In Reply The declining prevalence of youth cigarette smoking in the United States has been a welcome and encouraging trend. However, contrary to the suggestion from Ip and Middlekauff, the available empirical evidence does not support attributing this achievement to the emerging popularity of tobacco in other forms.
Adolescent cigarette use has been in decline for 20 years, starting well before electronic cigarettes (e-cigarettes) became the most commonly used nicotine or tobacco product among middle and high school students. Before and during the time that e-cigarettes and hookah appeared in national surveys, proven tobacco control measures were taking effect across the country, including mass media campaigns, clean indoor air policies, rising cigarette excise taxes, and, more recently, an increasing number of jurisdictions rising the minimum tobacco purchase age to 21 years.1 Importantly, during this impressive downward trend, there was no acceleration in the decline of youth cigarette use after e-cigarettes emerged.2 In fact, when e-cigarette and hookah use spiked, the overall number of youths using any form of nicotine or tobacco increased.3
Watkins SL, Glantz SA, Chaffee BW. Noncigarette Tobacco Products—Gateway or Diversion?—Reply. JAMA Pediatr. 2018;172(8):784–785. doi:10.1001/jamapediatrics.2018.1076
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