual survey of more than 40,000 students in 400 US secondary schools showed that 8.7% of 14-year-olds had smoked an e-cigarette in the previous month. Among 16- and 18-year-olds, the figures were higher, at 16.2% and 17.1% respectively. By comparison, the survey found that 4% of 14-year-olds, 7% of 16-year-olds and 14% of 18-year-olds reported using a tobacco cigarette.
Compton said: "It is quite surprising that a larger number of teenagers in the US are now reporting current use of e-cigarettes than traditional tobacco cigarettes."
The same survey, based on spring 2014 data compiled by the University of Michigan, found that 36% of 14-year-olds who had tried e-cigarettes in the past month had never tried smoking or chewing tobacco. Among the older teens, 30% and 21% of e-cigarette smokers aged 16 and 18 respectively said they had not previously tried tobacco products.
"That's a concern, because this may be a unique and new pathway to nicotine exposure and could open up the potential for the development of addiction to nicotine, with the potential for long-lasting complications and progression to the use of absolutely harmful forms of tobacco," said Compton. He said the use of e-cigarettes by teenagers was a particular issue because adolescence seemed to be a critical time for the seeds of addiction to be sown.
But other experts said children trying e-cigarettes instead of traditional cigarettes was no bad thing. "Smoking prevalence in youth is showing an unprecedented decline and it is now lower than ever before," said Peter Hajek, director of the tobacco dependence research unit at Barts and the London school of medicine. "The fact that young people are trying e-cigarettes instead of cigarettes is a cause for relief rather than alarm."
Hajek added: "A lot of adolescents try e-cigarettes by taking a puff from someone's device, but, crucially, they do not progress to regular use. In fact, they usually do not try them again, and there is even some evidence that this may protect them from picking up smoking."
In the UK, about 80,000 people a year die from tobacco smoke-related diseases - nearly a fifth of all deaths in the over-35s. The most damaging health effects - cancer and heart disease - are linked to inhaling tar and other chemicals produced when the tobacco burns. Though e-cigarettes produce fewer noxious chemicals, tests have found the vapour from some to contain cancer-causing substances such as formaldehyde and acetaldehyde.
Deborah Arnott, head of Action on Smoking and Health (Ash), said: "Nicotine can be harmful to the growing brain, so it's best if young people avoid it. But if they're going to experiment, it's better to use e-cigarettes, as vaping is far less dangerous than smoking and much less addictive. We need to keep track, but so far in the UK and the US smoking rates are going down more than e-cigarette use is growing. This would not be the case if vaping really were a gateway into smoking."
Estimates from Ash suggest that 1.3 million people in the UK use electronic cigarettes, with about 400,000 people using them instead of traditional cigarettes.
Roy Harrison, professor of environmental health at Birmingham University, said: "There are likely public health benefits from e-cigarettes if they provide a pathway for smokers to give up tobacco use. There is evidence that this can happen, and little doubt that e-cigarettes are much less harmful to the smoker than tobacco. However, if adolescents who have never used tobacco take up e-cigarette use, this is a matter of profound concern as they are deliberately exposing themselves to a highly addictive substance."
A man using an electronic cigarette. Photograph: Yui Mok/PA