How E-Cigs Could Be a Gateway

Electronic cigarette use in teens tied to higher likelihood of smoking tobacco

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Some say electronic cigarettes may be less harmful than conventional cigarettes. But they may have serious health consequences among teens.

A new study found that high school students who had used e-cigarettes were more likely to start smoking tobacco than students who abstained altogether.

Students from 10 Los Angeles high schools participated in this study. Researchers followed up with them six months and 12 months after an initial survey.

“If [teens] use e-cigarettes, and they enjoy the experience of inhaling nicotine, it’s possible that they might be more open to trying other tobacco products, like conventional cigarettes and other smokeable tobacco products,” said lead study author Adam M. Leventhal, PhD, of the University of Southern California in Los Angeles, in an audio interview for JAMA. “Of course, that’s a major public health concern.”

E-cigs are battery-powered devices that heat a liquid nicotine (an addictive chemical found in tobacco) solution to produce a vapor the user inhales. Their popularity has risen sharply in recent years.

For this study, Dr. Leventhal and team looked at whether students who used e-cigs would then turn to conventional smoking, which can cause cancer and heart disease.

These researchers interviewed 2,530 high school students and asked about their e-cig and tobacco usage. They found that students who had used the devices were more than twice as likely to smoke cigarettes than non-users.

Exposure to e-cigs was also tied to smoking cigars and hookah.

Despite these findings, Dr. Leventhal and team noted that more research is needed to determine whether e-cigs are, in fact, a "gateway" to traditional tobacco.

In an editorial about this study, Nancy A. Rigotti, MD, of Massachusetts General Hospital, wrote, “Prompt, effective action is needed to protect youth and reduce the demand for e-cigarettes by nonsmokers of all ages.”

The study and editorial were published Aug. 18 in JAMA.

The National Institutes of Health funded this research. The authors disclosed no conflicts of interest.


Review Date: 
August 14, 2015
Last Updated:
August 24, 2015