Could e-cigarettes contribute to harm reduction for children as well as adults?
Time: 11:25 - 11:40
Date: Tuesday 7th December 2021
Current policy approaches to e-cigarette regulation in the USA give primacy to the need to protect children from addiction over fostering increased adult smoking cessation. But, as well as failing to maximise the potential public health gain from adult use of new nicotine delivery products, the focus on minimizing children’s use of e-cigarettes might itself be a net contributor to harm at the population level, by inadvertently favouring the incumbent cigarette and hampering the transition to genuinely reduced risk alternatives.
This talk will give data from the Youth Risk Behavior Survey, conducted on a national sample of high school students in the USA, on risk behaviours in a number of domains, including drug use, violence, sexual behaviour, psychological wellbeing, and school attendance and performance. Current use of e-cigarettes and cigarettes are both associated with the whole range of problem behaviours, with the association being stronger for cigarettes than for e-cigarettes. Causal pathways between different behaviours cannot be identified, but the occurrence of any one behaviour tends to be positively associated with all of the others, lending support to the notion of shared vulnerability factors, the so-called common liability hypothesis. On this model, the rise in popularity of e-cigarettes to overtake cigarettes among youth is better understood as product substitution, rather than as a concerning new risk for enticing otherwise innocent youth into cigarette use and nicotine addiction.
The talk will also update information from the National Youth Tobacco Survey on nicotine dependence in youth e-cigarette and cigarette users. It remains the case that indicators of dependence are highest in those who smoke cigarettes, and considerably lower in e-cigarette users. In 2020 only 254,000 (2.3%) of otherwise tobacco-naïve high school students used e-cigarettes on 20 or more days in the past month. The estimated overall population burden of nicotine dependence in youth has decreased between 2012 and 2020.