E-cigarette and Other Smokeless Product Use Is Associated With Cigarette Smoking Initiation Among Adolescents

Rates of standard tobacco (cigarette) smoking among adolescents plummeted over the past 20 years, but more recently rates have stabilized and the use of non-cigarette products has increased. In this longitudinal survey of more than 10,000 youth aged 12–17, researchers examined whether use of smokeless tobacco products by non-smokers predicted cigarette initiation.

• 6% of non-smokers initiated cigarette smoking in the one-year observation period, and 2.1% reported past 30-day cigarette smoking.
• In adjusted models, odds of past 30-day cigarette smoking at follow-up was approximately twice as high among baseline cigarette non-smokers that used e-cigarettes, hookah, or other tobacco products, compared with those who had not.
• Youth who used more than one non-cigarette product at baseline had 3.8 greater odds of past 30-day cigarette smoking at follow-up, compared with those who had no tobacco product use at baseline.

Comments: E-cigarettes, hookah, and similar products are often promoted as harm reduction for cigarette smokers. This study demonstrates that use of any nicotine-based product by adolescents is associated with cigarette smoking initiation; this risk should be considered among the public health harms of these products. Efforts to regulate these products using strategies known to reduce youth cigarette use should be applied broadly to nicotine-containing non-cigarette products.

Sharon Levy, MD, MPH

Reference: Watkins SL, Glantz SA, Chaffee BW.  Association of noncigarette tobacco product use with future cigarette smoking among youth in the Population Assessment of Tobacco and Health (PATH) study, 2013-2015. JAMA Pediatr. 2018;172(2):181–187.