Vaping Might Make Smoking Habit More Likely in Teens

Young teens who vape and smoke cigarettes may be setting themselves up to be heavy smokers by the time they are older teens, a new study suggests.

The researchers chalked it up to what they called the “entrenchment hypothesis.”

“There has been a lot of attention on restricting e-cigarettes, so that they do not serve as a pathway into tobacco initiation,” said senior study author Jeremy Staff, a professor of sociology and criminology at Pennsylvania State University. “Our findings highlight that considering their impacts on youth who initiate smoking at an early age remains important as well.”

Staff said, “Among early-smoking teens in both the U.K. and U.S., those who had vaped before age 15 were more likely to be smokers, as well as frequent tobacco smokers, by the time they reached late adolescence.”

This study can’t prove that cigarette smoking and vaping cause heavier tobacco smoking in the late teens, only that there appears to be a connection, the researchers noted.

E-cigarette use among teens who already smoke early in adolescence generates more harmful patterns of tobacco use later on in adolescence, said lead researcher Brian Kelly, from the department of sociology at Purdue University, in West Lafayette, Ind.

“Many studies on youth vaping focus on the important goal of prevention of smoking, but less often consider youth who begin smoking early,” Kelly said. “Intervening on vaping among early smokers may help improve tobacco use outcomes in this high-risk group of teens.”

For the study, Staff’s team collected data on nearly 1,900 teen smokers who were part of the U.K. Millennium Cohort Study and the U.S. Population Assessment of Tobacco and Health.

Participants in these studies were surveyed about their use of e-cigarettes and traditional cigarettes up to age 17.

Among the British teen smokers, 57% said they also vaped, as did 58% of U.S. smokers. By their late teens, those who had both vaped and smoked in their early teens were more likely to continue smoking, the investigators found.

Among British participants, 61% of early vapers were smoking in their late teens, compared with 50% of those who didn’t vape. For U.S. participants, 42% of those who smoked and vaped in their early teens were smoking in their late teens, compared with 24% who had never used e-cigarettes.

The odds of continuing to smoke in their late teens among those who also vaped early were 45% higher than for non-vapers in the United Kingdom and 119% higher than for non-vapers in the United States, according to the report.

Not only that, but late teens who smoked more than six cigarettes a week was more common among young teens who used e-cigarettes than those who didn’t (37% versus 23% in Britain and 20% versus 7% in the United States).

In the United Kingdom, the odds of frequent smoking versus not smoking were twice as high among the early e-cigarette users, and five times higher in the United States, the study authors noted.

The findings were published online April 18 in the journal Tobacco Control.

“This study adds to the growing body of evidence that vaping during adolescence increases the risk of cigarette smoking and the dual use of e-cigarettes and combustible cigarettes, and that vaping is generally not an effective smoking cessation tool,” said Linda Richter, vice president for prevention research and analysis at the Partnership to End Addiction.

Nicotine in e-cigarettes has created a “nicotine arms race,” which has resulted in e-cigarettes with extremely high levels of nicotine, Richter said.

“As a result, smokers who use e-cigarettes tend to increase their nicotine intake above and beyond the amount they were exposed to when only smoking cigarettes, typically perpetuating, rather than attenuating, their addiction to nicotine,” she explained.

Companies who make electronic cigarettes have begun to pay for their part in the vicious cycle: Juul Labs announced last week that it has reached a $462 million settlement with several states over the aggressive marketing of its electronic cigarettes to minors. This latest settlement includes New York, California, Colorado, the District of Columbia, Illinois, Massachusetts and New Mexico. The company has already agreed to pay out more than $1 billion to 47 states and territories, Juul Labs said in a statement.

To help teens who are already vaping or using other nicotine products to quit, it is important for parents to think of youth vaping as a health problem rather than a discipline problem, Richter said.

The most effective approach to helping a young person quit is through counseling and family and peer support, she advised.

“It’s also important to address potential underlying mental, emotional or behavioral problems that might contribute to the desire to vape or use other addictive substances,” Richter added.

More information

For more on teen smoking and vaping, head to the American Lung Association.

SOURCES: Jeremy Staff, PhD, professor, sociology and criminology, Pennsylvania State University, University Park; Brian Kelly, PhD, department of sociology, Purdue University, West Lafayette, Ind.; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction; Tobacco Control, April 18, 2023, online