Teenagers who use electronic cigarettes are more likely to smoke conventional cigarettes than those who haven't tried the products, according to a new cross-sectional study published in JAMA Pediatrics.

Electronic cigarettes, or e-cigarettes, are often promoted as smoking cessation aids, but among teens they may increase the likelihood of smoking conventional cigarettes, according to a new cross-sectional study reported in March (JAMA Pediatr 2014 Mar 6 [Epub ahead of print]).

E-cigarettes deliver nicotine-containing vapor without many of the toxins found in conventional cigarettes. Their use has climbed rapidly in recent years, particularly among adolescents, according to the National Youth Tobacco Survey, designed by the Centers for Disease Control and Prevention (CDC) to assess smoking behavior among youth. In 2011, 4.7% of high-school students who responded to the survey reported trying e-cigarettes; in 2012, that number rose to 10%.

Lauren Dutra, ScD, and Stanton A. Glantz, PhD, of the Center for Tobacco Research and Education at the University of California, San Francisco, analyzed survey answers from the CDC's national survey of teens who had ever experimented with cigarettes to better understand the connection between e-cigarette use and conventional smoking.

They reported that adolescents who had puffed on an e-cigarette were nearly eight times as likely to smoke conventional cigarettes as peers who had never tried one. In addition, teens who had never used e-cigarettes were three times as likely to have gone a year without smoking conventional cigarettes as those who had.

On the other hand, teenage smokers who used e-cigarettes were one and a half times as likely to intend to quit in the next year, compared with those who didn't use e-cigarettes, suggesting that youth may be trying to quit using these devices. However, the survey did not include data on quit attempts.

Dutra points out that their study is based on data from the 2011 and 2012 surveys, and the e-cigarette landscape has changed dramatically in the last 2 years.

“Many products have popped up since then,” Dutra says. These new products, with names like hookah pens or vape pens, are often flavored to taste like fruit or candy and represent manufacturers' attempts to market to kids and teens while steering clear of the term “cigarette.” They're also likely causing a further uptick in the market. “I certainly think it's likely that the numbers we saw for e-cigarette use were underestimated,” Dutra adds.

Because cross-sectional studies show only a snapshot of behavior at a given time, “we need longitudinal data to see if kids are starting with e-cigarettes and moving on to conventional cigarettes or not,” she says.

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