8 ms·

E-cigarette use as a predictor of cigarette smoking

village-idiot 8y ago
Nicotine addictive, vaping seen as a way to hook the next generation by tobacco execs, and other unsurprising facts tonight at 11.
minikites 8y ago
I'm not sure why we collectively decided to trust the tobacco industry on this issue, this can't be overly surprising given their level of interest in this emerging market.
seibelj 8y ago
I'm trying to follow the logic. E-cigarettes are already banned for those under-18 in America. Cigarettes and e-cigarettes are legal for those 18 and over. Because those who smoke e-cigarettes are more likely to smoke real cigarettes, we should ban e-cigarettes? Even though they are way less harmful than real cigarettes? Why not just ban real cigarettes? Wouldn't that solve all the problems? Oh yes... black markets, prohibition, arrests, expanding prison population, and on and on... If we aren't going to throw cigarette smokers in jail, and e-cigarettes are already illegal for those under-18, then I'm not sure what else we can do. The state could aggressively fine retail stores who sell to those underage (although I doubt they sell them illegally). More likely, arrest 18 year old high school kids who buy them for their friends and underclassmen. Alcohol and cigarettes were bought for me by the burnout and local junior college kids when I was in high school.
- antonvs 8y ago
  > Because those who smoke e-cigarettes are more likely to smoke real cigarettes, we should ban e-cigarettes? The conclusion in the article suggests "restricting youth access to e-cigarettes." It's not talking about a general ban. > e-cigarettes are already illegal for those under-18, In the US, individual states have varying laws, and the FDA position has been evolving. Research like this presumably provides input to that ongoing process. > Why not just ban real cigarettes? They are already restricted at the federal level for under 18. > Alcohol and cigarettes were bought for me by the burnout and local junior college kids when I was in high school. The problem with personal anecdotes like this is that they give no idea of how many kids actually didn't do alcohol or cigarettes, or consumed less than they would have otherwise, because of restrictions. Your unstated premise seems to be that restrictions like this don't work. If you look into that, you'll find that's incorrect.
  - seibelj 8y ago
    Yes, they are already banned. So why should the FDA ban the sale of Juul entirely?
loudandskittish 8y ago
But...why? I smoked a pack a day for a little more than 10 years, got an e-cigarette and haven't looked back. I don't understand why anyone would do the reverse.
- koolba 8y ago
  Maybe the same reason people go from smoking heroin to shooting it: it’s a stronger high (ie more nicotine)
  - p1necone 8y ago
    You can definitely get way more nicotine in a vape hit that you can from a cigarette.
    - LyndsySimon 8y ago
      You can get less, too - in fact, you can tinker with it to get pretty much anything you want.
  - mrob 8y ago
    E-cigarettes can contain any concentration of nicotine, and can have powerful enough heating elements to release huge quantities of it. E-cigarettes can deliver far more nicotine than cigarettes if you build them that way. But the user titrates the dose to the subjective effects, so dose per inhalation doesn't matter much. However, in most cases e-cigarettes deliver only nicotine, while tobacco also also contains harmala alkaloid monoamine oxidase inhibitors. In animal studies[0][1] these have a synergistic effect in producing addiction when combined with nicotine, and anecdotally many humans report whole tobacco alkaloids having a subjectively different effect than pure nicotine. [0] https://www.ncbi.nlm.nih.gov/pubmed/16177026 https://www.ncbi.nlm.nih.gov/pubmed/16177026 [1] https://www.ncbi.nlm.nih.gov/pubmed/14592678 https://www.ncbi.nlm.nih.gov/pubmed/14592678
    - sigmaprimus 8y ago
      I used to smoke a pack a day, switched to ecigs, bought enough concentrated nicotine juice to last me for the next 100 years, mix my own juice so no worries about getting a bad product. It's been 5 years now and I can't stand being in a car or house full of cigarette smoke anymore. If nothing else my health has improved just from the fact I'm no longer being taxed into the poor house and can afford to buy healthier food. I don't know if there are going to be long term effects from ecig use but having lost my mom to lung cancer I know there are from using cigarettes. I am against kids smoking anything but I would say that kids that admit to trying ecigs are probably just more prone to high risk activities, I bet most of them also drank and did drugs too in the past 12 months that doesn't mean the vaping is the cause. As for your comment I agree that some people that vape still get cravings for what ever else is in tobacco as my dad will vape 99% of the time but still carries a pack of cigarettes of which he will smoke one or two of per week. Still much better that just smoking and when he does smoke he goes outside of his home, which has resulted in an added benefit that more non smokers come to visit him more often reducing the loneliness any widower will suffer from.
maehwasu 8y ago
"Smoked a cigarette in the last 12 months" is an incredibly low bar, to the point where I'd guess the study had a desired outcome. The important question isn't "were vapers more likely to smoke 1+ times"--it's "how many cigarettes (from 0 to n) would the average vaper have smoked in the absence of vape options?" The latter is a counterfactual, and thus much harder to study. It's almost as if valuable research is hard, and you can't just slap together a few variables and toss the "Science!" label on it. Edit for context: I'm an ex 1-2 packs-a-day smoker, and vaping definitely helped me substitute a less harmful behavior. I smoke 5-30 cigarettes per year still, and vape about the same number of times per year. Having substitute options definitely helps avoid slipping back into cycles of addiction, to the point where I don't worry about that at all now.
- deleted 8y ago
  [deleted]
- doctorpangloss 8y ago
  I submitted this partly to see how people would explain away the result. 4.78 RR for smoking one year after vaping for non-smokers is pretty huge. That’s definitely a clinically significant result. Smoking itself is the highest OR for lung cancer and therefore mortality of any behavior (in the 60s for Americans), and using cigarettes really dooms you to that outcome. Nicotine patches, as transdermal delivery, don’t get people as high as Juul does, and that’s the likely reason you don’t observe either recreational use of them nor people becoming smokers from using them.
  - dionidium 8y ago
    You've used some jargon here that I don't understand, so I'm probably just missing it, but I don't see where any of this addresses the claim that, "Smoked a cigarette in the last 12 months" is a strikingly low bar.
    - doctorpangloss 8y ago
      On the one hand, I don't want to condescend. Relative risk and odds ratio are best explained on Wikipedia. If you want to get advice on smoking cessation, ask a doctor. There have been no clinical trials for Juul or any e-cigarette product. No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation. The strikingly low bar thing... People here defend Juul like people defended Theranos. Nobody wants to accept that the Juul guys are liars. Not yet anyway. If e-cigarette companies had a study, much like Theranos, they'd publish it. They'd compare it to nicotine patches. They just don't. There's no secret, it's really just an agglomeration of personal experiences and unfortunate but real stories quitting addiction masquerading as a positive public health development. This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. Correlation versus causation, whatever logic puzzles commenters invoke, it just distracts from both the evidence presented here and the total lack of a rigorous trial from e-cigarette sellers.
exabrial 8y ago
Why the heck are e-cigs illegal for anyone? They're as harmless as theater haze.
- mrob 8y ago
  The carrier liquid might be the same thing as theater haze, but theater haze doesn't contain nicotine (which has known health risks even without combustion products), doesn't contain flavorings that are only tested for food use (and the example of "popcorn lung" from diacetyl shows that inhaling flavorings directly is not the same as using them in food), and is inhaled in much lower concentrations. E-cigs are safer than smoking, but to call them "harmless" is a strong claim that requires evidence.
  - shermanyo 8y ago
    (Full disclosure: I run a small business making and selling flavoured e-cigarette liquid) The levels of diacetyl from a conventional cigarette can be around 750x that of what you'd get from an e-cigarette containing such a flavouring. Most concentrate manufacturers have removed or replaced any flavours that contain this or other known irritants wherever possible, and provide material safety data sheets for all ingredients. As far as I am aware, there have been no reported cases of "popcorn lung" from vapers or smokers. If I am mistaken or unaware of any contradictory information, I would really appreciate being pointed in the right direction. http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-average-diacetyl.html http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-...
innocentfelon 8y ago
The biggest flaw in this study has gone unmentioned: smokers lie. No one’s following these kids around to verify their responses are accurate. A sizable percentage of high school kids lie about anything for any number of reasons. Yeah man, I vape, can I go now? Yeah man, I smoke, are we done? That alone is plenty to throw out this data. The agenda here is clear: more research funding to justify harebrained regulations supported by halfassed written surveys.
- minikites 8y ago
  So we shouldn't research anything related to the social sciences because some people might lie about it? What leads you to believe that smokers lie more than nonsmokers if not social science research?
  - innocentfelon 8y ago
    The term for this situation is ”streetlighting”, where the possible reigns over the correct. “It’s dark in that alley. I’d never find my keys there.” Doesn’t matter if it’s extremely difficult to get good data here. What matters is we can’t substitute bad data if that’s all we can come up with. And although I stated it as smokers lying, the implication is that the nonsmokers are lying (by claiming to smoke).
    - sigmaprimus 8y ago
      It is my understanding that most surveys will include a margin of error. This story does not mention this, I wonder if this is just slight of hand while the east coast of the US falls into the sea?!
      - sigmaprimus 8y ago
        Or maybe the cable news sites are distracting me from this?!?
  - deleted 8y ago
    [deleted]
ajaimk 8y ago
Where does hookah play into this? I seriously want to know as I’ve never smoked cigarettes or have a nicotine dependence.
- aldoushuxley001 8y ago
  Hookah is unfortunately one of the absolute worst offenders health-wise. Think one hookah session is easily multiple cigarettes, likely on the much higher side too
widowlark 8y ago
Increase tax on tabacco products and include e-cigs
pavanlimo 8y ago
As a vaper (ex-smoker), let me assert that vaping is like driving Tesla Model S P100D and smoking is akin to driving 2003 Ford Focus. I'd never gateway to Ford Focus 2003 from Tesla Model S P100D. Cheeky but true.
OnlyRepliesToBS 8y ago
certainly trying really hard to correlate
abootstrapper 8y ago
Vaping: MAYBE it's not as unhealthy as smoking, but it's definitely not as cool.
- LyndsySimon 8y ago
  Interestingly enough, vapers themselves seem to be the ones reinforcing this. Every vape shop I've ever seen is filled with thick clouds, run by teenagers or burnouts, and just generally a pretty low-class place. On the other hand, I know several people who are successful professionals that vape. They order their stuff online, and don't advertise the fact that they vape.

Nicotine addictive, vaping seen as a way to hook the next generation by tobacco execs, and other unsurprising facts tonight at 11.

minikites 8y ago

I'm not sure why we collectively decided to trust the tobacco industry on this issue, this can't be overly surprising given their level of interest in this emerging market.

seibelj 8y ago

I'm trying to follow the logic. E-cigarettes are already banned for those under-18 in America. Cigarettes and e-cigarettes are legal for those 18 and over. Because those who smoke e-cigarettes are more likely to smoke real cigarettes, we should ban e-cigarettes? Even though they are way less harmful than real cigarettes? Why not just ban real cigarettes? Wouldn't that solve all the problems? Oh yes... black markets, prohibition, arrests, expanding prison population, and on and on... If we aren't going to throw cigarette smokers in jail, and e-cigarettes are already illegal for those under-18, then I'm not sure what else we can do. The state could aggressively fine retail stores who sell to those underage (although I doubt they sell them illegally). More likely, arrest 18 year old high school kids who buy them for their friends and underclassmen. Alcohol and cigarettes were bought for me by the burnout and local junior college kids when I was in high school.

antonvs 8y ago
> Because those who smoke e-cigarettes are more likely to smoke real cigarettes, we should ban e-cigarettes? The conclusion in the article suggests "restricting youth access to e-cigarettes." It's not talking about a general ban. > e-cigarettes are already illegal for those under-18, In the US, individual states have varying laws, and the FDA position has been evolving. Research like this presumably provides input to that ongoing process. > Why not just ban real cigarettes? They are already restricted at the federal level for under 18. > Alcohol and cigarettes were bought for me by the burnout and local junior college kids when I was in high school. The problem with personal anecdotes like this is that they give no idea of how many kids actually didn't do alcohol or cigarettes, or consumed less than they would have otherwise, because of restrictions. Your unstated premise seems to be that restrictions like this don't work. If you look into that, you'll find that's incorrect.
- seibelj 8y ago
  Yes, they are already banned. So why should the FDA ban the sale of Juul entirely?

loudandskittish 8y ago

But...why? I smoked a pack a day for a little more than 10 years, got an e-cigarette and haven't looked back. I don't understand why anyone would do the reverse.

koolba 8y ago
Maybe the same reason people go from smoking heroin to shooting it: it’s a stronger high (ie more nicotine)
- p1necone 8y ago
  You can definitely get way more nicotine in a vape hit that you can from a cigarette.
  - LyndsySimon 8y ago
    You can get less, too - in fact, you can tinker with it to get pretty much anything you want.
- mrob 8y ago
  E-cigarettes can contain any concentration of nicotine, and can have powerful enough heating elements to release huge quantities of it. E-cigarettes can deliver far more nicotine than cigarettes if you build them that way. But the user titrates the dose to the subjective effects, so dose per inhalation doesn't matter much. However, in most cases e-cigarettes deliver only nicotine, while tobacco also also contains harmala alkaloid monoamine oxidase inhibitors. In animal studies[0][1] these have a synergistic effect in producing addiction when combined with nicotine, and anecdotally many humans report whole tobacco alkaloids having a subjectively different effect than pure nicotine. [0] https://www.ncbi.nlm.nih.gov/pubmed/16177026 https://www.ncbi.nlm.nih.gov/pubmed/16177026 [1] https://www.ncbi.nlm.nih.gov/pubmed/14592678 https://www.ncbi.nlm.nih.gov/pubmed/14592678
  - sigmaprimus 8y ago
    I used to smoke a pack a day, switched to ecigs, bought enough concentrated nicotine juice to last me for the next 100 years, mix my own juice so no worries about getting a bad product. It's been 5 years now and I can't stand being in a car or house full of cigarette smoke anymore. If nothing else my health has improved just from the fact I'm no longer being taxed into the poor house and can afford to buy healthier food. I don't know if there are going to be long term effects from ecig use but having lost my mom to lung cancer I know there are from using cigarettes. I am against kids smoking anything but I would say that kids that admit to trying ecigs are probably just more prone to high risk activities, I bet most of them also drank and did drugs too in the past 12 months that doesn't mean the vaping is the cause. As for your comment I agree that some people that vape still get cravings for what ever else is in tobacco as my dad will vape 99% of the time but still carries a pack of cigarettes of which he will smoke one or two of per week. Still much better that just smoking and when he does smoke he goes outside of his home, which has resulted in an added benefit that more non smokers come to visit him more often reducing the loneliness any widower will suffer from.

maehwasu 8y ago

"Smoked a cigarette in the last 12 months" is an incredibly low bar, to the point where I'd guess the study had a desired outcome. The important question isn't "were vapers more likely to smoke 1+ times"--it's "how many cigarettes (from 0 to n) would the average vaper have smoked in the absence of vape options?" The latter is a counterfactual, and thus much harder to study. It's almost as if valuable research is hard, and you can't just slap together a few variables and toss the "Science!" label on it. Edit for context: I'm an ex 1-2 packs-a-day smoker, and vaping definitely helped me substitute a less harmful behavior. I smoke 5-30 cigarettes per year still, and vape about the same number of times per year. Having substitute options definitely helps avoid slipping back into cycles of addiction, to the point where I don't worry about that at all now.

deleted 8y ago
[deleted]
doctorpangloss 8y ago
I submitted this partly to see how people would explain away the result. 4.78 RR for smoking one year after vaping for non-smokers is pretty huge. That’s definitely a clinically significant result. Smoking itself is the highest OR for lung cancer and therefore mortality of any behavior (in the 60s for Americans), and using cigarettes really dooms you to that outcome. Nicotine patches, as transdermal delivery, don’t get people as high as Juul does, and that’s the likely reason you don’t observe either recreational use of them nor people becoming smokers from using them.
- dionidium 8y ago
  You've used some jargon here that I don't understand, so I'm probably just missing it, but I don't see where any of this addresses the claim that, "Smoked a cigarette in the last 12 months" is a strikingly low bar.
  - doctorpangloss 8y ago
    On the one hand, I don't want to condescend. Relative risk and odds ratio are best explained on Wikipedia. If you want to get advice on smoking cessation, ask a doctor. There have been no clinical trials for Juul or any e-cigarette product. No doctor following the letter of what they're supposed to be doing is going to recommend an e-cigarette product to a person seeking smoking cessation. The strikingly low bar thing... People here defend Juul like people defended Theranos. Nobody wants to accept that the Juul guys are liars. Not yet anyway. If e-cigarette companies had a study, much like Theranos, they'd publish it. They'd compare it to nicotine patches. They just don't. There's no secret, it's really just an agglomeration of personal experiences and unfortunate but real stories quitting addiction masquerading as a positive public health development. This study shows pretty unequivocally that vaping can't possibly just substitute for cigarette smoking. If it did, we'd observe zero cigarette smokers in the vaping-only population. Correlation versus causation, whatever logic puzzles commenters invoke, it just distracts from both the evidence presented here and the total lack of a rigorous trial from e-cigarette sellers.

exabrial 8y ago

Why the heck are e-cigs illegal for anyone? They're as harmless as theater haze.

mrob 8y ago
The carrier liquid might be the same thing as theater haze, but theater haze doesn't contain nicotine (which has known health risks even without combustion products), doesn't contain flavorings that are only tested for food use (and the example of "popcorn lung" from diacetyl shows that inhaling flavorings directly is not the same as using them in food), and is inhaled in much lower concentrations. E-cigs are safer than smoking, but to call them "harmless" is a strong claim that requires evidence.
- shermanyo 8y ago
  (Full disclosure: I run a small business making and selling flavoured e-cigarette liquid) The levels of diacetyl from a conventional cigarette can be around 750x that of what you'd get from an e-cigarette containing such a flavouring. Most concentrate manufacturers have removed or replaced any flavours that contain this or other known irritants wherever possible, and provide material safety data sheets for all ingredients. As far as I am aware, there have been no reported cases of "popcorn lung" from vapers or smokers. If I am mistaken or unaware of any contradictory information, I would really appreciate being pointed in the right direction. http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-average-diacetyl.html http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-...

innocentfelon 8y ago

The biggest flaw in this study has gone unmentioned: smokers lie. No one’s following these kids around to verify their responses are accurate. A sizable percentage of high school kids lie about anything for any number of reasons. Yeah man, I vape, can I go now? Yeah man, I smoke, are we done? That alone is plenty to throw out this data. The agenda here is clear: more research funding to justify harebrained regulations supported by halfassed written surveys.

minikites 8y ago
So we shouldn't research anything related to the social sciences because some people might lie about it? What leads you to believe that smokers lie more than nonsmokers if not social science research?
- innocentfelon 8y ago
  The term for this situation is ”streetlighting”, where the possible reigns over the correct. “It’s dark in that alley. I’d never find my keys there.” Doesn’t matter if it’s extremely difficult to get good data here. What matters is we can’t substitute bad data if that’s all we can come up with. And although I stated it as smokers lying, the implication is that the nonsmokers are lying (by claiming to smoke).
  - sigmaprimus 8y ago
    It is my understanding that most surveys will include a margin of error. This story does not mention this, I wonder if this is just slight of hand while the east coast of the US falls into the sea?!
    - sigmaprimus 8y ago
      Or maybe the cable news sites are distracting me from this?!?
- deleted 8y ago
  [deleted]

ajaimk 8y ago

Where does hookah play into this? I seriously want to know as I’ve never smoked cigarettes or have a nicotine dependence.

aldoushuxley001 8y ago
Hookah is unfortunately one of the absolute worst offenders health-wise. Think one hookah session is easily multiple cigarettes, likely on the much higher side too

widowlark 8y ago

Increase tax on tabacco products and include e-cigs

pavanlimo 8y ago

As a vaper (ex-smoker), let me assert that vaping is like driving Tesla Model S P100D and smoking is akin to driving 2003 Ford Focus. I'd never gateway to Ford Focus 2003 from Tesla Model S P100D. Cheeky but true.

OnlyRepliesToBS 8y ago

certainly trying really hard to correlate

abootstrapper 8y ago

Vaping: MAYBE it's not as unhealthy as smoking, but it's definitely not as cool.

LyndsySimon 8y ago
Interestingly enough, vapers themselves seem to be the ones reinforcing this. Every vape shop I've ever seen is filled with thick clouds, run by teenagers or burnouts, and just generally a pretty low-class place. On the other hand, I know several people who are successful professionals that vape. They order their stuff online, and don't advertise the fact that they vape.