There is much debate about whether e-cigarette use is a gateway to conventional smoking. Now, a new study adds fuel to the fire, finding that teenagers who use the devices are more likely to smoke standard cigarettes a year later.

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E-cigarettes may be a gateway to conventional smoking for teenagers, research suggests.

The use of e-cigarettes (electronic cigarettes) is increasing among teenagers; last year, a study from the Centers for Disease Control and Prevention (CDC) found that between 2013-2014, e-cigarette use among middle and high school students in the US tripled.

While some studies have concluded that e-cigarettes are significantly less harmful than smoking, others have suggested that the devices may encourage conventional smoking among youth.

Now, Dr. Thomas Wills, of the University of Hawaii Cancer Center in Honolulu, and colleagues have reached the same conclusion with their latest research, findings of which are published in the journal Tobacco Control.

To reach their findings, in 2013, Dr. Wills and colleagues surveyed 2,338 high school students of an average age of 14.7 years.

The students were asked whether they had ever used e-cigarettes or conventional cigarettes, whether they currently use them, and if so, how often they use them. A year later, the students were asked the same questions again.

Overall, the researchers found that the teenagers who reported using e-cigarettes in 2013 were almost three times more likely to report using them 1 year later, compared with those who reported not using e-cigarettes in 2013.

Fast facts about e-cigarettes
  • There are more than 250 e-cigarette brands currently on the market
  • In 2014, around 1 in 7 high school students in the US reported using e-cigarettes within the past 30 days
  • In 2012-2013, 1.9% of adults in the US reported using e-cigarettes in the past 30 days.

Learn more about e-cigarettes

This finding remained after accounting for potentially confounding factors, including students’ home environment and parental education, according to the authors.

Around 31% of the students reported having used e-cigarettes by 2013. By 2014, this had risen to 38%. In 2014, approximately 15% of the students reported ever smoking conventional cigarettes, increasing to 21% a year later.

On analyzing the results by level of e-cigarette use, the team found that any level of e-cigarette use in 2013 was associated with smoking conventional cigarettes one to two times or three to four times a year later. However, only regular users of e-cigarettes in 2013 went on to become regular cigarette smokers in 2014.

Among non-users of e-cigarettes or conventional cigarettes in 2013, 1 in 10 had tried e-cigarettes by 2014, 2% had experimented with standard cigarettes and 4% had tried both.

Of these initial non-users, older students, those of white or Native Hawaiian ethnicity and those with greater rebelliousness were most likely to start smoking both e-cigarettes and conventional e-cigarettes in 2014.

Additionally, the team found that students who used both e-cigarettes and standard cigarettes in 2013 did not reduce their level of conventional smoking over time.

While the team admits that their findings are purely observational and cannot prove cause and effect, they say their results support those of previous studies assessing smoking behavior among teenagers.

The authors conclude:

Adolescents who use e-cigarettes are more likely to start smoking cigarettes. This result together with other findings suggests that policies restricting adolescents’ access to e-cigarettes may have a rationale from a public health standpoint.”

While e-cigarettes are often believed to be smoking cessation aids, Medical News Today recently reported on a study suggesting that the devices may actually reduce the likelihood of smokers quitting.