Survey: Teens still intrigued by e-cigarettes

Cigarette use among teens hit an all-time low, but their fascination with e-cigarettes remains strong, a national survey of nearly 45,000 youth found.

The students surveyed favored e-cigarettes, which heat liquid into a vapor that can be inhaled, over traditional cigarettes.  And more than half of them credited curiosity as their primary motivation for trying the battery-operated devices.

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“They wanted to see what they were like — to experiment,” Lloyd Johnston, the principal investigator for the annual Monitoring the Future study conducted by the University of Michigan and sponsored by the National Institute on Drug Abuse (NIDA).

Monitoring the Future, now in its 41st year, surveyed 44,892 students in the 8th, 10th and 12th grades at 382 schools nationwide. The survey asks teens about their use of alcohol, cigarettes, and legal and illegal drugs.

Among 8th graders, 9% reported using e-cigarettes in the previous 30 days, while 4% reported using cigarettes. Among 10th graders, 16% said they used an e-cigarette and 7% said they used a tobacco cigarette in the same time period. Slightly more high school seniors – 17% – reported use of e-cigarettes, while double the percentage – 14% – smoked a tobacco cigarette.

This year marked a drop in rates of tobacco cigarette use among teens from last year’s numbers, but their e-cigarette use, which has only been measured in the survey for two years, held steady from 2014 to 2015.  And it’s becoming a point of concern among researchers.

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“The saving grace of e-cigarettes was that people who were addicted to nicotine cigarettes could switch over to these so they weren’t getting the contaminants in tobacco,” Johnston says.

But teens aren’t using e-cigarettes that way, the survey found. One in 10 reported using e-cigarettes to quit smoking, a number Johnston calls “negligible.” Forty percent of the students surveyed reported using e-cigarettes because they taste good.

Unlike traditional cigarettes, e-cigarettes don’t contain tobacco and carcinogens or produce smoke. But that’s not to say they come without risks.

Researchers at Harvard University recently found evidence of chemicals that cause respiratory problems in 47 of 51 types of flavored e-cigarettes they tested. What’s more, Johnston says the lack of federal regulation on e-cigarettes makes it nearly impossible to tell what, exactly, the device’s cartridges — called cartomizers — contain aside from their “fun” flavors.

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“[You] just buy these inserts that go into the vaporizer and it can be with nicotine or not. The same stores sell them all," he says. "I don’t even think you always know what’s in them.”

And that's exactly what the survey revealed. Among 8th graders alone, 13% admitted to being unsure of what they were inhaling while using e-cigarettes.

It’s a world that J. Taylor Hays, director of the Mayo Clinic Nicotine Dependence Center, has likened to the Wild West. And it’s a world in need of increased oversight, the survey’s researchers say.

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“There’s good chance that the Food and Drug Administration will introduce limitations on who can buy these,” Johnston says. “There should be age limitations.”

Although 41 states bar children under 18 from buying e-cigarettes, a March report published in JAMA Pediatrics revealed 94% could easily purchase them online. Banning youth-friendly cartridge flavors, such as bubble gum, cotton candy and tutti frutti, may deter teens from using the devices, Johnston says.

NIDA director Nora Volkow says nicotine hiding in some e-cigarettes may serve as a “gateway” to more dangerous substance addictions. Teens may also repurpose the device for other substances, she says. Yale University researchers recently found about 27% of high school students who have used both marijuana and e-cigarettes reported using the e-cigarette devices to vaporize cannabis.

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“It’s becoming a fashion or a trend to use an e-cigarette,” Volkow says. “That by itself will drive the use of e-cigarettes whether they have drugs or not.”

Decreasing their appeal will become “more urgent as studies emerge that identify the adverse outcomes,” she says.

"If we are not proactive with prevention campaigns, we may lose some of the ground we have gained in the very successful campaigns against cigarette smoking,” Volkow says.

The results of this year’s survey indicate no ground has been lost when it comes to teens’ use of cigarettes, illicit drugs and alcohol. Most of the categories measured continued long-term declines in 2015, while some – such as marijuana use – held steady from 2014. Smart Approaches to Marijuana president Kevin Sabet blames increased commercialization and industrialization of marijuana for the lack of decline in teen usage rates.

"[The industry] is promoting marijuana use and selling products like marijuana sodas and gummi bears," the former White House drug policy advisor said in a statement. "It has counteracted the hard work and advances made by drug prevention advocates, all in favor of financial gain."

The use of both alcohol and cigarettes among teens reached their lowest points since the study’s inception in 1975. Students for Sensible Drug Policy executive director Betty Aldworth said the steadily declining numbers of teens using tobacco and alcohol indicate that education, public health-based prevention and regulation work better than criminalization.

​"Youth marijuana use is stable, and even falling in some categories, all while a growing number of states enact legalization," Aldworth said in a statement. "This new data solidifies early indications that the scare tactics peddled by prohibitionists are false. Criminalization isn't the way to encourage young people to make healthy choices; regulating a legal market and honest, reality-based education is."

Survey: Teen marijuana use declines even as states legalize

While this year's survey results are heartening, Johnston says he remains cautiously optimistic.

“I worry that, when everything seems to be going in the right direction, that we get over-confident,” he says.

Which is why Volkow says, “we cannot become complacent … we need to continue with prevention efforts.”