E-cigarettes in Hawaii More Popular Than Traditional Ones Among Teens

Hawaii recently received some welcome news when it was once again named the healthiest state in America as calculated by the United Health Foundation—owing to factors such as good physical activity and low smoking rates.

Around the same time, however, another study coming from the University of Hawaii painted a different picture when it found that nearly 30 percent of Hawaii teens had tried e-cigarettes—a substantially higher prevalence than that found among teens on the mainland. Of this group, about 17 percent of the teens reported using only e-cigarettes, while 12 percent had used both e-cigarettes and traditional cigarettes, and 3 percent of teens had used only traditional cigarettes.

Moreover, the teens who used e-cigarettes were not as influenced by risk factors—such as sensation seeking, rebelliousness, or friends who smoke—that are associated with traditional smoking.

As lead author Thomas Wills, Ph.D., at the University of Hawaii Cancer Center pointed out, “This suggests a model where e-cigarette usage is driven by curiosity and exploration as opposed to reckless behavior and peer influence.”

Wills, whose study appears in Pediatrics, noted that Hawaii has a market that supports curious behavior, as e-cigarette advertising is aggressive and prevalent—ads appear in malls and movie theaters and on radio and TV. This has led to a high awareness of e-cigarettes as well as favorable perceptions; two-thirds of the teens surveyed in the study said that they considered e-cigarettes to be healthier than regular cigarettes. Wills aims to conduct follow-up studies exploring how advertising influences teen consumption of e-cigarettes.

While Hawaii does feature some unique geographical, cultural, and demographic traits in comparison to the mainland states, Wills also believes this study has national implications: “We did some previous analysis and found that the factors that drive teen substance use in Hawaii are the same ones that influence teens in Los Angeles or Baltimore or the rest of the United States.”

Indeed, survey results released by the National Institute on Drug Abuse as part of its Monitoring the Future (MTF) program confirm a high national prevalence of e-cigarette usage among teens even as rates for regular cigarettes, alcohol, and other drugs continue to decline. The 2014 MTF survey found that about 16 percent of 10th-graders and 17 percent of 12th-graders reported trying an e-cigarette within the past 30 days, compared with 7 percent and 13 percent of those groups, respectively, trying regular cigarettes.

This was the first MTF survey to measure e-cigarette usage, so officials couldn’t identify specific trends, but given results of other recent surveys, electronic smoking among teens does appear to be growing.

“It’s very concerning to see that e-cigarette usage has surpassed other tobacco products so quickly among teens,” said Laurie Witsel, Ph.D., director of policy research for the American Heart Association (AHA). “As the recent data have shown, we’ve made great progress in reducing cigarette use among kids, and it would be a shame if we lost those gains.”

This rapid rise may suggest that e-cigarettes are a passing fad, given the current ease of access, assortment of appealing flavors, and technological aspect of the delivery system. “Even so, this remains a major problem as nicotine is very addictive, and short-term use could turn into long-term abuse,” Witsel told Psychiatric News.

Witsel believes these new data reinforce many of the concerns raised in the recent AHA policy statement regarding electronic cigarettes (Psychiatric News, November 21, 2014)—for which Witsel served as a panel member—and that the Food and Drug Administration needs to develop strong regulations for these products.

Both Wills and Witsel agreed that a key step forward for research is to untangle what’s going on with the high number of dual users identified in the Hawaii study; does this group represent teen smokers looking for an alternative, teens transitioning from e-cigarettes to the real thing, or something else entirely?

“This is an important and unknown aspect of electronic cigarettes to be talking about—and one relevant for child psychiatry,” said Douglas Ziedonis, M.D., M.P.H., chair of the Department of Psychiatry at the University of Massachusetts Medical School. “Many adolescents who develop mental illness are already smokers or start smoking soon after, and we need to understand how e-cigarettes fit in this dynamic.”

The study was supported by a grant from the National Cancer Institute. ■

“Risk Factors for Exclusive E-Cigarette Use and Dual E-Cigarette Use and Tobacco Use in Adolescents” can be accessed here. Data from the 2014 Monitoring the Future Survey is available here.