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Are E-cigarettes Leading More Kids to Smoke?

Posted on by Dr. Francis Collins

Cigarettes vs. E-Cigarettes


Today, thanks to decades of educational efforts about the serious health consequences of inhaled tobacco, fewer young people than ever smoke cigarettes in the United States. So, it’s interesting that a growing of number of middle and high school kids are using e-cigarettes—electronic devices that vaporize flavored liquid that generally contains nicotine.

E-cigarettes come with their own health risks, including lung inflammation, asthma, and respiratory infections. But their supporters argue that “vaping,” as it’s often called, might provide an option that would help young people steer clear of traditional cigarettes and the attendant future risks of lung cancer, emphysema, heart disease, and other serious health conditions. Now, a new NIH-funded study finds that this is—pardon the pun—mostly a pipe dream.

Analyzing the self-reported smoking behaviors of thousands of schoolkids nationwide, researchers found no evidence that the availability of e-cigarettes has served to accelerate the decline in youth smoking. In fact, the researchers concluded the opposite: the popularity of e-cigarettes has led more kids—not fewer—to get hooked on nicotine, which meets all criteria for being an addictive substance.

The study, published recently in the journal Pediatrics, builds on publicly available data from the Centers for Disease Control’s National Youth Tobacco Survey (NYTS) [1]. First administered in 1999, the survey was designed to capture the attitudes, behaviors, and exposure of kids in grades 6 through 12 to cigarettes and other tobacco products.

To capture youth smoking behaviors before and after e-cigarettes came on the scene in 2007, Lauren Dutra at RTI International, Berkeley, CA, and Stanton Glantz at the University of California, San Francisco, specifically analyzed survey data collected from 2004 to 2014. Not surprisingly, the data show a decline in cigarette smoking. In 2004, almost 16 percent of kids said they had smoked cigarettes within the last month, which is the definition of a current smoker. By 2014, only about 6 percent of kids said they had. But did the rate of decline accelerate with the arrival of e-cigarettes on the market?

Researchers say the answer is no. Many kids who smoked cigarettes also started vaping, as did some nonsmokers. But the sudden popularity of e-cigarettes had no apparent effect on curbing cigarette use.

Dutra and Glatz decided to drill down further. They turned their attention to survey questions that could help tease out contributing factors that increase a kid’s risk of smoking cigarettes, such as rebelliousness, sensation seeking, and whether their friends or parents smoked. Such questions included, “Do you think smoking cigarettes makes young people look cool or fit in?” and “If one of your best friends offered you a cigarette, would you smoke it?”

Based on the answers, Dutra and Glantz developed a behavioral model to predict whether an adolescent was likely to be a smoker. The model showed that they were very much on the right track, correctly classifying as smokers more than 75 percent of kids who reported lighting up in the last 30 days.

But the model didn’t work so well for e-cigarettes. The researchers found less than a quarter of e-cigarette users fit the profile of a cigarette smoker.

The finding shows that vaping has expanded the market for tobacco products to include kids at low risk of smoking cigarettes. As a result, the number of tweens and teens who used e-cigarettes, traditional cigarettes, or both in 2014 is greater than the number that smoked cigarettes in 2009. That’s a concern because e-cigarettes do come with health risks. Also of great concern is the possibility that vaping is a gateway to traditional cigarettes. Other studies have shown that people who use e-cigarettes are three times as likely to take up smoking within a year [2,3].

In fact, there are signs this has already begun. The 2015 NYTS survey data, which became available only after the researchers had completed their newly reported analysis, show almost no decline in smoking among middle schoolers between 2014 and 2015. The percentage of kids in high school who reported smoking in 2015 actually ticked up slightly compared to the previous year.

The findings highlight the importance of public health measures to discourage vaping, and there has been some progress on this front. Last August, the FDA restricted the sale of e-cigarettes to adults age 18 or older. By August 2018, e-cigarettes will bear labels warning of the addictive nature of the nicotine. Policymakers are also talking about prohibiting the sale of e-cigarettes with flavors known to attract young people. As this study also shows, e-cigarettes seem to be making the tobacco problem worse, not better.


[1] E-cigarettes and National Adolescent Cigarette Use: 2004-2014. Dutra LM, Glantz SA. Pediatrics. 2017 Jan 23. pii: e20162450. doi: 10.1542/peds.2016-2450.

[2] Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults. Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD. JAMA Pediatr. 2015 Nov;169(11):1018-23

[3] Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, Stone MD, Khoddam R, Samet JM, Audrain-McGovern J. JAMA. 2015 Aug 18;314(7):700-7


Tobacco (National Cancer Institute/NIH)

National Youth Tobacco Survey (Centers for Disease Control and Prevention)

Stanton Glantz (University of California, San Francisco)

NIH Support: National Cancer Institute


  • Carol Vills says:

    I think if you take into consideration the number of adults who have been able to stop smoking with the help of a e-cig, the outcome of regular smokers has been greatly reduced.
    I still see a large amount of teenagers smoking but very few with a e-cig. There are better ways of controlling e-cgs. Dont sell them in grocery stores or gas stations and if you do only offer cigarette flavor with no nicotine. Make them only available in cape shops or online. Raise the age to 21,
    In Texas you cannot purchase e-cigs without proof of age with a license number or SS# to prove age.
    I stopped smoking cigarettes after 30 years of smoking using a e-cig. The goal is to start at a higher level of nicotine and then keep reducing the level to 0%. The more popular online sights do recommend that.
    I still find it a better alternative to cigarettes. If kids want cigarettes or e-çigs, they will get them.

  • Andrew Day says:

    With less than 0.1% of never smokers using e-cigarettes more than 10x month it is very hard to claim a) that non-smoking youth are getting addicted to e-cigarettes (or nicotine through e-cigarettes) and b) that youth are using e-cigarette use to transition to tobacco products.

    These findings mirror what stats keepers in the UK have known and observed for a long time. The only groups (young or old) that use e-cigarettes frequently are current and former smokers.

    Hyperbolic statements that imply that e-cigarettes are luring never smokers or youth that would have never smoked to cigarettes and a lifetime of nicotine addiction are just that, hyperbole. They are clear examples of researchers and policy makers being factually dishonest. They are as is custom to call them these days #AlternateFacts.

  • Peter Hajek says:

    There are several bits of inaccurate information here. The Dutra and Glanz study found no sign that vaping is leading to smoking (although it is true that the authors claimed otherwise). They detected no increase in youth smoking, on the contrary, the continuous decline in smoking shows that e-cigarettes are not expanding smoking. In fact, if the decline in smoking over 2004-2011, before vaping become more widespread, is compared with the decline over following years, it may well have significantly accelerated.

    The claim that e-cigarette–only users (non-smokers who mostly only tried e-cigarette once or twice) would be unlikely to have initiated tobacco product use otherwise makes no sense because e-cigarette only users have not initiated any tobacco product use! Studies that assessed frequency of use report that as with non-smokers who try nicotine replacement products such as nicotine chewing gum, it is extremely rare for non-smokers who try vaping to progress to regular use. While some smokers find e-cigarette satisfactory and switch to vaping, virtually no non-smokers progress to daily use.

    It is also not true that ‘E-cigarettes come with their own health risks, including lung inflammation, asthma, and respiratory infections’. On the contrary, vapers report a reduction in respiratory infections

    possibly due to bactericidal properties of propylene glycol;

    and smokers with asthma who switch to vaping show a reduction in asthma symptoms while smokers with lung disease show improvements as well.

    E-cigarettes have not been luring children to smoking; and there is no doubt that encouraging smokers to switch to vaping would benefit public health.

  • Igor says:

    With less than 0.1% of never smokers using e-cigarettes more than 10x month it is very hard to claim a) that non-smoking youth are getting addicted to e-cigarettes (or nicotine through e-cigarettes) and b) that youth are using e-cigarette use to transition to tobacco products.

  • Priyanka says:

    Vaping is less harmful than smoking, but it means not It is good for health. I suggest, we should not have vape if we are under 18.

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