Dtsch Arztebl Int 2018; 115(14): 243-8; DOI: 10.3238/arztebl.2018.0243
E-Cigarettes and the Use of Conventional Cigarettes
A cohort study in 10th grade students in Germany
Background: In 2015, 12.1% of 12– to 17-year-olds in Germany had reportedly already tried e-cigarette smoking at least once. We carried out a study of the “gateway” hypothesis, according to which the use of e-cigarettes can motivate adolescents to start smoking conventional cigarettes.
Methods: During the 2015/2016 school year, 2186 tenth-graders in the German states of Lower Saxony and Schleswig-Holstein who had never smoked conventional cigarettes before took part in a survey over a 6-month period (mean age 15.5 years, standard deviation 0.65; 53.6% female).
Results: 14.3% of the survey population (313 adolescents) said at the start of the survey period that they had already tried e-cigarettes at least once. By the end of the survey period, 12.3% (268) of those who had never smoked before had begun to experiment with conventional cigarettes. The risk of beginning such experimentation was 2.2 times higher among e-cigarette users. This association remained (relative risk = 2.18 [1.65; 2.83]) after statistical control for age, sex, state, immigrant background, type of school, socioeconomic status, various personality traits (sensation-seeking, impulsivity, anxiety, hopelessness, extraversion, agreeableness, conscientiousness, neuroticism, openness), and the use of alcohol, cannabis, and other illicit drugs. Further analysis revealed that the association between the use of e-cigarettes and the onset of conventional cigarette smoking was stronger among adolescents with low sensation-seeking scores and without any experience of alcohol intoxication.
Conclusion: Among adolescents who have never smoked, experimentation with conventional cigarettes is more common in those who have used e-cigarettes. This effect seems to be stronger among adolescents who, in general, have a lower risk of starting to smoke. The 6-month observation period of this study is too short to allow any inference regarding a connection between e-cigarette use and the development of tobacco dependence.
Die Studie gibt einen Hinweis, dass E-Zigaretten eine Einstiegsdroge für Jugendliche sein könnten. Allerdings sind weiterhin rauchende Eltern ein starker Risikofaktor, dass die Kinder später mit dem Rauchen anfangen.
Für uns bleibt der Nutzen und Schaden der E-Zigarette insbesondere zur Raucherentwöhnung offen.
Eventuell bei der E-Zigarette langsam den Nikotingehalt reduzieren, wenn man aufhören will (wie beim Nikotinpflaster)?