Cannabis is estimated to be responsible for around 13% of new regular tobacco use

Teens and young adults who use cannabis are more likely to become regular tobacco users – even if they haven’t previously tried tobacco – compared to similar people who do not use cannabis, suggests a US study published online in the journal Tobacco Control.

Around 13% of new onset tobacco use was estimated to be attributable to cannabis, the study found.

Tobacco smoking has been considered a gateway to cannabis use since the 1970s when smoking was much more prevalent and when almost all people who used cannabis had smoked tobacco first.

Although tobacco use among teens and young adults has declined considerably in the United States since the 1970s, cannabis use has not. This raises the question of whether a reverse gateway from cannabis to regular tobacco use might exist.

To investigate the authors mined data from a regular survey of US households called PATH (Population Assessment of Tobacco and Health) to look at the association of cannabis use by teens and young adults in 2017 and their likelihood of regular tobacco use four years later in 2021.

A total of 13,851 respondents aged 12–24 years who in 2017 had said they had never or never regularly used any form of tobacco (combustible or non-combustible) and who completed the subsequent surveys were identified, of which 15.4% had admitted using cannabis in the last 12 months. The likelihood of cannabis use increased with age of the respondent.

Each person who used cannabis was matched to a similar non-user according to a number of characteristics including demographics, history of experimentation with tobacco products, perceived harmfulness of cigarettes and mental health symptoms.

The study found that 32.7% of US teens aged 12–17 years who had used cannabis had progressed to regular tobacco use four years later – an increase of 15.6 percentage points compared with their matched controls. Among the young adults aged 18–24 years, 14% of those who used cannabis reported regular tobacco use – an increase of 5.4 percentage points over their matched controls.

The analysis attributed 13% of total new regular tobacco use to cannabis and when extrapolated across the entire US population, the authors estimated that 509,800 fewer US teens and young adults would have progressed to regular tobacco use in 2021 if they had not had previous experience of cannabis in 2017.

This is an observational study, and as such, can’t establish cause and effect, and the authors also acknowledge several limitations including the use of self-reported measures for tobacco and cannabis use. Although a comprehensive list of baseline covariates was considered, some factors such as peer influences, socioeconomic factors and an underlying liability to substance use may not have been captured fully. Assessing cannabis use in the past 12 months rather than current use is also likely to have attenuated the estimated effect size.

Nevertheless, the authors conclude that cannabis use by US youth is a major risk factor for progression to regular tobacco use, independent of whether or not they have yet tried tobacco.

“The finding that prior cannabis use is a major risk factor for initiation of current regular tobacco use among youth, independent of whether or not they have tried tobacco, suggests that cannabis prevention should be included as a key goal in tobacco control programmes” the authors said.

“While early cannabis use is seen as a major public health problem, none of the major health agencies have addressed the potential of early cannabis use to increase future regular tobacco use.”

They add, “This study provides evidence that failure to address cannabis use among young people has the potential to undermine the progress tobacco control efforts have made in reducing tobacco initiation and progression to regular use.”

23/10/2025

Notes for editors
Research: Cannabis use and progression to regular tobacco use among United States youth and young adults: evidence from the Population Assessment of Tobacco and Health (PATH) study, 2017–2021 doi: 10.1136/tc- 2025-059634
Journal: Tobacco Control

External funding: Tobacco- Related Disease Research Program (TRDRP) of the University of California, Office of the President and the National Cancer Institute of the National Institutes of Health.

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

About the journal
Tobacco Control is one of 70  journals published by BMJ Group. ‌The title is owned by BMJ.
https://tobaccocontrol.bmj.com/

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Teenagers and young adults

The post Teenagers and young adults who use cannabis have a higher risk of progressing to regular tobacco use first appeared on BMJ Group.

As well as heightened risks of asthma, cough, injuries and mental ill health + possibly pneumonia, bronchitis, headaches, migraines, dizziness, low sperm count, poor oral health

Vaping among teens and young people is consistently linked to subsequent smoking, marijuana and alcohol use, finds an overarching (umbrella) review of systematic reviews of the evidence, published online in the journal Tobacco Control.

And it’s associated with other harmful consequences, including heightened risks of asthma, cough, injuries and mental ill health as well as possibly pneumonia, bronchitis, headaches, migraine, dizziness/lightheadedness, low sperm count, and poor mouth health.

The findings reinforce policy measures to restrict sales and marketing of vapes to young people, conclude the researchers.

The World Health Organization (WHO) has described the rise in the prevalence of children who vape around the world as “alarming.” The proportion of 15–16 year olds who vape ranges from 5.5% to 41% in WHO Europe region countries alone, note the researchers. And concerns persist about the harms of vaping in young people, in particular whether vaping leads to smoking.

Although four umbrella reviews on the topic have been published, these don’t focus exclusively on young people or do so only for a narrow set of outcomes, such as smoking initiation, they add.

To strengthen the evidence base and uncover the extent of physical and mental harms associated with vaping among young people, the researchers carried out an overarching review of existing systematic (and umbrella) reviews after scouring research databases.

The 56 reviews (52 systematic reviews and 4 umbrella reviews) included pooled data analyses and health technology assessment reports, published between 2016 and 2024, with most (47) published after 2020.

Synthesis of the data from 21 systematic reviews revealed a consistent and significant association between vaping and starting smoking, ranging from a 50% to 26-fold higher risk, and suggesting a causal relationship, say the researchers.

Most of these reviews suggested that young people who vape are about 3 times as likely to start smoking as those who don’t vape.

Pooled data analysis of the results of 5 systematic reviews showed a strong link between vaping and substance use, ranging from a near tripling to 6-fold heightened risks for marijuana, a 4.5 to more than 6-fold increased risk for alcohol, and a 4.5 to a nearly 7-fold increased risk for binge drinking.

Asthma was the most common respiratory health outcome, with consistent associations of between 20% and 36% heightened risks of being diagnosed with the condition, and a 44% heightened risk of worsening symptoms.

Synthesis of the findings from 3 systematic reviews showed associations between vaping and suicidal outcomes, and 6 others suggested associations between burn injuries or similar.

Significant associations emerged between vaping and other harmful health outcomes, including pneumonia, bronchitis, lower total sperm counts, dizziness, headaches, migraines and poor mouth health, although this evidence was largely derived from limited surveys or case series/reports, note the researchers.

They acknowledge that the quality of umbrella reviews depends on the quality of the included systematic reviews. And much of the evidence on outcomes was observational. Inferring causality therefore remains difficult, say the researchers.

“None the less, given the consistent associations we observed with increased smoking and multiple possible harms to health and wellbeing in this age group, which are consistent with possible causal effects, the evidence supports policy measures to protect young people who do not smoke from the potential risks associated with vaping,” they emphasise.

These measures include restricting the sales and marketing of vapes to young people, and curbs on advertising design features that are likely to appeal to them.

“Such efforts may form part of a wider set of measures to restrict harms, including raising the public’s and young people’s awareness of these harms, and counter-marketing to raise public and policy awareness of the marketing and strategies that e-cigarette companies have targeted at children and young people,” they add.

19/08/2025

Notes for editors
Research: Vaping and harm in young people: umbrella review Doi:10.1136/tc-2024-059219
Journal: Tobacco Control

External funding: National Institute for Health and Social Care Research (NIHR) Policy Research Programme

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Umbrella review of systematic reviews
Subjects: People

The post Youth vaping consistently linked to subsequent smoking, marijuana and alcohol use first appeared on BMJ Group.

Likelihood of smoking 1.5% among teens who don’t vape, but 33% among those who do

UK teens who currently vape are as likely to take up smoking as their peers in the 1970s,  despite a substantial fall in the prevalence of teenage smoking over the past 50 years, suggests a long term intergenerational study published online in the journal Tobacco Control.

The likelihood of starting to smoke among teens who don’t vape was around 1.5%, but 33% among those who do, the findings indicate.

It’s not entirely clear if the rise in popularity of e-cigarettes (vapes) among teens threatens the steady decline in the prevalence of cigarette smoking in this age group, say the researchers, as the published research is somewhat equivocal.

And if historic declines are slowing, it’s not clear how the risk of cigarette smoking among today’s young people—especially those who vape—compares to that of previous generations who came of age before notable tobacco control legislation and the advent of e-cigarettes, they add.

To try and find out, they drew on intergenerational data from three nationally representative birth cohorts of UK teens* born in 1958 (National Child Development Study; NCDS), 1970 (The British Cohort Study; BCS), and 2001 (Millennium Cohort Study; MCS).

As well as baseline surveys at either birth or 9 months, MCS participants provided data at ages 3, 5, 7, 11, 14, 17 and 23; BCS participants at ages 5, 10, 16, 26, 30, 34, 38, 42, 46 and 51; and NCDS participants at ages 7, 11, 16, 23, 33, 42, 46, 50, 55 and 62.

The prevalence of teen smoking was assessed in 1974 among 11,969 NCDS participants, in 1986 among 6222 BCS participants, and in 2018 among 9733 MCS participants. The odds of smoking  among 16 and 17 year olds were estimated, based on a common set of childhood risk and protective factors; teen vaping was included as a predictor in the MCS.

Risk/protective factors included whether they had ever drunk alcohol by age 16 or 17; how engaged they were with education at school; the extent of externalising behaviours reported by the mother or main caregiver at ages 10 or 11; and parental occupation, education, and smoking behaviour— including during pregnancy.

Analysis of the intergenerational data revealed a steep decline in the prevalence of cigarette smoking among teens, falling from 33% in 1974, to 25% in 1986, and to 12% in 2018. Around half of the MCS participants hadn’t vaped by the time they were 17; 41% said they had previously vaped; and 11% reported current vaping.

The decline in prevalence of teen smoking can be attributed to a mix of tobacco control legislation, better public understanding of the health consequences of smoking, and a shift away from the perception of smoking as socially acceptable, suggest the researchers.

Risk/protective factors also changed over time. For example, the percentage of teens who had started drinking by the age of 16 or 17 fell from 94% in the NCDS to 83% in the MCS.

The average age at which mothers left education also rose from 15.5 in the NCDS to 17 in the MCS. Similarly, the prevalence of parental smoking fell from over 70% in the NCDS to 27% in the MCS; and fewer mothers continued smoking while pregnant in the MCS than in the NCDS and the BCS.

Many risk factors for teen smoking were similar across the cohorts—drinking before the age of 17 and greater externalising behaviours, for example—as were some child level protective factors—greater engagement with education, for example.

To illustrate the likelihood of cigarette smoking for an ‘average’ teen (16-17) over time, the researchers worked out predicted probabilities of cigarette smoking with all risk factors included from the intergenerational data.

This probability was 30% in the NCDS and 22% in the BCS. Among those who had never vaped in the MCS this was around 1.5%, but 33% for the teens who reported current vaping.

“This probability is especially concerning given the recent increases in e-cigarette use prevalence among UK youth, despite some initial assurances that e-cigarettes would have little appeal to [them],” say the researchers.

The researchers acknowledge that they were unable to account for some sociodemographic characteristics, including race and ethnicity, due to insufficient sample sizes in the earlier cohorts. And they emphasise that estimates of the associations between vaping and smoking in the MCS aren’t causal and shouldn’t be interpreted as such, especially as the temporal sequencing of smoking and vaping isn’t explicit.

Nevertheless they conclude: “While our research shows that the historic decline in the likelihood of youth cigarette smoking has continued in this recent cohort of UK youth, overall, we find that this is not the case among e-cigarette users.

“Youth who had never used e-cigarettes had an estimated less than 1 in 50 chance of reporting weekly cigarette use at age 17, while those who had previously used e-cigarettes had over a 1 in 10 chance. Youth who reported current e-cigarette use had an almost 1 in 3 chance of also reporting current cigarette use.

“As such, the decline in the likelihood of cigarette smoking is waning for youth who have used e-cigarettes—about half of our sample—and has reversed for those currently using e-cigarettes.

“Among contemporary youth, efforts to reduce cigarette smoking should focus both on those who are currently using e-cigarettes and on the prevention of e-cigarette use among youth, to maintain the promising declines in youth nicotine use in years to come.”

30/07/2025

Notes for editors
*The Millennium Cohort Study (MCS) follows teens who were born in 2000–01 and who were children when e-cigarettes were introduced.
The British Cohort Study (BCS) follows children born in 1970, who were teenagers in the 1980s when cigarette use among young people was relatively widespread, and who were in their 40s before e-cigarettes were introduced.
The National Child Development Study (NCDS) follows children born in 1958 who were children when cigarette smoking was at its historic peak.

Research: Risk of adolescent cigarette use in three UK birth cohorts before and after e-cigarettes Doi: 10.1136/tc-2024-059212
Journal: Tobacco Control

External funding: The Economic and Social Research Council; National Cancer Institute; Criminal Justice Research Center, Penn State University

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Teenagers

The post UK teens who currently vape as likely to start smoking as their peers in the 1970s first appeared on BMJ Group.

Prevalence twice as high among those still puffing away as those who have never smoked
Figures suggest that 40% of 25 million adults experience some level of functional difficulty 

Around 1 in 7 of US adults who currently smoke may have some degree of disability, suggests the first study of its kind published online in the journal Tobacco Control.

And the prevalence of disability and/or some degree of functional difficulty is twice as high among those who continue to puff away as it is among those who have never smoked, the data analysis indicates.

All in all, the figures suggest that 40% of the estimated 25 million adults who currently smoke experience some level of functional difficulty, estimate the researchers.

In 2019, smoking was the third leading risk factor for disability in the United States. But relatively little is known about the prevalence, degree, and type of functional difficulty associated with smoking, say the researchers.

To explore this further, they analysed data for 150,220 people from the National Health Interview Survey (NHIS) for the period 2019 to 2023 inclusive.

Participants were grouped according to whether they currently, formerly, or had never smoked. And the Washington Group–Short Set (WG-SS) was used to measure the degree of functional difficulty in 6 core areas: vision (even when wearing glasses); hearing (even with a hearing aid); mobility (walking or climbing steps); communication (understanding or being understood); cognition (memory and concentration); self-care (washing and dressing).

Participants were considered to have a disability if they reported having “a lot of difficulty” or “cannot do at all” in 1 or more of these 6 core areas. Those who reported “some difficulty” in at least 1 core area were also included in the estimates.

Between 2019 and 2023, 1 in 7 (14%) of those who currently smoked reported a disability compared with 12.5% of adults who formerly smoked and 7% of those who had never smoked.

The most common disabilities among those who currently, formerly, or never smoked were, respectively, mobility (8%, 8%, and 4%) and cognitive issues (4.5%, 3%, and 2%).

Among adults who currently smoked, more than half (54%) reported “some”, “a lot of”, or “cannot do at all” for at least 1 disability type. And the prevalence of vision, hearing, mobility and cognitive disabilities among those who currently smoked was double that of those who had never smoked.

The estimates for disability were significantly higher for those who currently smoked than they were among those who had never smoked with the exception of self-care, and they were also significantly higher for adults who formerly smoked with the exception of communication.

Stratification of disability prevalence by age, sex, race/ethnicity, and educational level among adults who currently smoked showed that it was 16.5% among women and 12% among men and ranged from just over 21.5% among the over 65s to 9% among 25–44 year olds.

Similarly, the prevalence of disability ranged from 19% among non-Hispanic Others to 11% among Hispanics, and from 21.5% among those who didn’t graduate from high school to 8% among college graduates.

Overall, the pooled analysis reveals that of the estimated 25 million US adults who are still smoking in the US, about 40% experience at least some level of functional difficulty, estimate the researchers.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. It also relied on self report, which may be subject to imperfect recall, and in this case, societal pressures.

But they point out that smoking cessation initiatives frequently don’t factor in disability, prompting them to conclude: “Each disability type may present unique challenges and barriers to using conventional smoking cessation interventions, which can be addressed if considerations relating to universal design are incorporated upfront.”

They add: “Understanding that more than 1 in 7 adults who smoke live with a disability, and knowing the type, degree of functional difficulties, and demographic characteristics can aid public health officials in designing interventions to reduce smoking that are appropriate and effective for people with disabilities.

30/05/2025

Research: Estimating the prevalence of disability among adults in the USA who smoke cigarettes, 2019–2023  Doi 10.1136/tc-2024-059027

External funding: None declared

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Around 1 in 7 US adults who smoke may have some degree of disability first appeared on BMJ Group.

But there is a risk it may lead to fewer people switching from smoking to vaping

Standardising the colour and branding of disposable vaping devices may deter young people who have never smoked or vaped from trying them in the first place, suggests a comparative study, published online in the journal Tobacco Control.

But a potential trade-off is that there is a risk it may lead to fewer people switching from smoking to vaping, say the researchers.

Vaping has surged in popularity among young people in many countries over the past decade in tandem with the introduction of cheap disposable devices, point out the researchers.

Previously published research suggests that colourful branded packaging can increase the appeal of cigarettes and vapes to young people. But there’s no current evidence on whether standardising the appearance of disposable vape devices themselves would affect their appeal and perceptions of harm, they add.

To find out, the researchers drew on 15,259 respondents to the 2023 online International Tobacco Control Youth and Youth Adult Tobacco & Vaping Survey. All the respondents were aged between 16 and 29 and living in England, Canada, or the US.

They were randomly assigned to view images of either 4 branded disposable vapes (7638 participants) or 4 standardised white disposable vapes (7621) and asked which vape products they would be interested in trying, and how harmful they thought they were.

Analysis of the responses showed that standardisation increased the percentage of those reporting no interest in trying at least one of the vapes displayed. Just over 67% of those in the standardised group said they weren’t interested in trying any of the devices shown, compared with just under 63% of those in the branded group.

The smallest effect of standardisation was observed among those who had never vaped or smoked: 93% of those in the standardised group reported no interest compared with just over 91% of those in the branded group.

The greatest impact was observed among those who had smoked, but not vaped, within the past month–47.5% in the standardised group vs 37.5% in the branded group–and these are people who would stand to gain from switching entirely from smoking to vaping, say the researchers.

Among those who had vaped, but not smoked, 20% of those shown standardised packaging reported no interest in trying them compared with 16.5% shown branded devices.

Similar effects were observed among people who both smoked and vaped (13.5% vs 9.5%) and among those who formerly smoked or vaped (just over 72.5% vs 65%).

The effects of standardisation on participants’ harm perceptions of the vaping product displayed were minimal, however.

Just over 31% of those in the standardised group viewed the vape product as less harmful than smoking compared with just under 33% in the branded group. There was no clear difference in how standardisation affected harm perceptions across smoking and vaping groups.

Product and packaging regulations have been used by several countries to reduce the appeal of cigarettes. And in January 2024, the UK government announced plans to introduce new measures to ensure that vape manufacturers implement standardised packaging for their products, but it’s not clear what this would look like, say the researchers.

“Our findings suggest that the integration of regulation on device design into new policy further reduces the appeal of vapes to young people. However, compared with people who have never smoked or vaped, the reduction in interest was more pronounced among smokers, who might benefit from using vapes to quit smoking.

There is a risk that the public health benefits of preventing youth uptake of vaping could be offset by a decline in the number of young people transitioning from smoking to exclusive vaping, or an increase in relapse from exclusive vaping to smoking, including dual use,” they add.

They conclude: “For countries interested in discouraging vaping among young people, standardising the colour of vaping devices could be considered alongside standardised packaging as a potential policy option.

“However, there may be unintended consequences in terms of discouraging those who smoke from switching to vaping, which should be further investigated and possibly balanced with other targeted policies to encourage smoking cessation.”

21/05/2025

Research: Impact of standardising the colour and branding of vape devices on product appeal among young people: a randomised experiment in England, Canada and the United States Doi 10.1136/tc-2024-059210
Journal: Tobacco Control

External funding: US National Institutes of Health (NIH);Cancer Research UK; National Institute for Health and Care Research (NIHR)

Externally peer reviewed? Yes
Evidence type: Comparative study
Subjects: People

The post Standardising disposable vape devices may curb young people’s desire to try them first appeared on BMJ Group.

And 37% lower risk of smoking uptake, indicating these bans’ influence on behaviour
More countries should adopt these policies to save lives, urge researchers

Implementing bans on the advertising, promotion, and sponsorship of tobacco products is linked to 20% lower odds of smoking, and 37% lower risk of taking up the habit, reveals a pooled data analysis of the available research, published online in Tobacco Control.

The findings indicate that these bans do influence behaviour, lending further weight to calls for their wider international implementation and enforcement, conclude the researchers.

In 2019 alone, more than a billion people around the globe regularly smoked tobacco, and smoking caused nearly 8 million deaths, note the researchers.

To curb the toll taken by smoking, the World Health Organization set out guidance for countries on how to adopt comprehensive tobacco control policies in its Framework Convention on Tobacco Control (FCTC), explain the researchers.

Yet only 17 of the 182 parties involved have implemented comprehensive bans of all the listed types of tobacco advertising, promotion, and sponsorship, while 37 haven’t implemented any bans at all, they add.

To update and strengthen the evidence base, amid a rapidly evolving media and advertising landscape, the researchers explored the impact of comprehensive tobacco product advertising, promotional, and sponsorship bans on smoking prevalence, uptake, and cessation, drawing on the most recently published research up to April 2024.

After excluding studies that were duplicates, poorly designed, or ineligible, they included 16,  all of which were published in English, and involved around half a million participants, in their pooled data analysis.

Two studies analysed the impact of bans on current smoking over a period of less than 5 years, 5 over a period of 5–10 years, and 3 over a period of more than 10 years.

Smoking uptake was evaluated for fewer than 5 years in 2 studies, and for more than 10 years in another 2. All 3 studies looking at smoking cessation evaluated the impact of bans over 5–10 years.

Pooled data analysis of all the study results showed that bans were associated with a 20% lower prevalence of smoking and a 37% lower risk of smoking uptake.

But there was no association between the bans and smoking cessation, possibly because of the small number of studies assessing this and the relatively high attrition rates noted in those studies, suggest the researchers.

Further detailed analysis revealed that the associations found between the bans and smoking prevalence differed by duration of the evaluation period. For example, the reduction in this was greater in studies evaluating the policy over 5 to 10 years than in those evaluating shorter periods.

Twelve (81%) of the included studies had a moderate risk of bias, while 3 (19%) had a high risk, and most of the studies assessed only partial bans, acknowledge the researchers.

Most of the included studies were also of observational design with no direct comparators, so limiting their ability to make causal inferences.

“Tobacco advertising and promotion increase awareness and receptivity towards cigarettes and provoke positive attitudes towards tobacco smoking. Youth and young adult populations are particularly susceptible to the negative influences of tobacco advertisement as exposure to tobacco marketing more than doubles their chances of smoking initiation,” explain the researchers.

 “Our results suggest that [advertising, promotional, and sponsorship bans] can be effective in reducing smoking prevalence and the risk of smoking uptake…..Given the findings of this review, it is likely that comprehensive bans would have greater impacts on smoking behaviour,” they write.

And they conclude: “The findings reinforce the need for countries to implement and enforce existing [tobacco advertising, promotional, and sponsorship] bans to reduce tobacco smoking and its consequences.”

14/01/2025

Notes for editors
Systematic review: Effectiveness of tobacco advertising, promotion and sponsorship bans on smoking prevalence, initiation and cessation: a systematic review and meta-analysis Doi: 10.1136/tc-2024-058903
Journal: Tobacco Control

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Systematic review + meta analysis
Subjects: People

The post Tobacco advertising + sponsorship bans linked to 20% lower odds of smoking first appeared on BMJ Group.

Potentially harmful to brain and organ development, suggest researchers
Findings underscore need for implementation of regulations and targeted prevention

Frequent teen vaping might boost the risk of exposure to lead and uranium, potentially harming brain and organ development, suggests research published online in the journal Tobacco Control.

The findings underscore the need for implementation of regulations and prevention efforts targeting teens, emphasise the researchers.

Vaping is popular with teens. In 2022, an estimated 14% of US high school students—around 2.14 million—and more than 3% of middle school students—around 380,000—reported vaping in the preceding month, note the researchers.

Certain metals have been identified in e-cigarette aerosols and liquids. Their absorption is especially harmful during periods of development, say the researchers, citing research showing that increased levels of exposure are linked to cognitive impairment, behavioural disturbances, respiratory complications, cancer, and cardiovascular disease in children.

The researchers wanted to find out whether potentially toxic metal levels might be associated with vaping frequency and whether flavour might be influential.

They drew on responses to the nationally representative Wave 5 (December 2018 to November 2019) of the PATH Youth Study, involving 1607 teens between the ages of 13 and 17. After exclusions, 200 vapers were included in the final analysis. 

Their urine samples were tested for the presence of cadmium, lead, and uranium, and vaping frequency was designated as occasional (1–5 days/month), intermittent (6–19 days), and frequent (20+ days).

Vape flavours were grouped into four mutually exclusive categories: menthol or mint; fruit; sweet, such as chocolate or desserts; and others, such as tobacco, clove or spice, and alcoholic or non-alcoholic drinks.

Among the 200 exclusive vapers (63% female), 65 reported occasional use, 45 intermittent, and 81 frequent use; vaping frequency information was missing for 9. 

The average number of recent puffs per day increased in tandem with vaping frequency: occasional = 0.9 puffs; intermittent = 7.9 puffs; frequent = 27 puffs.

In the preceding 30 days 1 in 3 (33%) vapers said they used menthol/mint flavours; half (50%) favoured fruit flavours; just over 15% opted for sweet flavours; and 2% used other flavours.

Analysis of the urine samples showed that lead levels were 40% higher among intermittent vapers, and 30% higher among frequent vapers than they were among occasional vapers. Urinary uranium levels were also twice as high among frequent vapers than among occasional vapers 

Comparison of flavour types indicated 90% higher uranium levels among vapers who preferred sweet flavours than among those opting for menthol/mint. 

No statistically significant differences were found in urinary cadmium levels between vaping frequency or flavour types.

This is an observational study, and as such no definitive conclusions can be drawn about toxic metal levels and vaping frequency/flavours, acknowledge the researchers, who also caution that the levels of toxic metals in vapes will vary by brand and type of vaporiser used (tank, pod, mod).

Although urinary levels indicate chronic exposure, they were assessed at just one point in time, added to which the presence of uranium in the urine may be attributable to various sources including environmental exposure from natural deposits, industrial activities, and dietary intake, they add.

“None the less,these compounds are known to cause harm in humans,” they write. Of particular concern were the increased uranium levels found within the sweet flavour category, they add. 

“Candy-flavoured e-cigarette products make up a substantial proportion of adolescent vapers, and sweet taste in e-cigarettes can suppress the harsh effects of nicotine and enhance its reinforcing effects, resulting in heightened brain cue-reactivity.” 

And they conclude: “E-cigarette use during adolescence may increase the likelihood of metal exposure, which could adversely affect brain and organ development.

“These findings call for further research, vaping regulation, and targeted public health interventions to mitigate the potential harms of e-cigarette use, particularly among adolescents.”

30/04/2024 

Notes for editors
Research: Biomarkers of metal exposure in adolescent e-cigarette users: correlations with vaping frequency and flavouring Doi 10.1136/tc-2023-058554
Journal: Tobacco Control

External funding: National Institute on Drug Abuse

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Teen vapers

The post Frequent teen vaping might boost risk of toxic lead and uranium exposure first appeared on BMJ Group.

Long term health risks also much higher despite lower smoking rates + more quit attempts
Minority adults who smoke stand to benefit more from tobacco control policies

The annual tobacco-related healthcare spend of US Minorities who smoke is double that of White adults who smoke, finds an analysis of national health and medical spend survey data, published online in the journal Tobacco Control. 

And the excess risks of 3 or more long term health conditions associated with smoking are more than 40% higher among Minority adults, despite their lower smoking rates and more numerous quit attempts than their White peers, the analysis indicates.

The findings prompt the researchers to conclude that Minority adults who smoke stand to benefit substantially more from tobacco control policies than do White adults who smoke.

Each year, 480,000 people die before their time from diseases linked to smoking, making tobacco use the leading cause of preventable illness and death in the USA, note the researchers.

In 2022, the US Food and Drug Administration proposed regulations that would set a maximum nicotine level to help reduce the addictiveness of cigarettes and stop an estimated 33 million people from smoking by 2100.

But this type of far-reaching regulation requires the Office of Management and Budget (OMB)–the office that assists the US President to develop and execute policies–to prove that the benefits would outweigh the costs.

And earlier this year, the President requested that cost-benefit analyses for new tobacco control regulations should account for their impact on different sectors of the population.

For the first time, therefore, the researchers estimated the racial and ethnic disparities in medical spending and health outcomes associated with smoking in the US.

They linked data from the 2008-19 Medical Expenditure Panel Survey (Household Component) and the National Health Interview Survey for 118, 084 adults to estimate the proportion of the top 10 health conditions and annual healthcare spend—adjusted for inflation—attributable to smoking by race and ethnicity.

Between 2008 and 2019, 15% of Minority adults smoked, compared with 17% of White adults, who smoked the most cigarettes every day: 14 vs 9.

While the proportion of White adults trying to quit smoking fell to 53% in 2019, this increased to 63% for Minorities.

Tobacco related health issues accounted for just under 12% of the  total yearly medical care spend ($876 out of $7208) for White adults who smoked, but were twice as much—25% ($1509 of the $6253)—for Minority adults who smoked, primarily driven by Hispanic and other racial groups.

 Minority adults were also significantly more likely to have 3 or more of the top 10 conditions associated with smoking in the US: high cholesterol; high blood pressure; diabetes; joint pain; cancer; heart attack; arthritis; asthma; heart disease; and stroke. They were 34% more likely to do so compared with 24% for White adults who smoked.

Between 2008 and 2016, smoking comprised 7.5% of the nation’s total healthcare spend for White adults and nearly 11% for Minority adults.

In 2017–19, this had fallen to 2.5% for White adults but only 9% for Minority adults, indicating that they have not benefited much from the medical cost savings associated with the large reduction in smoking rates over the decades, say the researchers.

Based on these data, the researchers estimated that any new tobacco control regulations would save $134 million a year for every 100,000 Minority adults who didn’t start smoking— 135% more than the $57 million for the same number of White adults.

This would also save federal healthcare programmes $83 million a year for every 100,000 adults not taking up smoking—$60 million from Minority adults and $23 million from White adults, the researchers add.

They acknowledge various limitations to their findings. These include an exclusive focus on cigarettes rather than other tobacco products or vapes, and the exclusion of the military and  prison populations as well as nursing home spend from their calculations.

But they nevertheless conclude: “Our results indicate that the Minority population will benefit much more than the White population under anti tobacco regulations that reduce smoking, exemplifying the importance of agencies including such distributional analyses in their regulatory cost benefit analyses.”

06/12/2023

Notes for editors
Research: Racial and ethnic disparities in healthcare costs and outcomes of cigarette smoking in USA: 2008–2019 doi 10.1136/tc-2023-058136
Journal: Tobacco Control

Funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Tobacco related annual medical spend of US Minorities who smoke double that of White peers first appeared on BMJ Group.

Relatively small compared with overall toll of tobacco, but costs cumulative and preventable
Bans on single use plastics increasingly common, but tobacco sources overlooked

The costs of environmental pollution caused by plastics in cigarette butts and packaging amount to an estimated US$26 billion every year or US$186 billion every 10 years—adjusted for inflation—in waste management and marine ecosystem damage worldwide,  finds a data analysis published online in the journal Tobacco Control.

These costs may seem small compared with the overall economic and human toll of tobacco, but they are cumulative and preventable, highlights the researcher. 

And although great strides have been made in developing policies to curb or ban single use plastics around the globe, tobacco’s plastic has been overlooked, she adds.

This is despite the fact that cigarette filters—the main component of cigarette butts—are the most common item of rubbish collected on the planet. And they are made of single use plastic.

To try and gauge the global economic toll of tobacco products’ toxic waste, and better inform tobacco control and environmental protection agencies, the researcher drew on currently available public data sources for cigarette sales, clean-up costs, and plastic waste on land and sea.

These sources included the World Bank, the Organization for Economic Cooperation and Development (OECD),The Tobacco Atlas, and the World Wildlife Fund.

The average weight of each plastic filter is 3.4 g. As cigarette butts are often littered along with plastic packaging, which weighs an average 19 g for a standard pack size of 20 cigarettes, this was also included in the calculations.

The researcher estimated the annual and 10-year projections of the environmental economic costs of tobacco plastic based on the tonnage. Ten-year projections were included because cigarette butts are reported to take 10 years to degrade.

The total figure reflects cost estimates of clean-up and disposal (adjusted for inflation) of the total plastic generated by filtered cigarette sales potentially ending up as waste in the sea, landfills, or in the environment.

The researchers estimated that the annual economic cost of cigarette plastics waste is around US$26 billion, made up of US$20.7 billion in marine ecosystem damage and US$5 billion in waste management costs, adding up to US$186 billion over 10 years.

“Although this amount is small compared with the annual economic losses from tobacco (US$1.4 trillion per year) and may appear insignificant compared with the 8 million deaths attributable to tobacco each year, these environmental costs should not be downplayed as these are accumulating and are preventable,” emphasises the researcher.

Countries with the highest number of cigarette butts are mostly low and middle income countries–the same countries where the ‘leakage’ rate for plastics into the environment, thought to be between 1% and14%, is likely higher, she adds.

The costs of tobacco product plastic pollution are likely highest in China, Indonesia, Japan, Bangladesh and the Philippines, the estimates suggest.

The researcher acknowledges that the figures are only estimates, but they are likely to be conservative, she says, because they don’t account for the toxic metals and chemicals in cigarette butts that accrue over time, making them more harmful than general plastic waste. 

“Cigarette filters have been polluting our oceans and land for at least five decades, and these trash items may have a carrier effect with the toxic chemicals leached from them. Human and ecosystem impacts of this toxic chemical accumulation are unknown,” she writes. 

“The general estimates provided here could provide fiscal evidence of the need to mitigate tobacco plastic waste pollution,” and the data could help “in assigning industry responsibility for these losses, including that of the [tobacco industry],” she suggests.

Policies to shift the responsibility for the clean-up costs to the tobacco industry are under consideration in France, the UK, the European Union and the USA, she adds.

29/11/2023 

Notes for editors
Research: Tobacco industry accountability for marine pollution: country and global estimates doi 10.1136/tc-2022-057795
Journal: Tobacco Control

Funding: Bloomberg Philanthropies

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: Cigarette butt plastics

The post Plastic pollution from cigarette butts likely costs US$26 billion/year first appeared on BMJ Group.

But no reported change in black market purchases, reveals time-trends analysis

The proportion of smokers’ discounted overseas tobacco purchases— from duty free or  from countries with cheaper products, and known as cross-border purchases—has tripled  in England since 2019, rising from just over 5% to just over 16%, but there’s been no reported change in black market purchases, reveals a time-trends analysis published online in the journal Tobacco Control.

Between 2002 and 2014, between 12% and 20% of UK adult smokers said their last tobacco purchase had been from a low or untaxed source. And smokers who buy their tobacco from low/untaxed sources—and those who switch to cheaper products—are less likely to try to quit smoking than those who continue to pay the full price, explain the researchers.

They were therefore keen to find out if the significant social and economic changes in England, prompted by Brexit rule changes on permissible tobacco purchases for personal use, the social and travel restrictions imposed by the COVID-19 pandemic, and the cost of living crisis, had affected these purchasing patterns.

They drew on respondents to The Smoking Toolkit Study, a nationally representative monthly cross-sectional survey in England.

For the current study, they used data from 11,232 adults who had smoked in the past year, analysing changes between February 2019—a year before the UK formally left the European Union—and October 2022, the most recent data available on source of purchase at the time of the analysis.

Just over 46% of the respondents were women and more than half (58%) of the total belonged to social grades C2 (skilled manual jobs) or DE (semi-skilled and unskilled manual jobs; unemployed). Their average age was 42.

Analysis of the responses showed that the proportion of respondents reporting cross border purchases rose from just over 5% in February 2019 to just over 16% in October 2022.

Although this trend was observed across all social grades, the prevalence was higher, and the changes more noticeable among those from ABC1 (professional/managerial/supervisory jobs) social grades than among those from social grades C2DE.  

The proportion of respondents who said they had bought on the black market didn’t change significantly, rising from just over 9% to just over 14% between February 2019 and November 2020, then falling back to 8.5% by October 2022. 

Prevalence was higher among less advantaged social grades (C2DE), but time trends didn’t differ significantly by social grade. 

The researchers acknowledge several limitations to their findings. All the data were self-reported and related to purchases within the preceding 6 months, introducing scope for reporting and recall bias. Nor were participants asked about the frequency or quantity of tobacco purchases so no distinction could be made between occasional and regular use of these cost cutting strategies.

But they nevertheless conclude: “A rise in cross-border tobacco purchasing is a cause for concern given people who use cheap tobacco are less likely to try to quit smoking.” 

And they suggest: “Policy measures that reduce access to cheaper sources of tobacco could help increase the rate of quit attempts among those who smoke and accelerate progress towards the government’s Smoke free 2030 target.” 

18/07/2023

Notes for editors
Research: Trends in cross-border and illicit tobacco purchases among people who smoke in England, 2019–2022 doi 10.1136/tc-2023-057991
Journal: Tobacco Control

Funding: Cancer Research UK

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational; time-trends analysis
Subjects: People

The post Tripling in proportion of smokers’ discounted overseas tobacco purchases since 2019 in England first appeared on BMJ Group.