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E-Cigarettes May Be A "Gateway" Drug For Teenagers, Study Shows

This article is more than 9 years old.

In the past week, two extremely provocative studies have come out suggesting that e-cigarettes pose serious addiction risks for teens and young adults.

First, the CDC published survey results showing that more than 263,000 teenagers who've never smoked a regular cigarette now use e-cigarettes. And that the number of middle and high school students using e-cigarettes, or "vaping" tripled over three years, from 79,000 in 2011 to more than a quarter million in 2013.

Then yesterday the New England Journal of Medicine published a study calling e-cigarettes a "gateway drug" for nicotine addiction and possibly for other addictive drugs as well.

Certain to launch a volley of passionate praise and vitriolic criticism, the study is a groundbreaking collaboration between husband and wife Eric and Denise Kandel that combines epidemiology, psychology, and molecular biology.

Pointing to a body of previous epidemiological research demonstrating that nicotine is a gateway for marijuana and cocaine use, the Kandels argue that e-cigarettes, by introducing nonsmoking kids to nicotine, extend that gateway. To back up the accusation, they marshal biological data on the effects of nicotine in the brains of mice, and psychological studies into the processes of addiction.

The scholars making this argument are heavyweights. Denise Kandel is the originator of the "gateway" hypothesis, which posited that one addiction could tended to lead to another in a stepping-stone sequence. Since it's publication in 1975, the "gateway" hypothesis has become something akin to gospel in addiction medicine and psychology.

A psychiatry professor at Columbia University who also heads up the department of the epidemiology of substance abuse at the New York State Psychiatric Institute, Kandel has conducted decades of studies that have been used as the basis for major policy decisions.

Neuropsychiatrist Eric Kandel is no less renowned, having received the 2000 Nobel Prize for his studies on the molecular biology of memory.

Kandel's contribution to the current study focuses on the idea of addiction as a form of learned experience, in which relapses are triggered by persistent memories of a drug's positive effects. To put it more simply, you "vape," you enjoy it, you feel good, and those positive memories build the basis for an addiction.

Building on his own previous studies into the brain chemistry of memory formation, Kandel created a mouse model to analyze "the behavioral, electrophysiological, and molecular genetic effects of particular drug-use sequences." What the study found: Mice "primed" with nicotine use were much more likely than their counterparts to develop a preference for cocaine.

While the Kandels' study will almost certainly set off a storm of controversy, there's no question that health experts from across numerous fields are turning against e-cigarettes as more data come out.

Last week the American Heart Association issued a new policy statement in the journal Circulation calling for tighter regulatory control of e-cigarettes by the FDA. Citing data that 1.78 million high school and middle school students reported using e-cigarettes last year, the AHA called for greater FDA regulation of sales and marketing to minors, as well as state regulations banning sales.

And for good reason; a study published in the Journal of the American Medical Association in March found that kids who used e-cigarettes were more likely to start smoking.

Currently, it's still legal  to sell e-cigarettes to those under 18 in 14 states, and regulations are weak and full of loopholes in many other states. Meanwhile, trendy vaping shops are popping up across the country, stocked with hip-looking tech-y devices in iridescent colors and flavors like "maple pancakes" and "vanilla cupcake."

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