By Dr. Liji Thomas, MDMay 16 2023

Nicotine use among young people is a growing concern for public health scientists and policymakers. However, this may be led up to by multiple other factors. A new study explores the potential role played by caffeine in promoting teenage nicotine use.

Study: Possible role of caffeine in nicotine use onset among early adolescents: Evidence from the Young Mountaineer Health Study Cohort. Image Credit: TierneyMJ / Shutterstock

Introduction

Caffeine effects

Caffeine is the single psychoactive substance with the highest spectrum of consumption in all of history. It is found in multiple drinks, including coffee, tea, energy drinks, soda, and even candy, apart from the concentrated forms of caffeine called caffeine “shots.” These are often marketed with young people as the target.

Caffeine is readily absorbed and has multiple actions on the brain and peripheral organs. First, it inhibits adenosine at its receptors by competing with its binding.

It causes increased alertness by increasing central neurotransmitter levels, constricts cerebral and coronary blood vessels, promotes urine production, and dilates the airways. It also increases the levels of epinephrine and norepinephrine, the stress catecholamine hormones.

Caffeine may also boost the effects of nicotine because both substances induce dopamine release at neural synapses. Dopamine is involved in reward circuits which are powerful in building addiction.  

Earlier research suggests that up to three-quarters of children below 17 years are regularly ingesting caffeine. This could be detrimental to neurodevelopment during this vulnerable period, especially when children are subjected to incessant demands for social and educational engagement.

Caffeine is linked in moderate amounts to a host of adverse effects in young people, including behavioral and mood changes, altered alertness, and sleep disruption. Nausea, headache, drowsiness, loss of concentration, aggressiveness, and reduced academic achievement have all been reported with the use of caffeine in this age group.

Other studies suggest that caffeine consumption is linked to smoking and vaping. Also, “research has repeatedly documented that early consumption of one habit-forming substance tends to be linked with experimentation with and/or regular use of other substances.”  

Caffeine may thus act like early tobacco use on the odds of smoking and tobacco use in later life. With the high prevalence of caffeine use in young people, the fallout in terms of smoking and other substance abuse could be costly.

What did the study show?

The current study, published in the journal PLOS ONE, attempted to determine whether caffeine use among young teens was linked to a higher risk of onset of nicotine use.

The researchers relied on data from the Young Mountaineer Health Study Cohort, which collected information via a survey from about 1,300 sixth graders in West Virginia from fall 2020 to spring 2021.

Caffeine was used in the form of soda by about 70% of participants. Tea was the next most common form, used by over half the survey participants.

None of the students in the survey had used nicotine at the first time point. However, by the follow-up survey, 8% said they had used it at least once. About 5% used only vapes or e-cigarettes, or other electronic nicotine delivery systems (ENDS). These are touted as being less harmful and addictive than actual cigarettes.

Among the eight percent of nicotine users at follow-up, about 60% used only ENDS, over 80% had used ENDS once or more, 28% smoked cigarettes at least once, and a fifth used other forms of nicotine.

After controlling for other factors that influence nicotine use, the researchers found that each decile unit increase in caffeine use was associated with a 15% rise in the use of nicotine and a 13% rise in the use of only ENDS. That is, those who drank the most caffeine at the beginning of the study were about 2.5 times more likely to use nicotine by the follow-up point than those who did not use caffeine.

Parental attitudes to the use of alcohol, tobacco, or other drugs (ATOD) made the most significant impact on nicotine use, along with the use of nicotine modeled by peers. Both of these were associated with a rise in the odds of nicotine use by almost a fifth.

As for ENDS use in isolation, alcohol use at the beginning of the study was linked with a more than doubled risk of nicotine use by follow-up, while parental attitudes towards ATOD contributed an increase of about a fifth.

What are the implications?

The findings of this study indicate that caffeine is related to new nicotine use in a dose-dependent manner and that the first form of nicotine to be sampled among early teens is ENDS. Despite attempts to ban or restrict the marketing of such devices among young people, ENDS remains the dominant form of nicotine use in this age bracket.

ENDS may increase nicotine use among young people since the same categories appear to be vulnerable to cigarette smoking and ENDS use. The current study, showing that caffeine is involved in some way in nicotine use onset, is important as a beginning point for research into the mechanisms of such an association.

Apart from the biological harms of caffeine, it seems that it may contribute to the risk of adolescent nicotine use. In fact, the association of caffeine consumption with both smoking and ENDS use underlines the likelihood of a common biological pathway.

“Early exposure to caffeine may serve to prime biological mechanisms that enhance the habit-forming potential of nicotine.”

Stress associated with changes from lower to higher schools with different routines, structures, and demands, the undue use of social media, and sleeplessness; these may all contribute to a decision to use caffeine or nicotine.

With the known and well-attested harms of nicotine, this leads the researchers to conclude, “Confirmation that early caffeine exposure may promote subsequent nicotine use should give rise to concern and efforts to limit caffeine consumption among youth.”