Tobacco smoking among U.S. youth has fallen since 1998, but some experts worry that acceptance of e-cigarettes may promote acceptance of traditional cigarettes and reverse the trend, the study team writes in Journal of Adolescent Health.

“The public health community has worked very hard to educate the population about the harm of smoking, and we have observed a shift in acceptability of cigarette smoking, which, in part, led to the decline in the prevalence of smoking,” lead study author Kelvin Choi told Reuters Health.

“E-cigarettes may reverse what has been accomplished, but there was a lack of data to support or refute this issue. That’s why we conducted the study to get an answer that can inform the discussion,” said Choi, a researcher at the National Institute on Minority Health and Health Disparities in Bethesda Maryland

“Our findings show that e-cigarette use by youth who never smoked cigarettes is associated with seeing adult smoking as acceptable, which in turn is associated with openness to try cigarette smoking,” Choi said.

The study findings help explain how e-cigarette use may lead to cigarette smoking later, he added.

To test the idea, Choi and colleagues analyzed data from the 2014 Florida Youth Tobacco Survey, which was answered by almost 70,000 middle school and high school students in 765 Florida schools.

Students were asked if they had ever smoked or used e-cigarettes or if they had seen or heard commercials about the devices. In addition, they were asked if they lived with anyone who used e-cigarettes.

The kids were also asked whether their friends and community members viewed adult cigarette smoking as acceptable.

About 20 percent of high school students and roughly 8 percent of middle schoolers had tried e-cigarettes. Almost 13 percent of high schoolers and 12 percent of middle schoolers lived with e-cigarette users.

The study team found that students who had never smoked had a positive view of adult smoking if they were exposed to electronic cigarette use at home or in advertisements or if their friends and community members accept regular cigarette use by adults.

“Living with someone who uses e-cigarettes, and seeing e-cigarette advertisement, are also associated with seeing adult smoking as acceptable and also openness to try cigarette smoking, regardless of e-cigarette use experience. This may suggest that e-cigarettes can influence youth cigarette smoking without them trying e-cigarettes,” Choi said.

The study is limited because it only looked at one state and one point in time, Choi noted. “The next steps will be to examine if our findings are true nationally, and also the confirm our findings with longitudinal studies,” he said.

Future research is also needed to evaluate if including e-cigarettes in current clean indoor air policies, upholding high e-cigarette prices and regulating e-cigarette advertising would lower youth exposure to e-cigarettes, and in turn, lower youth acceptability of adult smoking at the population level, Choi said.

“We have known for a long time that exposure to smoking - such as seeing people smoke in real life or in advertising or movies – increases the chances that youth will also try smoking,” said Lucy Popova, a researcher at the Georgia State University School of Public Health in Atlanta who was not involved in the study.

Exposure to e-cigarettes may have a similar effect on openness to try smoking, she told Reuters Health by email.

“When kids think that something is normal or acceptable, they are more likely to try it. This study found that exposure to electronic cigarettes makes smoking to be perceived as normal, which makes children more likely to give it a try and start down the road to lifelong addiction,” Popova said.

Parents, teachers, and other adults who are concerned about children starting to smoke should lead by example, she added.

“Institute smoke-free rules in your home – don’t smoke or use any tobacco inside your house or car and don’t let others use it. If you are smoking – quit. If you are using e-cigarettes, quit them as well,” Popova said.

/Reuters/

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