Young adults using e-cigarettes are more likely to progress to smoking, study shows

Adolescents and young adults who use electronic cigarettes are more likely to progress to smoking tobacco cigarettes than those who do not, shows a small US study that researchers say supports regulations to limit sales and reduce the appeal of e-cigarettes to young people.

The study, published in JAMA Pediatrics,1 followed up a nationally representative sample of 694 teenagers and young adults aged 16 to 26 who had never smoked. Their attitudes showed that they were not susceptible to smoking cigarettes because they had responded “definitely no” when asked whether they would try a cigarette offered by a friend or whether they believed that they would smoke a cigarette within the next year.

The young people completed a survey about smoking when they were recruited to the study, from 1 October 2012 to 1 May 2014. They were then reassessed a year later.

Results showed that 16 adolescents and young adults (2.3% of the study sample) used e-cigarettes at baseline. Over the one year follow-up, 11 of 16 e-cigarette users and 128 of 678 study participants who had not used e-cigarettes (18.9%) progressed towards cigarette smoking, which researchers defined as either being susceptible to smoking (not ruling out smoking in the future) or actually smoking (having at least one puff of a cigarette).

Young people who used e-cigarettes were more than eight times more likely to progress to smoking than those who did not (adjusted odds ratio 8.3 (95% confidence interval 1.2 to 58.6)) or to be susceptible to smoking (8.5 (1.3 to 57.2)), although the authors acknowledged that the study’s most important limitation was the relatively small number of people who used e-cigarettes at baseline, which limited its statistical power.

Brian Primack, lead study author and director of the Center for Research on Media, Technology, and Health at the University of Pittsburgh in Pennsylvania, said, “These differences remained statistically significant and robust even when we controlled for multiple known risk factors for initiating cigarette smoking, such as age, sex, race, ethnicity, socioeconomic status, sensation seeking, parental smoking, and friend smoking.”

He added, “E-cigarettes are not subject to many laws that regulate traditional cigarettes, such as age limits on sales, taxation, and labeling requirements. They also come in youth oriented flavourings that laws have limited in traditional cigarettes, such as apple bubble gum and chocolate candy cane.”

In an accompanying editorial Jonathan Klein, of the American Academy of Pediatrics in Illinois, said that the study “is one more piece of evidence that the effect of e-cigarettes on youth is happening now in real time and that these products harm non-smokers and result in a net harm to society and public health.”2

Commenting on the findings Peter Hajek, professor of clinical psychology and director of the Tobacco Dependence Research Unit at Queen Mary University of London, UK, said, “The study just confirms that cigarettes and e-cigarettes attract the same people who like trying risky things.

“People who like to try things go on trying things. The study actually confirms the obvious intuition about one characteristic of this group: the 16 experimenters had significantly higher ‘sensation seeking’ scores (measured by items such as ‘I like to do dangerous things’) than the other 678 participants.”

Ann McNeill, professor of tobacco addiction at the National Addiction Centre at King’s College, London, said, “The study focuses on only 16 people, aged 16-26 years, who had tried an e-cigarette at baseline and were deemed ‘non-susceptible’ to cigarette smoking. Hence trying an e-cigarette had not, at this point, made them susceptible to smoking cigarettes.

“Sadly, therefore, this study cannot throw any light at all on what influenced a proportion of these 16 people to soften their attitudes towards cigarette smoking or try a traditional cigarette one year later.”

• Download figure
• Open in new tab
• Download powerpoint