Students who have used electronic cigarettes by the time they start ninth grade are more likely than others to start smoking traditional cigarettes and other tobacco products within the next year, according to a new study funded by the National Institutes of Health. Electronic cigarettes, or e-cigarettes, deliver nicotine to the lungs by heating a liquid solution that contains nicotine and other chemicals to produce a spray that the user takes in.

As part of a survey of substance use and mental health among high school students in Los Angeles, the study compared the start of tobacco use among 222 students who had used e- cigarettes, but not any other tobacco products, and 2,308 who had neither used e-cigarettes or any other tobacco products when initially surveyed at the start of ninth grade. The 2,530 students who initially reported never using tobacco underwent follow-up assessments after six and 12 months. Students were asked about lifetime and past six-month use of e-cigarettes or any other forms of tobacco products.

During the first six months after being surveyed, 30.7 percent of those who had used e- cigarettes started using tobacco products, such as cigarettes, and cigars, compared to only 8.1 percent of those who had never used e-cigarettes. Over the following six months leading into the start of 10th grade, 25.2 percent of e-cigarette users had used tobacco products, compared to just 9.3 percent of nonusers.

“While teen tobacco use has fallen in recent years, this study confirms that we should continue to closely watch teen smoking patterns,” said NIDA Director Nora D. Volkow, M.D. “Parents and teens should recognize that although e-cigarettes might not have the same harmful effects of regular cigarettes, they do carry a risk of addiction.”

“Recreational e-cigarette use is becoming increasingly popular among teens who have never smoked tobacco,” said Adam M. Leventhal, Ph.D., the first author on the study. “While we cannot conclude that e-cigarette use directly leads to smoking, this research raises concerns that recent increases in youth e-cigarette use could ultimately lead to the spread of smoking- related illness."

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