Nicotine experimentation could become nicotine addiction for youth who never used any other tobacco products, USC study suggests 
 
 A new USC study debunks the popular belief that electronic cigarettes are merely a substitute for cigarettes among teens. Instead, the study suggests that some teens who never would have smoked cigarettes are now vaping. 
 
 E-cigarettes, which entered the U.S. market in 2007, vaporize liquids that may or may not contain nicotine. In 2011, about 1.5 percent of high schoolers had vaped in the past 30 days, according to the National Youth Tobacco Survey. Four years later, that number skyrocketed to 16 percent. 
 
 A USC study of 5,490 high school juniors and seniors shows tobacco use among teens in Southern California is on the rise. 
 
 In 2014, about 14 percent of 12th-graders said they had either smoked or vaped in the previous 30 days. A decade earlier -- before e-cigarettes were sold in the United States -- 9 percent of surveyed teens in this age group reported that they had smoked, said Jessica Barrington-Trimis, lead author and a postdoctoral scholar research associate in the Department of Preventive Medicine at the Keck School of Medicine of USC. 
 
 "If teenagers who vape are using e-cigarettes instead of cigarettes, we would have expected to see the decline in smoking rates continue through 2014," Barrington-Trimis said. "But what we've seen is a downward trend in cigarette use from 1995 to 2004 but no further decrease in cigarette smoking rates in 2014. The combined e-cigarette and cigarette use in 2014 far exceeded what we would have expected if teens were simply substituting cigarettes with e-cigarettes. The data suggest that at least some of the teens who are vaping would not have smoked cigarettes." 
 
 The study, published on July 11 in the journal Pediatrics, followed five groups of high schoolers who graduated in 1995, 1998, 2001, 2004 and 2014. Researchers collected the history of tobacco use in an individually administered questionnaire. 
 
 Cigarette use is the largest preventable cause of death and disease in the United States. Cigarette smoking kills more than 480,000 Americans annually, according to the Centers for Disease Control. 
 
 "An important question in the rapidly evolving landscape of youth tobacco product use is whether e-cigarettes are replacing cigarettes," said Rob McConnell, the study's senior author and professor of preventive medicine at Keck Medicine of USC. "However, use of e-cigarettes by youth who would not otherwise have smoked results in exposure to the hazards of inhaled vaporized liquids and flavorings in e-cigarettes and may result in exposure to nicotine that can damage the adolescent brain." 
 
 USC is one of 14 U.S. research institutions that received National Institutes of Health funding to establish the Tobacco Centers of Regulatory Science. 
 
 What the numbers suggest 
 
 The National Youth Tobacco Survey has reported a long-term decline in teen smoking rates followed by a leveling off between 2014 and 2015. 
 
 The USC study found that the number of 12th-graders in Southern California who had smoked in the past 30 days dropped from 19 percent in 1995 to about 9 percent in 2004 and then leveled off, with the rate of smoking just under 8 percent in 2014. 
 
 But when cigarettes and e-cigarettes were combined, some 14 percent of high school seniors in 2014 said they had smoked or vaped in the last 30 days. 
 
 "Because e-cigarettes are perceived as less harmful and less dangerous than combustible cigarettes, another concern is that teens may be introduced to nicotine use via e-cigarettes," Barrington-Trimis said. "In California, where smoking rates are among the lowest in the country, the increase in vaping, possibly followed by increases in smoking, could erode the progress that has been made over the last several decades in tobacco control." 
 
 A perilous experiment 
 
 In fact, older teens who experiment with electronic cigarettes are six times more likely to try regular cigarettes within about a year when compared to those who have never vaped, reported Barrington-Trimis and her USC colleagues in a study published last month in Pediatrics. 
 
 Although some e-liquid providers say their products do not contain nicotine, this industry has not been regulated until just recently. The U.S. Food and Drug Administration announced plans to regulate all tobacco products -- including e-cigarettes, cigars and hookah tobacco -- in May. Last month, California became the second state, behind Hawaii, to raise the age of tobacco purchase -- including e-cigarettes -- from 18 to 21. 
 
 "E-cigarettes may be recruiting a new group of kids to tobacco use," Barrington-Trimis said. "E-cigarettes may be safer than regular cigarettes for adults who are transitioning from smoking to vaping, but for youth who have never used any other tobacco products, nicotine experimentation could become nicotine addiction." 
 
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 The study was supported by the National Institutes of Health National Cancer Institute and the Food and Drug Administration Center for Tobacco Products (P50CA180905). ||||| Photo 
 
 Many teenagers who never would have smoked cigarettes are now “vaping” with flavored e-cigarettes, leading to a new generation using nicotine at rates not seen since the 1990s, a new study suggests. 
 
 The study, released Monday in the journal Pediatrics, tracked the use of cigarettes and e-cigarettes among 5,490 California high school seniors who graduated between 1995 and 2014. E-cigarettes do not burn tobacco, but are battery-operated inhalers that heat up and vaporize liquid containing flavors and nicotine, a practice known as vaping. The liquids used in vaping range in taste from traditional tobacco and menthol flavors to fruity and sweet combinations like gummi bear, banana bread and cotton candy. 
 
 When e-cigarettes came on the market in 2007, some public health experts hoped that they would serve as a substitute for traditional tobacco products and lead to declines in tobacco use. 
 
 But the data from the latest study, conducted by researchers at the University of Southern California, tell a different story. E-cigarettes do not appear to have made a dent in regular cigarette use — the number of high school seniors who reported smoking tobacco in the past 30 days has largely plateaued. In 2004, the number of 12th graders who reported smoking tobacco in the past 30 days was 9 percent; in 2014 that number was just under 8 percent. 
 
 But the rate of teenagers using nicotine — either through tobacco cigarettes or e-cigarettes — is on the rise. About 14 percent of Southern California high school seniors in 2014 said they had smoked or vaped in the last 30 days. Researchers say they have not seen similar levels of nicotine use among teenagers since 1995, when 12th-grade smoking rates were 19 percent. 
 
 The numbers suggest that rather than prompting teenagers to replace cigarette smoking with vaping, e-cigarettes instead have enticed an entirely new group of teenagers to use nicotine. While the study focused on California teenagers, researchers say the numbers are consistent with national trends. 
 
 “Kids are not just using e-cigarettes instead of cigarettes. That is what we were frankly hoping to find,” said Jessica Barrington-Trimis, the lead author of the study and a postdoctoral scholar research associate in the department of preventive medicine at the U.S.C. Keck School of Medicine. All of the teenagers that were expected to be using cigarettes in 2014 are using them, she said, “and then there is a whole group of kids using e-cigarettes on top of that.” 
 
 The amount of nicotine in the liquids used with e-cigarettes — often called “vape juice” — varies, and users can purchase liquid with no nicotine or nicotine content ranging from 3 milligrams per milliliter to 18 milligrams per milliliter or even higher. While earlier studies have suggested that some teens are using nicotine-free vaping liquids, researchers say the majority of teens appear to be using nicotine-infused liquid in their e-cigarettes. 
 
 Dr. Jonathan Winickoff, professor of pediatrics at MassGeneral Hospital for Children and Harvard Medical School, who wrote an accompanying paper in Pediatrics, said this is the first study of e-cigarette use in adolescents to show such a strong longitudinal sample with such a drastic effect. 
 
 “We had a trend of decreasing nicotine use,” said Dr. Winickoff. “What the e-cigarette has done is halted that decrease in its tracks…. We don’t want a fifth of our high school students graduating with nicotine addiction.” 
 
 While e-cigarettes do appear to be safer than smoking tobacco, they are not risk free. Nicotine disrupts neurotransmitter activity and is highly addictive, particularly in a developing brain. And the liquids contain solvents, formaldehyde and other ingredients that pose health risks when inhaled. 
 
 While it’s true that there are nicotine-free vaping liquids, the e-cigarette industry is not regulated, which makes it hard to know what ingredients are actually in any given product. Though the Food and Drug Administration recently took jurisdiction over e-cigarettes, it will be years before any regulations are put into effect. Currently, many products continue to be made in China with little — if any — oversight by the United States. 
 
 “The F.D.A. has done tests on these vaping products that supposedly do and do not contain nicotine, and what is advertised is really not what’s in the product,” Dr. Winickoff said. “When the product is labeled as no nicotine, they’ve found nicotine. So kids don’t know what they’re getting, and as a pediatrician it really scares me.” 
 
 Not everyone agrees that e-cigarettes pose a significant risk to teenagers. Dr. Michael Siegel, professor of community health sciences at the Boston University School of Public Health, countered that many teenagers say they are using e-cigarettes that contain only flavorings and no nicotine, and therefore are not getting addicted. 
 
 “E-cigarette use among teenagers is a largely social phenomenon,” he said. “The fact that you tend to see teenagers doing this in groups, not out in the cold vaping alone, suggests that e-cigarettes are not addictive.” 
 
 But there is a growing body of research showing that e-cigarettes do serve as a gateway to traditional tobacco products. Last month, the U.S.C. researchers also reported in Pediatrics that adolescents who vape are six times more likely to smoke cigarettes in early adulthood as nonusers. 
 
 “Once kids get hooked on e-cigarettes, they are more likely to go on to become cigarette smokers,” said Stanton A. Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. ||||| The use of electronic cigarettes by high school students tripled from 2013 to 2014 — a surprising boom that threatens to wipe out hard-won gains in the fight against teen smoking, a new government report says. 
 
 The percentage of American high school students who smoked traditional cigarettes on a regular basis dropped from 15.8% in 2011 to 9.2% in 2014, according to a study by a team from the Centers for Disease Control and Prevention. 
 
 But that drop has been more than offset by increases in e-cigarette use, which increased from 1.5% of high school students in 2011 to 13.4% in 2014, the study says. 
 
 E-cigarettes are now the most popular tobacco product used by both high school and middle school students, the federal data show. 
 
 As a result, overall tobacco use by high school students — including the use of cigars, pipes, hookahs, bidis, snus and other smokeless tobacco — has remained essentially flat, with nearly 1 in 4 students using some kind of tobacco product. 
 
 Among them is Dean Wilson, an 18-year-old who attends Polytechnic High School in Long Beach. Though he has tried regular cigarettes, he said he prefers “vaping” with e-cigarettes because they are new and trendy, and because they come in a variety of appealing flavors. 
 
 He also believes they are less dangerous than traditional cigarettes. “They supposedly have less nicotine,” he said. 
 
 Fellow student Jose Sanchez said he wouldn't use any type of cigarette because he has asthma and smoking would interfere with his ability to play soccer. But he has certainly noticed his classmates using the electronic devices. 
 
 “They're a lot more popular now,” he said. “People want to fit in.” 
 
 With their colorful designs and candy-store flavors, e-cigarettes — battery-powered devices that heat a nicotine solution into a vapor — seem perfectly designed to get kids and teens hooked on nicotine, many public health experts say. The Food and Drug Administration defines e-cigarettes as a tobacco product because they use nicotine. 
 
 Some experts fear e-cigarettes are becoming a “gateway drug” that makes young people more inclined to try traditional cigarettes, cigars or other dangerous products. 
 
 “They're like cigarettes on training wheels,” said UC San Francisco tobacco researcher Stanton Glantz. 
 
 The new study, based on data from the National Youth Tobacco Survey and released Thursday in the CDC's Morbidity and Mortality Weekly Report, doesn't prove that hypothesis. But it isn't exactly reassuring either. 
 
 The CDC study backs up a Monitoring the Future report released in December by the University of Michigan, which found that twice as many eighth- and 10th-graders had used e-cigarettes in the previous month than had smoked traditional cigarettes. E-cigarettes were also more popular among 12th-graders, 17% to 14%. 
 
 The Michigan report was the first to show that e-cigarettes had become teens' tobacco product of choice. 
 
 Their appeal extends to students in middle schools, the new CDC study shows. In 2014, 3.9% of students in grades six through eight were using e-cigarettes. That was well above the 2.5% rate for traditional cigarettes and for hookahs. 
 
 Among the high school crowd, hookahs were the second most popular form of tobacco, with 9.4% of students reporting current use. Regular cigarettes came in third, with a 9.2% use rate, followed by cigars at 8.2%. 
 
 Altogether, 24.6% of ninth- through 12th-graders were regularly using some kind of tobacco product in 2014. 
 
 That equates to more than 3.7 million teens. An additional 910,000 middle school students were regular tobacco users in 2014, or 7.7% of kids in this age group. 
 
 The speed with which electronic cigarettes have swept through schools has alarmed the nation's health experts. In 2011, when the CDC first tracked their use, only 1.5% of high school students said they had used the devices in the previous 30 days. That rate tripled to 4.5% by 2013 before tripling again last year. 
 
 Glantz said he was particularly troubled because “the epidemic was building from the bottom up.” 
 
 Unlike traditional smoking, a habit that has trickled down from adults to kids, e-cigarettes seem to be gaining the strongest foothold with the youngest users and expanding upward, he said. 
 
 He added that psychology studies suggest that many kids who pick up e-cigarettes would never have tried traditional cigarettes. 
 
 “This is explosive growth,” he said. “If we were talking about the spread of any other toxic chemical it would be a public health crisis.” 
 
 Michael Siegel, a professor of community health sciences at Boston University's School of Public Health, said that public health advocates were drawing the wrong conclusion from the study. 
 
 “The CDC should be celebrating that we're seeing a decline in youth smoking,” he said. 
 
 If vaping is a gateway to smoking regular cigarettes, he added, the data would have revealed an increase in their use. 
 
 “We're getting kids off tobacco,” he said. “That's the goal.” 
 
 The FDA has been trying to regulate e-cigarettes since 2009, first as medical devices and later as tobacco products. But legal challenges, a lack of clear-cut data on their health effects and other hurdles have slowed the effort. 
 
 “These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health,” said Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products. 
 
 Last year, the federal agency said it intended to ban e-cigarette sales to minors and require manufacturers to put health warnings on the devices, as is required for traditional cigarettes. These rules have not yet been implemented because the FDA is still reviewing public comments. 
 
 The FDA's proposal did not include other restrictions that might limit e-cigarettes' appeal to young people, such as restrictions on advertising and flavorings.
– With the debut of vaping in the US in 2007, there was hope that teens who smoked would replace old-school cigarettes with e-cigarettes, curbing tobacco use. But a new USC study in the journal Pediatrics has found teens who never would have smoked regular cigarettes are experimenting with vaping. Another USC study finds older teens who try vaping are six times more likely to try a tobacco-filled cigarette than non-vapers, per a press release. "E-cigarettes may be recruiting a new group of kids to tobacco use," says Jessica Barrington-Trimis, lead author of both studies. While e-cigs may seem safer than tobacco, if they come pumped with nicotine (some don't), kids can get addicted. The New York Times notes chemicals in the vaping liquid may be harmful; WebMD adds long-term effects are unknown. Using participants from USC's Children's Health Study, scientists followed 5,490 teens who graduated high school in select years between 1995 and 2015, asking them via questionnaire about their tobacco use. It's true that rates among Southern California teens who said they had smoked over the past 30 days fell significantly from 1995 to 2004 (19% to 9%), and slightly more in the decade after that (a bit less than 8% by 2014). But when teens were asked to include e-cigarettes in their assessments, the smoking rate jumped back up to 14% in 2014. And that's got scientists worried, especially with the prevalence of e-cigarettes that come in kid-friendly flavors such as cotton candy. "E-cigarettes may be safer than regular cigarettes for adults who are transitioning from smoking to vaping, but for youth who have never used any other tobacco products, nicotine experimentation could become nicotine addiction," Barrington-Trimis says.