Cigarettes, E-Cigarettes, and Substance Use in Adolescents

If you follow our articles and blogs, you may have noticed we spend time and energy writing about tobacco use. More specifically, we write about e-cigarette use – a.k.a. vaping nicotine – and its dramatic increase in prevalence in the adolescent population over the past five years. In a recent article highlighting the results of the 2020 Monitoring the Future Survey (2020 MTF), we described this phenomenon in detail.

To read that article, click here: Monitoring the Future 2020: Key Findings.

In the meantime, we’ll address a question some of you may have: why do we spend time addressing rates of cigarette smoking and nicotine vaping in the adolescent population?

We have answers.

Tobacco 21: The New Federal Legislation

In 2019, the President of the United States signed legislation amending existing federal laws governing the sale of tobacco products. In the U.S., the new law, known as Tobacco 21, made it illegal to sell tobacco products to anyone under 21 years old.

The list of tobacco products prohibited for sale to minors includes:

  • Cigarettes
  • Smokeless tobacco (chewing tobacco)
  • Hookah tobacco
  • Pipe tobacco
  • Cigars
  • Electronic nicotine delivery systems, i.e. e-cigarettes, nicotine vaping products, and e-cigarette/nicotine liquids

While the new federal law does not make it illegal for people under 21 to possess tobacco or nicotine products, most states quickly passed legislation banning the use of tobacco products for people under 21. To date, 33 states have enacted and implemented Tobacco 21 legislation.

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That’s our first reason for bringing awareness to the increase in tobacco use – particularly vaping – in the adolescent population over the past five years: it’s illegal.

But there’s another reason that’s equally concerning.

Smoking, Vaping, and Alcohol/Substance Use: The Connection

The second reason is the connection between nicotine use and alcohol/drug use, which we’ll discuss now.

Health officials and concerned adults once believed the connection between nicotine use and subsequent alcohol or drug use was simple and straightforward. Tobacco was considered a gateway drug, a term which most people know. A gateway drug is a drug which, if one uses, may lead to the use of other, more dangerous drugs later in life.

Research now shows this claim to be only partially true. While there is correlative data to connect early tobacco use with later drug use, it’s not conclusive. For instance, a recent study shows that early initiation of tobacco use – age 14 or under – is associated with:

However, the data also shows that the average age of onset of use for alcohol and marijuana is, on average, earlier than the average age of onset of use of tobacco products. For clarification, age of onset of use means when someone first tried the substance in question.

It gets more complicated, though. The same study showed that 99% of adolescents who use alcohol report early onset tobacco use in some form. This tells us more research is needed to untangle the complex relationship between tobacco use and drug use.

Does Nicotine “Prime” the Brain for Addiction?

Research published in 2011 appeared to support – and prove, in the minds of some – the status of nicotine as a gateway drug. The evidence was, indeed, compelling. It identified changes in the brain caused by the presence of nicotine that could make the brain more vulnerable to addictive behaviors. Here’s what the research showed:

  • Nicotine altered brain activity in the striatum, an area of the brain associated with addiction
  • Nicotine blocked the action of a specific chemical in the brain that increased the likelihood of cocaine addiction
  • The action only worked one way: nicotine made the brain more vulnerable to cocaine addiction, but cocaine did not make the brain more vulnerable to nicotine addiction

Those results came with a catch.

Two, actually.

The first was the fact that researchers obtained the evidence using the rodent model, i.e. the experiment was on laboratory mice. The second was the fact that the data only supported the connection between nicotine and cocaine.

Since 2011, the results have not been replicated in humans. Researchers have identified correlative data to indicate that humans addicted to cocaine are more likely to have used tobacco before the onset of cocaine use. But this data, again, is correlative as opposed to causal. There is a concept at work that makes sense to most people, though. Researchers theorize that any early experience with addiction – particularly an extremely addictive substance like nicotine – teaches the brain how to become addicted to substances.

While that makes intuitive sense to many people, including researchers, studies have yet to prove the nicotine priming theory in humans, on a molecular level, for drugs other than cocaine. Evidence for the priming theory for other drugs in the rodent model continues, and many researchers are hard at work on this hypothesis as we write this article.

Another Important Point: Physical Health

It would have been easy to start the we have answers section of this article with the simple fact that nicotine use has severe health negative health consequences for anyone who uses it – and these consequences are more pronounced in adolescents than in other populations.

While most people reading this know the following information, it helps to put it in one place so we don’t forget about or minimize the consequences of nicotine use. We’ll start with cigarette smoking, which decades of evidence proves can cause:

  • Cancer
  • Heart disease
  • Lung disease
  • Diabetes
  • Chronic obstructive pulmonary disease (COPD)

In addition, cigarette smoking increases the risk of:

  • Tuberculosis
  • Emphysema
  • Chronic bronchitis
  • Immune deficiency
  • Rheumatoid arthritis

That’s the run-down on cigarettes: they’re terrible for your health. In some cases, long-term use can kill you. Now we’ll move on to the data on e-cigarettes. The latest research shows vaping nicotine can increase the risk of:

  • Lung disease
  • Lung damage
  • Heart disease
  • Heart attack
  • Asthma complications
  • Chronic coughing and wheezing

When we combine these facts with data that indicates people who start vaping nicotine as teens are three times more likely to progress to daily cigarette smoking than people who don’t vape nicotine as teens, we know we need to say something to all the parents, teens, and adults who read our articles. Our message is this: while vaping nicotine may be less harmful than smoking cigarettes, it’s far from harmless – and that’s a fact everyone needs to know.

Ready to Get Help for Your Child?

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