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Adolescents who use e-cigarettes are twice as likely to smoke, new report says
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If your teen uses e-cigarettes and other alternate forms of tobacco, she could be twice as likely to smoke cigarettes this time next year. New research suggests that vaping could be a gateway to tobacco addiction. - photo by Jennifer Graham
Teens may think they're playing it safe by using e-cigarettes, hookahs and smokeless tobacco, but they're twice as likely to have smoked cigarettes a year later if they use alternative tobacco products, a new report says.

Consequently, the gains made in public health as cigarette smoking has declined in recent years may be at risk if the use of novel tobacco products continues to rise, according to the authors of the study, published Tuesday in the journal JAMA Pediatrics.

Researchers at the University of California, San Francisco, examined the records of 13,651 adolescents enrolled in the Population Assessment of Tobacco and Health, a nationwide study begun in 2013 by the National Institutes of Health and the Food and Drug Administration.

At the beginning of the study period, the teens, ages 12-17, had not smoked a cigarette, and a year later, a majority of them were still not tobacco users.

However, youths who reported using e-cigarettes or other non-cigarette forms of tobacco the first year of the study were twice as likely to have smoked at least one cigarette or smoked in the past 30 days one year later.

These alternative forms include hookah tobacco, smokeless tobacco and other types of combustible tobacco, such as bidis, cigarillos, filtered and traditional cigars, kreteks and pipes.

Having smoked at least once is significant in teens, the study authors said, because of how fast tobacco addiction can take hold.

About 90 percent of adult smokers had their first cigarette before they turned 18, and smoking only one cigarette a month in adolescence is associated with future daily smoking in adulthood, the report said.

"Cigarette ever use is a meaningful outcome given that nicotine dependence can manifest in adolescents soon after their first puff, but other smoking milestones, such as daily smoking, can take years to develop," the report said. "Past 30-day use is the standard surveillance measure for current smoking among youths and is associated with smoking in adulthood."

The lead author of the study said that previous research has shown an association between e-cigarette use and future cigarette smoking, but this study is the first to demonstrate that the association is consistent across every alternate type of tobacco delivery.

We hear so much talk about e-cigarettes, which are now the most used tobacco product among adolescents, even higher use than cigarettes. And there is a lot of talk about cigarettes, which is absolutely justified. But when you look at these other products too, like smokeless tobacco and cigarillos, theyre having the same magnitude of relationship with future smoking, said Shannon Lea Watkins, a postdoctoral fellow at the Center for Tobacco Control Research and Education at the University of California, San Francisco.

Even a little bit of use of these products can get kids addicted, she said.

The findings are also important because some of the novel tobacco products have especially high rates of use among adolescents in vulnerable populations. For example, smokeless tobacco use is higher among rural white adolescents, while cigarillo use is seen more often among lower-income African-American teens, she said.

Although rates of smoking among teens have declined steadily in the past 20 years, in 2016 about 3.9 million middle and high school students were using at least 1 tobacco product, and 1.8 million were using two or more, the JAMA Pediatrics report said.

In Utah, about 15.5 percent of high school seniors reported using e-cigarettes in 2017, according to the state Department of Health. Among all high school students, about 11 percent reported vaping last year, compared to 5.8 percent in 2013.

The new findings can help public-health officials better target anti-tobacco messaging and also shows that it's important for such campaigns to include all types of tobacco delivery, not just e-cigarettes, Watkins said.

We should think about the overall public health burden, and their potential to convert non-cigarette users to cigarette users, when we are making choices about the regulation of these product, Watkins said.

We should think not only the harm these types of products cause, but also the potential harm that comes from cigarettes. And even if kids use these products and dont convert to cigarette smoking, its not the only relevant health concern.

In 2016, the Food and Drug Administration announced its intention to begin regulating all tobacco products, including e-cigarettes, hookahs and cigars, as it does cigarettes. Companies that make e-cigarettes and other non-combustible products have until 2022 to submit applications for approval; manufacturers of combustibles such as cigars and hookah tobacco must apply by 2021. They are allowed to continue to sell the products while the FDA reviews their applications.

E-cigarettes also known as vapes or vape pens deliver nicotine and flavorings through vapors that users inhale. Critics, which include the Campaign for Tobacco-Free Kids, want the FDA to ban flavoring that attracts kids.

Its not surprising that products like e-cigarettes and cigars have become popular with kids when they are sold in sweet flavors like gummy bear and cherry dynamite, said Vince Willmore, vice president of communications for the Campaign for Tobacco-Free Kids, which was not involved in the research.

Our nation has made enormous progress in reducing youth cigarette smoking. We cant allow a new generation of tobacco products to undermine these gains, Willmore said.

E-cigarettes are commonly marketed as a safer alternative to conventional smoking, a claim that is not supported by research, according to a new study by researchers at the Keck School of Medicine at the University of Southern California. In that report, the authors examined more than 2 million social media posts that involved e-cigarettes and found that automated bots were using fake accounts to promote the idea that e-cigarettes help people quit smoking.

And in another report released Tuesday, researchers said that nearly 3 million American teens had been exposed to online marketing of tobacco, as cigarette manufacturers have shifted their marketing strategies from traditional forms of media to the internet.

"Online marketing may make these adolescents more susceptible to tobacco use initiation by altering perceived norms and risk perceptions regarding tobacco use," the authors wrote.

Tobacco use is the leading cause of preventable disease and death among Americans, the Centers for Disease Control and Prevention says. If current smoking rates continue, more than 5 million people who are now under the age of 18 will die prematurely from smoking-related conditions, according to the CDC.
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From the book 'Outliers' comes proof that good health is more than just genetics
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Friends Jim Young, left, Mike Natale, Jeff Natale and Ryan Kiernan were on Greenwich High School football team together and Jim and Mike were captains. Jim, who was the youngest in Sherry Young's family, was welcome in the homes of the other three boys who still had siblings around and grandparents near. - photo by Sherry Young
As I look back on my life and the lives of others, both personally and in the reading I have done, I am convinced of the necessity of positive human contact in our lives. We are doubly blessed when we are able to make good friends or are a part of a family where we are accepted and loved.

Malcolm Gladwell in his book Outliers tells of a time in the 1950s when Dr. Stewart Wolf met a physician who practiced in the area of Roseto, Pennsylvania. Roseto was settled by a group of Italian families from Roseto, Italy, who re-created their life again in America.

This was in the 1950s before drugs and measures to prevent heart disease became important. In their conversation the physician said, You know, Ive been practicing for 17 years. I get patients from all over, and I rarely find anyone from Roseto under the age of 65 with heart disease.

Wolf was surprised by these words as, It was impossible to be a doctor, common sense said, and not see heart disease.

Wolf enlisted the aid of a sociologist and friend John Bruhn to help him. They found, There was no suicide, no alcoholism, no drug addiction, and very little crime. They didnt have anyone on welfare. Then we looked at peptic ulcers. They didnt have any of those either. These people were dying of old age. Thats it.

They checked into diet, genetics and possibilities of something in the foothills of eastern Pennsylvania but nothing made sense.

What they found was that Rosetans visited one another, stopping to chat in Italian on the street, say, or cooking for one another in their backyards. (Researchers) learned about the extended family clans that underlay the towns social structure. They saw how many homes had three generations living under one roof and how much respect grandparents commanded. They went to Mass at Our Lady of Mount Carmel and saw the unifying and calming effect of the church. They counted 22 separate civic organizations in a town of just under 2,000 people. They picked up on the particular egalitarian ethos of the community, which discouraged the wealthy from flaunting their success and helped the unsuccessful obscure their failures.

What they found eventually convinced the medical establishment to look beyond the individual and understand the culture people are part of their friends, families and town they came from. They determined that the people we surround ourselves with and the values of the world we inhabit have a profound effect on who we are.

Likely, this study could have been done with other ethnicities. However, my family's experiences with the Italian families in Connecticut ring true to the study. Our hungry and growing sons, especially our youngest son, Jim, who was left home alone with two beady-eyed parents, all had some memorable experiences being fed and loved in the Cos Cob multigenerational families. Proof of the African proverb, It takes a village to raise a child.

We live in an age when the contact we have with people often is on the internet, and many of us live among strangers. Unless we make the effort to reach out, we will become isolated, especially as we age. The Rosetan study is proof that reaching out and communicating may be good for our health.
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