Vaping products could provide a "gateway" to binge drinking and drug use, warns a new study. Researchers found that teenagers who vape nicotine products were more likely to binge drink than those who don't and 12 times more likely to use cannabis than peers who only smoke tobacco.
The study looked at data collated from more than 50,000 adolescents across the United States and discovered that those who vaped and smoked were a shocking 40 times more likely to use cannabis than those who did neither. The scientists, from the Columbia University Mailman School of Public Health, warned the data showed vaping was 'strongly tied' to the use of other substances - and could even act as a gateway.
The study, published in the peer-reviewed journal Substance Use and Misuse, took its findings from the US-based survey Monitoring the Future. The survey was conducted by the National Institute on Drug Abuse (NIDA) to track trends in the use of cigarettes, alcohol, cannabis, and vaping - of nicotine, cannabis and other substances - for young people aged 13 to 18.
The team examined data from 51,872 young adults who took part in the survey between 2017 and 2019. They directed their focus on the links between nicotine use in the past 30 days (no use; smoking only; vaping only; smoking and vaping) and past 30-day cannabis use, whilst making adjustments for demographic factors such as age, sex, race, parental education, and the 'urbanicity' of participants.
The researchers found that adolescents who smoked were eight times more likely to use cannabis than peers who didn't use nicotine products at all. However, surprisingly, those who vaped were 20 times more likely to use cannabis than those who used no nicotine products.
Rebellious teens who both smoked and vaped, on the other hand, were found to be a shocking 40 times more likely to use cannabis than those who used no nicotine. When focusing on binge drinking, the researchers similarly found a strong correlation between those who smoked and vaped.
Tellingly, the correlation between smoking and vaping with binge drinking tended to 'increase in magnitude at greater levels of binge drinking'. For example, those who both smoked and vaped - compared with those who used no nicotine products - were 5.6 times more likely to have participated in binge drinking on one occasion.
This same group were also 21.6 times more likely to have participated in binge drinking on between three and five occasions and a huge 36.5 times more likely to have participated in binge drinking on ten or more occasions. Lead author Noah Kreski, a data analyst at the Columbia University Mailman School of Public Health, said their results proved vaping is not an 'isolated' behaviour, and should be monitored closely.
They said: "While the overall health risks of vaping are lower than smoking, electronic cigarettes are still harmful to adolescents and warrant ongoing surveillance – especially as the long-term impacts remain unknown. "Our results indicate that vaping is not an isolated behaviour, but rather strongly tied to other substance use that can harm adolescents and make quitting nicotine more difficult.
"Recognising the strong overlap between various forms of substance use, effective intervention efforts should work to simultaneously address vaping, drinking and cannabis use to encourage the health and well-being of young people. "The links between vaping-only, or both smoking and vaping and cannabis use and binge drinking outcomes in adolescents are particularly striking – especially at the highest levels of binge drinking.
"While the causal direction of these associations is unclear, the size of the effect is concerning given the harms these substances pose to adolescents. Given the strong links between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce vaping in adolescents – efforts that acknowledge co-occurring substance use."
Despite the success of their study, the team recognise the limitations of the data used - such as the data having been collected from school students during the school day, excluding those absent on the day, and the fact that nicotine vaping and smoking were self-reported, making them vulnerable to measurement and recall bias.
