Are e-cigarettes a gateway to traditional smoking for teens?

Teenagers who have used electronic cigarettes by the time they start ninth grade are more likely than others to start smoking tobacco-based products such as cigarettes, cigars, and hookahs in the future, according to a new study.

Researchers from the University of Southern California compared tobacco use initiation among 222 students who had used e-cigarettes and 2,308 who had neither used e-cigarettes nor combustible tobacco products when initially surveyed at the start of ninth grade.

According to the study, which was published on Tuesday in the Journal of the American Medical Association, 30.7 percent of teen e-cigarette smokers switched to more traditional tobacco products within six months, compared with just 8.1 percent of those who had never used e-cigarettes.

“Recreational e-cigarette use is becoming increasingly popular among teens who have never smoked tobacco. Adolescents who enjoy the experience of inhaling nicotine via e-cigarettes could be more apt to experiment with other nicotine products, including smokeable tobacco,” study author Adam M. Leventhal, who is an associate professor of preventative medicine at the University of Southern California, said in a press release. “While we cannot conclude that e-cigarette use directly leads to smoking, this research raises concerns that recent increases in youth e-cigarette use could ultimately perpetuate the epidemic of smoking-related illness."

Professor Levanthal and his colleagues write:

"These data provide new evidence that e-cigarette use is prospectively associated with increased risk of combustible tobacco use initiation during early adolescence. Associations were consistent across unadjusted and adjusted models, multiple tobacco product outcomes, and various sensitivity analyses.

"Some teens may be more likely to use e-cigarettes prior to combustible tobacco because of beliefs that e-cigarettes are not harmful or addictive, youth-targeted marketing, availability of e-cigarettes in flavors attractive to youths, and ease of accessing e-cigarettes due to either an absence or inconsistent enforcement of restrictions against sales to minors."

National data show that e-cigarettes have become more popular among teens than traditional cigarettes, as The Christian Science Monitor previously reported. Electronic cigarettes are battery-powered devices that heat liquid nicotine into inhalable vapor a process often called “vaping.”

In 2014, the US Food and Drug Administration proposed rules that would ban the sale of electronic cigarettes to minors and would add the devices to the list of tobacco products it regulates.

E-cigarette manufacturers and some public health experts say that e-cigarettes can be a safer alternative for people who are trying to quick smoking cigarettes. Others have expressed concerns that the new devices could serve as an attractive gateway for teens that could undermine decades of public health campaigns designed at discouraging tobacco use.

In 2014, a study by Yale University found that, antismoking campaigns have saved 8 million lives since smoking was declared harmful in 1964.