Overall, adolescents who used e-cigarettes before trying any other tobacco products were more than four times as likely to be smoking traditional cigarettes within a couple of years compared to those who had never tried any type of vaping device or non-cigarette tobacco products, the study team reports in JAMA Network Open.
“E-cigarettes may be a pathway to cigarette smoking, and a sizeable one,” said senior study author Andrew Stokes of the Boston University School of Public Health.
Overall, smoking rates have dropped significantly, Stokes said. “That’s been a real success story for public health and in that context, it’s pretty alarming that a new product has come on the market potentially drawing a whole generation into using tobacco,” he added.
Stokes and his colleagues explored the influence of e-cigarettes through the Population Assessment of Tobacco and Health Study (PATH), a nationally-representative sample of kids aged 12 to 15 who completed annual questionnaires between 2013 and 2016.
Along with questions about vaping and smoking, the surveys asked about kids’ socioeconomic backgrounds and their attitudes about smoking. They were also asked questions designed to illuminate how prone they were toward risky behaviours and sensation-seeking.
Those who reported using a tobacco product in the three years of surveys were asked which of 12 products they had “tried first,” including traditional cigarettes, cigars, pipes, hookahs, chewing tobacco, snus and e-cigarettes.
Stokes and his colleagues focused on the 6,123 kids who said in the first-wave survey that they had never used any tobacco product. By the third survey, 6.1% of these kids reported smoking or having tried traditional cigarettes.
Among kids who had first tried e-cigarettes, just over 20% had tried or were regularly smoking cigarettes by wave three, and among kids who first tried other non-cigarette tobacco products, more than 21% had tried or were smoking cigarettes. That compares with just 4% of kids who had not used any type of non-cigarette tobacco products.
The new findings are “pretty consistent with what we’ve seen before in this area in terms of demonstrating that people who experiment with electronic cigarettes, even if they swear at baseline that they would never smoke regular cigarettes, are at much more risk of transitioning to regular cigarettes,” said Dr Brian Primack, director of the Centre for Research on Media, Technology and Health at the University of Pittsburgh in Pennsylvania.