Youth Vaping Triples Odds for Adult Smoking

Vaping may not be a way for kids to avoid the smoking habit, after all. A new study finds that teens who start vaping are three times more likely to smoke cigarettes in adulthood than those who never started with electronic cigarettes.

Although the number of teens who start smoking cigarettes in high school has declined, vaping has soared. From 2016 to 2019, the number of cigarette smokers among U.S. high school seniors dropped from 28% to 22%, but e-cigarette use increased from 39% to 46%, the researchers found.

“The rapid rise in e-cigarette experimentation among the youth of our country appears to mean that we will have a whole new generation of cigarette smokers along with all the health consequences that follow,” said lead researcher John Pierce. He’s a professor emeritus in the department of family medicine and public health at the University of California, San Diego.

“There is an urgent need to reconsider the policies on e-cigarettes and at least hold them to the same standards as the cigarette companies, such as restricting their right to advertise to our teens,” Pierce said.

For the study, the investigators collected data on nearly 16,000 people in the United States, aged 12 to 24. Nearly two-thirds had tried at least one tobacco product, and almost one-third tried five or more tobacco products, of which e-cigarettes and cigarettes were the most popular, the findings showed.

Each additional product tried increased the users’ odds of becoming a daily cigarette smoker, as did trying tobacco before age 18, according to the report published online Jan. 11 in the journal Pediatrics.

Dr. Pamela Ling is interim director of the Center for Tobacco Control Research and Education at the University of California, San Francisco. She said, “This is a problem because the tobacco companies are continuing to produce more new tobacco products every year.”

E-cigarettes and other new tobacco products gained popularity because people think of them as safer alternatives to cigarettes, explained Ling, who was not involved in the study. But this study shows that in the hands of young people, e-cigarettes lead to harm.

“Some young people may think they are decreasing their risk because they smoke a little, vape a little, chew a little, but may not use any single product very much. But this poly-tobacco use behavior increases risk to end up a daily smoker,” Ling said.

Pierce noted that there are a number of people who advocate e-cigarettes as a way of reducing the harm caused by cigarettes. These people have assumed that young people who start using e-cigarettes will become dependent on them to get their nicotine.

“However, the evidence indicates that these young people only start with e-cigarettes and then most of them convert to become cigarette smokers. So e-cigarettes are not a harm-reduction strategy at all,” Pierce said.

State tobacco control programs have been instrumental in decreasing tobacco use among adults, teens and young adults over the last several years, said Patricia Folan, director of the Center for Tobacco Control at Northwell Health in Great Neck, N.Y.

“Anti-tobacco media campaigns, age restrictions, tobacco-free environments and increased taxes on tobacco products are some of the strategies that have effectively reduced tobacco use prevalence in the U.S.,” Folan said.

But with the introduction of newer tobacco products, with attractive flavors and promises of greater safety, teens have been enticed to try new forms of tobacco and have become addicted, she added.

“Tobacco control advocates and health care providers have been very concerned that use of these alternative tobacco products might lead to traditional cigarette smoking. This study certainly validates their fears,” Folan said.

These alternative tobacco products have the potential to undo much of the good that has been done in tobacco control, she explained.

“We know that the earlier a person becomes addicted to nicotine, the more likely they are to smoke into adulthood. Children as young as middle school students have been using e-cigarettes, reinforcing the need to stop this trend,” Folan said.

More information

For more on e-cigarettes, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: John Pierce, PhD, professor emeritus, department of family medicine and public health, University of California, San Diego; Pamela Ling, MD, interim director, Center for Tobacco Control Research and Education, University of California, San Francisco; Patricia Folan, DNP, director, Center for Tobacco Control, Northwell Health, Great Neck, N.Y.; Pediatrics, Jan. 11, 2021, online