Young e-cigarette users three times as likely to become cigarette smokers

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  • People under 18 who smoke e-cigarettes are more likely to take up cigarette smoking 
  •  E-cigarettes can be regarded as a 'gateway' for those who become daily cigarette smokers 
  • Participants were more likely to smoke cigarettes long-term than other tobacco products they experimented with

Young people under 18 who smoke e-cigarettes are more likely to become daily cigarette smokers before they turn 18, a new study finds.

Increase in cigarette smoking

Researchers enrolled 12- to 24-year-olds between 2013 and 2014 and re-interviewed them annually for four years to explore progression to daily use of tobacco products.

The research published in Pediatrics found that people aged 12 to 24 who used e-cigarettes were three times more likely to become daily cigarette smokers. Some of the people in the group who reported using a tobacco product saw their daily use increase through 28 years of age. The daily cigarette smoking nearly doubled in the groups aged between 18 to 21 and 25 to 28.

“This is the first paper that actually looks at progression to dependent cigarette smoking among young adults. In these data, e-cigarettes are a gateway for those who become daily cigarette smokers. The start product has changed from cigarettes to e-cigarettes, but the end product has stayed the same. When users become dependent on nicotine, they are converting to cigarette smoking,” says the study's first author, Prof John Pierce in a press release.

Experimenting with tobacco products 

The study further found that fewer than 1% of people who experimented with just one tobacco product progressed to daily cigarette smoking. However, those who used five or more products increased their risk of becoming daily cigarette smokers by 15%.

“Trying e-cigarettes and multiple other tobacco products before the age of 18 is also strongly associated with daily cigarette smoking," says senior author Prof Karen Messer.

"We know that e-cigarette use among high school seniors, most under the age of 18, increased from 38% in 2016 to 45% in 2019. These results suggest that recent rapid growth in adolescent e-cigarette use will lead to increased daily cigarette smoking among young adults in the United States, reversing decades of decline in cigarette smoking," Messer explains.

The findings also show that by the fourth year, 12% of the participants were using tobacco daily. Half of these participants became daily users after the first year. The results also revealed that 70% of daily users smoked cigarettes, and 63% used cigarettes exclusively. Of those who smoked cigarettes and used another tobacco product, half vaped e-cigarettes on a non-daily basis.

"What we're seeing is that the proportion who are daily e-cigarette users did not increase with age, whereas with cigarettes the number of users jumps up rapidly with age. This rapid increase with age only occurred with cigarettes, not with any other tobacco products,” says Pierce.  

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