Survey: In Teens, Most Vaping Does Not Involve Nicotine

Two-thirds reported using flavor-only products

Use of e-cigarettes and other vaping products has increased sharply among U.S. teens in recent years, but a large percentage appear to be using flavor-only, non-nicotine liquids when they vape, according to findings from a newly released survey.

Two out of three teens who reported vaping at least once said their last vaping session involved "just flavoring" vaping liquids without nicotine, while one in five reported using vaping liquids with nicotine.

Findings from the National Institute on Drug Abuse's (NIDA) 2015 Monitoring the Future survey suggest that the spike in e-cigarette use among teens does not represent an epidemic of new nicotine use in this age group, lead researcher Richard Miech, PhD, of the University of Michigan in Ann Arbor, told MedPage Today.

Miech and colleagues reported the findings in the journal Tobacco Control, published online Aug. 25.

He noted that the survey results challenge the common assumption that all adolescents who use vaping products are inhaling, and possibly becoming addicted to, nicotine.

The approximately 15,000 8th-, 10th-, and 12th-graders who took part in the survey were asked about their vaping habits, and 10%, 14%, and 16%, respectively, reported using e-cigarettes within the past 30 days.

"This is a rapid growth from a 30-day prevalence of nearly 1% among secondary school students in 2011," the researchers wrote. "The use has grown to such an extent that among adolescents, 30-day prevalence of e-cigarette use in 2015 was higher than prevalence of any tobacco product, including traditional tobacco cigarettes."

Students reporting having used e-cigarettes or other vape products were asked to describe the substances in the vaping mist they inhaled during their last vaping session, with choices being "Nicotine," Marijuana or hash oil," "Just flavoring," "Other," or "Don't know."

Respondents were also asked the frequency of their use of a vape product during the past 30 days, and whether they had smoked a regular cigarette during this period. Demographic information, including race/ethnicity, gender, and parental education, was self-reported.

The main results:

• A total of 3,837 students reported some vaping experience (34%, 32%, and 21% of 12th, 10th, and eighth graders, respectively);
• Between 65% and 66% of students in each grade reported vaping "just flavoring" the last time they vaped; and
• Of the students who had used a vape product in the past month (16% of 12th graders, 14% of 10th graders, and 8% of eighth graders), 59% to 63% reported vaping "just flavoring" at last use.

"Vaping of nicotine came in a distant second place," the researchers wrote. "Among respondents who had ever vaped, about 20% of 12th- and 10th-grade students and 13% of eighth-grade students reported vaping nicotine at last use."

Miech said the survey findings call into question the tactics being used by public health and anti-smoking groups to keep teens from using e-cigarettes and other vaping products: "They are trying to follow the playbook that has been so successful for [combustible] cigarettes, and I don't think it will work. Regular cigarettes kill about half the people who use them, and yet it took decades to come up with a definitive body of research to prove that."

He added that since the research on e-cigarettes is just getting underway, it will likely be a decade or more before the health effects of vaping are known.

What is increasingly clear, though, he said, is that use of e-cigarettes is associated with greater uptake of regular cigarettes by teens. Studies published within the last year in Tobacco Control, Pediatrics and JAMA all found that adolescents who used e-cigarettes were more likely to start smoking regular cigarettes. This was even true of teens who reported having no interest in smoking cigarettes.

"Just about every study has shown e-cigarette use to be a predictor of [cigarette] smoking," he said, adding that this message may be a more effective one.

Still, Erika Seward, of the American Lung Association, said the survey results may be misleading, because even though vaping liquids may claim to be nicotine-free, they may not be.

Vaping liquids were unregulated until recently, she noted. Manufacturers will now be required to tell the FDA what is in the products in order to stay on the market, but they have another two years to do so.

Seward pointed out that FDA's 2009 analysis of e-cigarette samples revealed that many products that claimed to be free of nicotine actually were not. Samples also included other ingredients known to be toxic to humans, including diethylene glycol, which is used in antifreeze.

Funding for the research was provided by the NIH's National Institute on Drug Abuse.

last updated 08.26.2016

Primary Source: Miech R, et al "What are kids vaping? results from a national survey of US adolescents" Tobacco Control 2016; DOI: 10.1136/tobaccocontrol-2016-053014.

This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.

Disclosures:

The researchers declared having no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner