Butt in: Ask patients about nicotine use

December 7, 2017
Study links vaping in teens to increased use of nicotine—a major risk factor for age-related macular degeneration.

A new study links the use of electronic cigarettes (vaping) among teenagers to more vaping and cigarette smoking.

Not only is smoking an irritant to the eyes, but it also is a major risk factor for age-related macular degeneration (AMD) and is the leading cause of preventable disease in the U.S. In the study, which appeared in the December 2017 issue of JAMA Pediatrics, students at 10 Los Angeles high schools were surveyed about their use of e-cigarettes.

The study looked at e-juice or the varying concentrations of nicotine, an addictive drug, in e-cigarettes in a cohort study of 181 students. Nicotine concentrations in e-cigarettes can range from 0 to more than 25 milligrams/milliliters.

"Among the adolescent e-cigarette users in this study, use of e-cigarettes with higher nicotine concentrations at baseline was associated with progression of smoking and vaping frequency and intensity at 6-month follow-up," researchers at the University of Southern California wrote.

"Given the U.S. Food and Drug Administration's 2016 Deeming Rule," they add, "the results of this study provide preliminary evidence that regulatory policies addressing nicotine concentration levels in e-cigarette products used by adolescents may affect progression of combustible cigarette and e-cigarette use among youths."

Researchers also noted that exposure to higher levels of nicotine during early adolescence "increases the risk for nicotine dependence and adversely affects attentional processes."

According to the Centers for Disease Control and Prevention, e-cigarettes were more popular among middle- and high-school students than combustible cigarettes.

Ask patients about smoking—and vaping

For more than a decade, Daniel Bintz, O.D., who practices in Elk City, Oklahoma, has been educating his patients about smoking's effect on their health. Like Dr. Bintz, doctors of optometry should ask patients these questions:

  • Do you smoke?
  • Are you a current or former smoker? Never smoked?
  • How much do you smoke?

A member of the AOA Health Promotions Committee, Dr. Bintz also queries patients about vaping. Doctors do have a role in counseling patients on habits and behaviors that promote better health.

"We treat any tobacco or nicotine use the same when discussing cessation with patients," Dr. Bintz says. "E-cigarettes haven't been around long enough to positively be linked to AMD, but I believe the AMD studies implicate nicotine as the culprit because it constricts blood vessels. E-cigarettes are a huge problem especially because they were essentially unregulated for the first few years.

"Many studies mimic this onethat it's a 'gateway' drug device to make nicotine more attractive and flavorful for kids, who then at some point will typically become traditional tobacco users. The only thing that makes this less harmful is the second-hand 'smoke' is not nearly as deadly as it is with traditional tobacco use."

Smoking resources:

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