Early high school students who have smoked electronic cigarettes (e-cigarettes) are more likely to progress to smoking regular tobacco products, according a school-based cohort study of 2,530, 14-year-old participants. In follow-up reports, researchers found:

• Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users than never users at the 6-month follow up. (31% vs. 8%) and at the 12-month follow-up (25.2% vs. 9.3%).

• Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses and in the analyses adjusted for socio-demographic, environmental, and intrapersonal risk factors for smoking.

• Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette, cigar, and hookah use.

Commentary: The effect of e-cigarette use on eventual uptake of cigarette smoking is a critical area of public health research. Most long-term tobacco use starts in the teenage years with 9 of 10 cigarette smokers trying their first cigarette by age 18¹. While adolescent smoking has decreased over the last 5 years, if the current rate of teenage smoking continues, it is estimated that 1 of every 13 Americans younger than 17 years of age will eventually die of a smoking related illness². Many people have referred to e-cigarettes as a healthy alternative to inhalation cigarette smoking, but this study shows, without question, that children who use e-cigarettes are substantially more likely to go on to smoking regular cigarettes, possibly due to exposure to the addictive qualities of nicotine. The bottom line – e-cigarette use by adolescents should be strongly discouraged. —Neil Skolnik, MD

1. US Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Updated July 24, 2015.

2. Centers for Disease Control and Prevention: Smoking & Tobacco Use. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm. Updated July 24, 2015.