E-Cigarette Use by Adolescents Associated With Higher Odds of Smoking


Media Advisory: To contact corresponding author Stanton A. Glantz, Ph.D., call Elizabeth Fernandez at 415-514-1592 or email Elizabeth.Fernandez@UCSF.edu. To contact editorial author Frank J. Chaloupka, Ph.D., call Sherri McGinnis-González at 312-996-8277 or email smcginn@uic.edu.


JAMA Pediatrics


Bottom Line: Electronic cigarettes, which deliver a heated aerosol of nicotine mimicking conventional cigarettes, was associated with higher odds of cigarette smoking by adolescents, whose use of e-cigarettes doubled between 2011 and 2012.


Author: Lauren M. Dutra, Sc.D., and Stanton A. Glantz, Ph.D., of the Center for Tobacco Research and Education, University of California, San Francisco.


Background: E-cigarettes are marketed in much the same way cigarette manufacturers marketed conventional cigarettes in the 1950s and 1960s, including on TV and the radio where cigarette advertising has been banned for more than 40 years. Studies have shown that exposing young people to cigarette advertising can cause them to start smoking. E-cigarettes also are sold in flavors (e.g. strawberry, licorice and chocolate) that are banned in conventional cigarettes because they appeal to young people.


How the Study Was Conducted: The authors examined survey data from middle and high school students in 2011 (n=17,353) and 2012 (n=22,529) who completed the National Youth Tobacco Survey, which was created to provide information for national and state tobacco prevention and control programs.


Results: In 2011, 3.1 percent of the adolescents in the study had ever tried e-cigarettes at least once (1.7 percent use with cigarettes, 1.5 percent only e-cigarettes) and 1.1 percent were current e-cigarette users (0.5 percent use with cigarette, 0.6 percent only e-cigarettes). By 2012, 6.5 percent of adolescents had tried e-cigarettes (2.6 percent use with cigarettes, 4.1 percent e-cigarettes only) and 2 percent were current e-cigarette users (1 percent use with cigarettes, 1.1 percent only e-cigarettes). Ever using e-cigarettes and currently using e-cigarettes was associated with an increase in odds of experimenting with conventional cigarettes, ever smoking (at least 100 or more cigarettes in their lifetime) and current cigarette smoking (having smoked at least 100 cigarettes and smoked in the past 30 days).  Among adolescents who experimented with conventional cigarettes (having tried even a puff or two), ever using e-cigarettes was associated with being an established smoker and current cigarette smoking. Cigarette smokers in 2011 who had ever used e-cigarettes were more likely to intend to quit smoking within the next year. However, e-cigarettes were associated with lower abstinence from cigarettes.


Discussion: “While the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa, our results suggest that e-cigarettes are not discouraging use of conventional cigarettes.”

(JAMA Pediatr. Published online March 6, 2014. doi:10.1001/jamapediatrics.2013.5488. Available pre-embargo to the media at http://media.jamanetwork.com.)


Editor’s Note: This work was supported by grants from the National Cancer Institute. Please see article for additional information, including other authors, author contributions and affiliations, etc.



Editorial: Tobacco Control Policy and Electronic Cigarettes

In a related editorial, Frank J. Chaloupka, Ph.D., of the University of Illinois at Chicago, writes: “During the past few years, the use of electronic nicotine delivery systems (ENDS), commonly known as electronic cigarettes (e-cigarettes), has risen rapidly in the U.S., with some analysts suggesting that ENDS sales could surpass sales of traditional cigarettes in the not-too-distant future. This rapid rise has stimulated a vigorous debate in the tobacco control community over the potential public health impact of ENDS and about how best to regulate them. The article by Dutra and Glantz highlights some of the concerns about the potential public health harms from ENDS, documenting the more than doubling of ever use among teenagers between 2011 and 2012, and the associations of ENDS use with more established smoking, and, among experimenters, reduced likelihood of abstinence from conventional cigarettes.”


“While much remains to be learned about the public health benefits and /or consequences of ENDS use, their exponential growth in recent years, including their rapid uptake among youths, makes it clear that policy makers need to act quickly. Adopting the right mix of policies will be critical to minimizing potential risks to public health while maximizing the potential benefits,” the editorial concludes.

(JAMA Pediatr. Published online March 6, 2014. doi:10.1001/jamapediatrics.2014.349. Available pre-embargo to the media at http://media.jamanetwork.com.)


Editor’s Note: The authors are supported by the Medical Research Council. Please see article for additional information, including other authors, author contributions and affiliations, etc.

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