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Although testing e-cigarettes may lead some young people to start smoking at the individual level, there is little evidence that this is the case at the population level, the researchers conclude. And these results are consistent over several years, they point out.
Earlier this year, the National Academies of Science, Engineering and Medicine published a report concluding that there was "substantial evidence" that a vaping among young people is strongly associated with progression to smoking.
But the report also noted that the recent increase in the popularity of electronic cigarettes was associated with a decline in smoking rates in this age group.
In an attempt to explore these trends in greater depth and to address the question of whether vaping could serve as a gateway to smoking, the researchers performed temporal trend analysis, using data available at the local level. public until 2017.
They were first inspired by nationally representative surveys on smoking and smoking among 15 to 25 year olds, as it is the oldest age group. likely to start and / or continue to smoke regularly.
They then examined smoking habits among teens and young adults, dating back to 2004, to assess smoking trends before the use of electronic cigarettes became popular.
They used the answers to five different national surveys. In cases where information was available, they included any use of cigarettes during the previous 30 days, as well as an established use, defined as a daily / half-pack per day / 100 cigarettes smoked to date and currently smoking some days.
Responses revealed that the prevalence of vaping was low between 2011 and 2013, but that it had reached much higher levels in 2014, which was therefore identified as the critical point when vaping became popular among drug users. adolescents and young adults.
The choice of this date is corroborated by data on retail sales, which more than doubled in 2014, and by the percentage of adults switching from electronic cigarettes to cigarettes, which also doubled between 2012-13 and 2013 -14.
The analysis showed that the downward trend in smoking prevalence among youth in the United States accelerated after 2013, when vaping became more prevalent, and this was particularly evident among 18-21 years old.
The analysis also showed that the decline in more established smoking accelerated rapidly as the prevalence of vaping increased. And the proportion of those who reported smoking in the past 30 days, who had dropped slowly in 2012, decreased more strongly (two to four times) once vaping became popular.
The results were consistent across different surveys, suggesting that the results were reliable despite different methods of data collection and after correction of data entry anomalies.
The researchers suggest that the increase in smoking prevalence associated with the prevalence of vaping, found by other researchers, could nonetheless be consistent with their findings.
"It is possible that trying to smoke electronic cigarettes has a causal link with smoking in some young people, but the overall effect of this relationship at the population level may be low enough for its effects to be submerged." by other factors that influence smoking behavior, "they suggest.
These factors could include media campaigns and tobacco control policies: further research would be needed to distinguish between their potential role and the rise in popularity of vaping, they add.
This is an observational study, and as such, can not establish the cause. And since the analyzes were all done with US data, the results may not be applicable elsewhere, warn researchers.
"While we are cautious in interpreting our findings, they provide a consistent picture of the accelerated reduction in smoking prevalence among youth and young adults as vaping increases. generalized, "they write.
And, referring to the report of the national academies, they add: "In our opinion, it is premature to conclude that the increased rate of decrease in smoking observed is due to the fact that vaping diverts young people from smoking, although it is a plausible explanation. "
They conclude, "If our main concern is with population trends in smoking among youth and young adults, which we feel is appropriate, then vaping is not a serious cause for concern … and can contribute to the recent decline in smoking among young people and young adults. "
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