Teen e-cig users more likely to smoke tobacco

Electronic delivery of nicotine raises rate that high school students turn to combustible products

GATEWAY TO TOBACCO  High school students who use e-cigarettes are about three times as likely as nonusers to start smoking tobacco within a year.


E-cigarettes may tempt kids into trying tobacco.

Teens who use e-cigarettes are more likely to start smoking cigarettes, cigars and other tobacco products than teens who don’t use e-cigarettes, researchers report in the Aug. 18 JAMA. The study is the first to draw a link between e-cigarette use and later experimentation with tobacco.

“The question of whether e-cigarette use promotes cigarette smoking has now been answered — and the answer is yes,” says tobacco control researcher Stanton Glantz of the University of California, San Francisco.

Unlike tobacco products, e-cigarettes can be advertised on TV and radio in the United States, and — in some states — e-cig makers can even sell their wares to minors. E-cigarettes don’t contain tobacco, but they usually do deliver hits of nicotine and other chemicals (SN: 6/28/14, p. 9), and can come in kid-friendly flavors like cotton candy and banana pudding (SN online: 5/18/15).

The number of teens who have tried e-cigarettes more than doubled between 2011 and 2012. Last year, Glantz and UC San Francisco colleague Lauren Dutra reported that e-cigarette users are more likely than nonusers to smoke tobacco.

But because that study didn’t follow e-cigarette users over time, the authors couldn’t say whether or not e-cigarette use led people to try tobacco. “We got yelled at because we suggested that e-cigarettes were promoting smoking,” Glantz says.

Some scientists have argued that e-cigarettes actually prevent smoking by giving teens a tobacco-free product to choose, says addiction scientist Adam Leventhal of the University of Southern California in Los Angeles.

Leventhal and colleagues asked 2,530 nonsmoking ninth-graders from 10 Los Angeles public high schools about their background, family history and habits. Of those students, 222 had used, or vaped, e-cigarettes. The team repeated the survey after six months, and again after a year. Compared with kids who didn’t use e-cigarettes at the beginning of ninth grade, those who did were about three times as likely to start smoking tobacco products during the year.

The idea that e-cigarettes steer teens away from tobacco just doesn’t fit, Leventhal says. “We actually found the opposite.”

The findings “blow away one of the head-in-the-sand arguments that a lot of the e-cigarette advocates have been making,” Glantz says.

Leventhal plans to continue following the study’s participants to find out if teens who use e-cigarettes are more likely than nonusers not just to experiment with tobacco but also to become hooked on it.

Editor’s Note: This story was updated August 25, 2015, to clarify the results of Glantz’s 2014 study and to note his coauthor.

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