Mounting evidence links e-cigs to cigarette smoking in youth

A growing body of research is making links between e-cigarettes and youth smoking

Youngsters using e-cigarettes, smokeless tobacco or tobacco water pipes are more likely to take up conventional cigarettes, according to new research by UC San Francisco (UCSF) published in JAMA Pediatrics.

Analysing the smoking and vaping behaviour of 10,384 youngsters aged 12-17, researchers found 19.1% of youth who had tried e-cigarettes had then tried a cigarette within the following year, compared with 4.6% of all youth sampled. Smoking was also higher among those who used hookahs (18.3%), non-cigarette combustible tobacco (19.2%) or smokeless tobacco (18.8%).

“After adjusting for smoking risk factors, the odds of smoking the previous month were approximately twice as high among e-cigarette users and more than three times as high for those who used multiple products, an increasingly common use pattern in adolescents,” says a UCSF news report.

The study joins four recent studies in finding links between vaping and smoking in youth – another study published in January has found that US college students who exclusively used e-cigarettes had a greater odds of non-users of subsequent cigarette initiation, while a Canadian study found e-cigarette use “strongly associated” with cigarette smoking behaviour, including smoking initiation.

A US study found that ratcheting up nicotine content in e-cigarettes had a direct impact on the number of e-cigarette users who subsequently turned to combustible cigarettes. And research from the University of Pittsburgh found young adults who use e-cigarettes are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not vape. Those findings “demonstrate that e-cigarettes are serving as a gateway to traditional smoking, contrary to their purported value as a smoking cessation tool,” according to the authors.

Recent research assessing links between e-cigarettes and smoking in youth
Title Published Age range Country Findings
Electronic cigarette use and smoking initiation among youth: a longitudinal cohort study October 2017 14-17 Canada Youth who reported e-cigarette use in the past 30 days were more likely to initiate cigarette smoking and more likely to report having smoked daily at follow-up, even after adjustment for a range of other factors at baseline.

Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use among Tobacco-Naïve U.S. Young Adults

December 2017 18-30 USA Baseline e-cigarette use was independently associated with initiation of traditional cigarette smoking at 18 months. This finding supports policy and educational interventions designed to decrease use of e-cigarettes among non-smokers.
Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents December 2017 15-17 USA Each successive increase in nicotine concentration vaped was associated with a 2.26 increase in the odds of frequent (vs no) smoking and a 1.65 increase in the odds of frequent (vs no) vaping at follow-up. Use of e-cigarettes with high (vs no) nicotine concentration was associated with a greater number of cigarettes smoked per day at follow-up.
Exclusive e-cigarette use predicts cigarette initiation among college students January 2018 18-25 USA 11% of college students initiated cigarette use over the 1.5 year study period. More e-cigarette users than non-users initiated cigarette use during the study period. Exclusive e-cigarette use predicted subsequent cigarette initiation.
Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015 January 2018 12-17 USA The odds of ultimate cigarette use were approximately twice as high among baseline ever users of e-cigarettes. Any use of e-cigarettes, hookah, noncigarette combustible tobacco, or smokeless tobacco was independently associated with cigarette smoking 1 year later.


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