Youth e-cigarette use can serve as a gateway to future cigarette smoking, a new study suggests.

Young people aged 12 to 24 who used electronic cigarettes were three times as likely as non-users to be daily cigarette smokers down the line, according to a four-year study published in the journal Pediatrics

The researchers analyzed nationally representative data from the longitudinal Population Assessment of Tobacco and Health (PATH) Study, which conducted interviews with participants for four years starting in 2013 and 2014.

“The start product has changed from cigarettes to e-cigarettes, but the end product has stayed the same,” first study author John Pierce, a professor emeritus at the University of California San Diego, said in a statement. “When users become dependent on nicotine, they are converting to cigarette smoking.”

By wave 4 of the study in 2017, some 62% of participants had tried at least one tobacco product and 30% had tried at least five, the most popular of which were e-cigarettes and cigarettes. 

Moreover, “progression to daily cigarette smoking between waves 1 and 4 was 3 times higher among e-cigarette ever users compared with nonusers,” the study found, with 3% among those who had never tried e-cigarettes compared to 10% among young people who had tried e-cigarettes, even just once or twice.


‘The rapid rise of teen nicotine vaping in recent years has been unprecedented and deeply concerning since we know that nicotine is highly addictive and can be delivered at high doses by vaping devices, which may also contain other toxic chemicals that may be harmful when inhaled.’


— Nora Volkow, director of the National Institute on Drug Abuse

“Each additional product [that was] tried markedly increased the odds of becoming a daily cigarette smoker, as did experimenting with tobacco before age 18 years,” the authors wrote. “These results suggest that recent rapid growth in adolescent e-cigarette use will lead to increased daily cigarette smoking in U.S. young adults.”

A separate study published in the journal Addictive Behaviors in December found that e-cigarette use heightened adolescent boys’ risk of smoking cigarettes, as well as their risk of smokeless tobacco use.

E-cigarettes have attracted close scrutiny in recent years amid an ongoing youth vaping epidemic and a 2019 outbreak of e-cigarette-related lung illnesses traced to vitamin E acetate, an additive found in some THC products. President Trump signed legislation in late 2019 raising the federal minimum age from 18 to 21 for tobacco purchases, including e-cigarette products.

Adolescent nicotine use “can harm the parts of the brain that control attention, learning, mood, and impulse control,” according to the U.S. Centers for Disease Control and Prevention.

Studies suggest that e-cigarettes are less harmful than combustible cigarettes, and there is some evidence that they can help adults stop smoking combustible cigarettes. But evidence on e-cigarettes’ ability to help smokers quit has been mixed, and concerns persist that e-cigarettes, which the Food and Drug Administration has not approved as a smoking-cessation aid, could be a gateway to cigarette smoking.

Despite the recent studies on links between e-cigarette use and cigarette smoking, results from a National Institute on Drug Abuse-funded survey published in December suggested that teen vaping may have leveled off in early 2020, though it was still high.

“The rapid rise of teen nicotine vaping in recent years has been unprecedented and deeply concerning since we know that nicotine is highly addictive and can be delivered at high doses by vaping devices, which may also contain other toxic chemicals that may be harmful when inhaled,” NIDA director Nora Volkow said in a statement. “It is encouraging to see a leveling off of this trend though the rates still remain very high.”

In a JAMA Network Open study conducted in May of more than 2,100 e-cigarette users aged 13 to 24, 32% quit using e-cigarettes during the COVID-19 pandemic, while 35% decreased the amount of nicotine and nearly 18% increased nicotine use. Almost 8% increased their cannabis use, while 7% switched to using other products.

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