The U.S. Centers for Disease Control and Prevention have recently become concerned about e-cigarette use yet scarcely mention that cigarette uptake has plummeted.

Cigarettes are the killer, not nicotine, but nicotine is what historically turned smoking into what the American Council on Science and Health (ACSH) deems a pediatric disease. Like caffeine, nicotine is addictive. If you smoked caffeine in a cigarette, it would be incredibly toxic whereas nicotine itself is relatively harmless. And because the CDC has overreacted to e-cigarettes, they become a cool rebellious thing for teems, just like cigarettes once were.

But because most e-cigarettes are based on flavors rather than nicotine, they are much easier to shake than coffee once the fad fades away. What ACSH deems "nicotine naive" uptake of e-cigarettes migrating to smoking (those who never smoked who took up e-cigarettes and then cigarettes) is almost non-existent. So e-cigarettes are most likely the kind of experimentation teens have done throughout history.  

"While e-cigarettes are frequently used as devices for smoking cessation in adults, we found most students in our survey (including 47.8% of those who recently smoked cigarettes) were motivated by the "cool/fun/something new" features of e-cigarettes," writes Dr. Michael Khoury, a pediatric cardiology resident at Stollery Children's Hospital, Edmonton, Alberta, Canada, and coauthors in 
CMAJ (Canadian Medical Association Journal). 

The study involved 2367 students aged 14-15 years enrolled in grade 9 in the Niagara region of Ontario, Canada.

Previous studies have found increasing rates of e-cigarette use by adolescents in the United States and Canada, and some have found higher rates of e-cigarette use in adolescents exposed to tobacco. In Canada, e-cigarette use is now more common than cigarette use by teenagers.

Researchers from SickKids and Heart Niagara in Niagara Falls, Ontario, sought to understand the motivation, frequency and other factors for use of e-cigarettes by teens who were part of a school-based program that screens for cardiovascular risk factors. Of the 2367 teens who responded to at least 1 question in the smoking section of the survey, nearly 70% (1599) had heard about e-cigarettes; almost a quarter of them (380) had learned about them from a display or a sign in a store. Over 10% (238) had used e-cigarettes.

E-cigarette use was more common among male respondents who were already using cigarettes and other tobacco products, and in those whose family or friends smoked. Smoking cessation did not appear to be a driver of e-cigarette use.

"Use of e-cigarettes was [also] associated with lower self-identified health level, greater stress level and a lower estimated household income, which suggests that e-cigarette use may have some key associations that may help to identify adolescents at risk," write the authors.

They acknowledge that, owing to the study's cross-sectional design, the findings represet association and cannot prove causation, and that since the study was limited to one region in Canada the findings are not necessarily generalisable.

The authors call for the continued development of strict regulations to reduce the use of e-cigarettes among adolescents.

In a related editorial (pre-embargo link), Dr. Matthew Stanbrook, Deputy Editor, CMAJ, and a respirologist, highlights as concerning the study's novel finding that e-cigarette use was highest among the most vulnerable youth, as reflected by poor health, high stress or low socioeconomic status. He also expresses concern over the study's confirmation that most teens were not substituting e-cigarettes for cigarettes; instead, the odds of e-cigarette use were 12-fold higher in youth who also smoked cigarettes (i.e., "dual users").

Dr. Stanbrook calls for expanded public health programs that apply anti-tobacco principles to e-cigarettes, government prohibition of the addition of flavourings, and restrictions on e-cigarette advertising.