Youth using e-cigarettes are more likely than their non-smoking peers to begin smoking cigarettes.


Smoking rates in teens declined between 2002 and 2014. Electronic-cigarette enthusiasts have suggested that this decline is due to the availability of e-cigarettes, which have been growing in popularity since their introduction to the American market in 2007.

E-cigarette “smoke” has been linked to cell damage, lung inflammation, asthmas and respiratory infections. Nicotine exposure during the teenage years can affect memory, attention, and emotional regulation.

E-cigarette products labeled “nicotine-free” often contain nicotine. Between 2011 and 2014, 13% to 40% of the teenage e-cigarette users in Canada and the United States reported using e-cigarettes containing nicotine. In addition, a significant percentage of teens reported not knowing whether their e-cigarettes contained nicotine.

A recent study examined samples of cross-sectional nationally representative data from the school-based National Youth Tobacco Survey among 6th to 12th graders between 2004 and 2014.

The results show that the rate of decline in smoking among teens did not increase after the introduction of e-cigarettes, debunking the idea that e-cigarettes were responsible for the decrease in smoking among teens. E-cigarette smoking led to higher levels of 30-day use of smoking either cigarettes or e-cigarettes. Some low-smoking risk teens were attracted to e-cigarettes.  In addition, using e-cigarettes led to a higher probability of smoking cigarettes.  Each of these findings raises the possibility that the decline in cigarette smoking among teens will reverse in the coming years.

E-cigarette products are included in smoke-free laws.  In May 2016, the Food and Drug Administration took over the jurisdiction of e-cigarettes, but has not introduced regulation regarding advertising, product placement in movies, nicotine content, or health claims made by e-cigarette companies.

The authors suggest that medical staff include e-cigarettes in their evaluation of teen smoking habits, and that government media campaigns inform teens that e-cigarettes are not harmless, that they attract youth at low risk of cigarette smoking, and that their use may lead to cigarette smoking.


Written By: Lynn Kim

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