Patterns of Adolescent E-cigarette and Combustible Cigarette Use Are Evolving

The use of e-cigarettes or vaping devices by US adolescents has rapidly increased over the past several years, raising concerns. Researchers used data from a nationally representative school-based survey of 36,506 US students aged 13–16 years, collected from 2015–2017, to evaluate e-cigarette and combustible cigarette initiation patterns.

• Overall, 49% of students with e-cigarette use did not use other nicotine products. Among students who had both combustible cigarette and e-cigarette use, it was more common that use was initiated with combustible cigarettes.
• Over the 3 years of the study, initiating e-cigarettes prior to combustible cigarettes became significantly more common, while combustible cigarette-first use declined.
• Students with dual use perceived less risk related to combustible cigarette use and were more likely to report past 30-day combustible cigarette use.

Comments: While e-cigarettes continue to be promoted as a smoking cessation tool for adults who use combustible cigarettes, among adolescents they increasingly represent the first exposure to nicotine products. This suggests that combustible cigarette smoking cessation is a rare motivation for e-cigarette use among adolescents. Public health efforts should continue to focus on reducing e-cigarette use rather than promoting e-cigarettes as a harm reduction tool, particularly among youth.

Sharon Levy, MD, MPH

Reference: Evans-Polce RJ, Veliz P, Boyd CJ, McCabe SE. Initiation patterns and trends of e-cigarette and cigarette use among US adolescents. J Adolesc Health. 2020;66(1):27–33.