Vape Now, Smoke Later

A new study published in the JAMA Network Open Journal, has found that teens who start vaping are nearly three times more likely to go on to smoke cigarettes than their peers who don’t use any type of tobacco product. The results are alarming for both medical experts — who would rather kids not smoke — and for the e-cigarette industry, which is increasingly marketing its products as smoking-cessation tools for adults.

The massive Population Assessment of Tobacco and Health (PATH) study — a long-term, nationwide survey of tobacco product use — provided the data for the study. Researchers led by Andrew Stokes, an assistant professor of global health at Boston University, analyzed survey responses from more than 6,100 12- to 15-year-olds between 2013 and 2016 who answered questions about their families, their tolerance for risk, and what they liked to smoke or vape.

By the end of the study, the percentage of kids who tried at least one or two puffs of cigarettes had grown to 20.5 percent. Kids who started out trying e-cigarettes were roughly four times more likely to go on to try cigarettes, and nearly three times more likely to have used cigarettes in the past 30 days compared to their classmates who didn’t vape or smoke anything.

The link between e-cigarette use and eventual cigarette use was especially strong for kids considered “low risk” for substance use: the ones that aren’t big on thrill-seeking, drinking, or misusing prescription drugs. “There seems to be something unique about e-cigarettes that leads to this increased risk of smoking initiation among low-risk youth,” St. Helen says. “We’re all concerned it would lead to more use.” The study authors don’t get into why that might be. Maybe starting out with vaping gets otherwise low-risk kids hooked on nicotine, or maybe it normalizes smoking behavior so they’re less turned off by cigarettes later on.

The findings seem to directly contradict a recent major clinical study that showed e-cigarettes helped a small proportion of adult smokers quit cigarettes. The back-to-back publications show the tightrope on which regulators and the e-cigarette industry are walking: on one hand, e-cigarettes may wind up being a useful tool for helping adults stop smoking. On the other hand, there’s a growing body of evidence that e-cigarettes act as what FDA commissioner Scott Gottlieb referred to as an “on ramp” to real cigarettes.

The findings are especially timely in light of the Food and Drug Administration’s recent announcement that 3.6 million high school and middle school students reported using e-cigarettes in 2018. The medical community has been looking forward to these results, which give regulators another reason to try to curb youth vaping.

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