E-cigarette use likely leads to future cigarette use

Adolescents and young adults who reported using electronic cigarettes (e-cigarettes) in a national survey were more likely to have progressed to smoking cigarettes 1 year later than their peers who did not use e-cigarettes. The survey was conducted in 694 individuals aged from 16 to 26 years who had never smoked cigarettes and were not susceptible to doing so in the future, as ascertained with several survey questions. 

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Only 16 of total participants (2.3%) used e-cigarettes at baseline. Whereas 31.3% of these e-cigarette users at baseline progressed to “susceptible” status, only 9.3% of those who did not use e-cigarettes at baseline made this progression. Similarly, 37.5% of individuals who used e-cigarettes at baseline progressed to cigarette smoking compared with 9.6% of those who did not use e-cigarettes. These findings held even after adjustment for multiple variables (Primack BA, et al. JAMA Pediatr. 2015:169[11]:1018-1023).

Commentary: I realize that I sound like a broken record in citing the many recent articles on e-cigarette use by adolescents. However, this is an important, rapidly evolving issue that affects the current and future health of our patients. Previous studies have shown that children increasingly use e-cigarettes, now more often than conventional cigarettes. Although manufacturers argue that e-cigarettes may be less harmful to current smokers than conventional cigarettes, evidence is incomplete, and neither is better than either for our patients who have never smoked in the past. This new longitudinal study is the first to show what cross-sectional studies have only hinted at previously: Adolescents who use e-cigarettes are more likely to go on to use conventional cigarettes. We need to strongly and clearly counsel our patients against initiating nicotine exposure by any means, including e-cigarettes -Michael G Burke, MD 

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.