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Progression to traditional cigarettes after electronic cigarette use in young people

The JAMA Network Journals

A new study of U.S. adolescents and young people suggests that using electronic cigarettes was associated with progression to traditional cigarette smoking, according to an article published online by JAMA Pediatrics.

Some studies suggest e-cigarettes may help smokers reduce the use of traditional tobacco products. Still, there is concern that e-cigarette marketing could position the product to recruit nonsmokers and the use of e-cigarettes has increased among both adolescents and young adults.

Brian A. Primack, M.D., Ph.D., of the University of Pittsburgh School of Medicine, and coauthors examined whether baseline e-cigarette use was associated with progression along a trajectory to cigarette smoking one year later.

The study included surveys from a national sample of 694 participants (between the ages of 16 to 26) who never smoked cigarettes and were attitudinally nonsusceptible to smoking cigarettes. They were asked about smoking in 2012-2013 and were reassessed a year after completing the initial survey. Progression to cigarette smoking was defined along a three-stage trajectory: nonsusceptible smokers were those who said they would not try a cigarette or smoke in the next year; susceptible nonsmokers were those who could not rule out smoking; and smokers.

Among the 694 participants, 53.9 percent were female and 76.5 percent were white. At baseline, 16 participants (2.3 percent) used e-cigarettes.

The authors found that over the one-year follow-up, 11 of the 16 e-cigarette smokers (68.9 percent) and 128 of 678 participants who had not used e-cigarettes (18.9 percent) progressed toward smoking cigarettes.

In further analyses, baseline e-cigarette use was associated with progression to smoking and progression to susceptibility among initially nonsusceptible nonsmokers.

However, the authors acknowledge that even though there was substantial risk associated with being an e-cigarette user at baseline, there were only a small number of e-cigarette users at baseline (2.3 percent). "Therefore, it could be interpreted that this small number may not translate into substantial public health risk." But the authors note it is important to continue surveillance among youth of both e-cigarette use and overlap with the use of other tobacco products.

"Our study identified a longitudinal association between baseline e-cigarette use and progression to traditional cigarette smoking among adolescents and young adults. Especially considering the rapid increase in e-cigarette use among youth, these findings support regulations to limit sales and decrease the appeal of e-cigarettes to adolescents and young adults," the study concludes.

(JAMA Pediatr. Published online September 8, 2015. doi:10.1001/jamapediatrics.2015.1742. Available pre-embargo to the media at

Editor's Note: This study was supported by grants from the National Cancer Institute and the National center for Advacning Translational Sciences. Please see article for additional information, including other authors, author contributions and affiliations, etc.

Editorial: Electronic Cigarettes Are Another Route to Nicotine Addiction for Youth

In a related editorial, Jonathan D. Klein, M.D., Ph.D., of the American Academy of Pediatrics, Elk Grove Village, Ill., writes: "This article by Primack et al is one more piece of evidence that the effect of e-cigarettes on youth is happening now in real time and that these products harm nonsmokers and result in a net harm to society and public health. At a time when many claim to be uncertain about the harms and benefits of e-cigarettes and argue for more studies, these data provide strong longitudinal evidence that e-cigarette use leads to smoking, most likely owning to nicotine addiction. We do not need more research on this questions; we have the evidence base, and we have strategies that work to protect nonsmokers from e-cigarettes and other forms of tobacco. What we still need is the political will to act on the evidence and protect our youth."

(JAMA Pediatr. Published online September 8, 2015. doi:10.1001/jamapediatrics.2015.1929. Available pre-embargo to the media at

Editor's Note: Please see article for additional information, including other authors, author contributions and affiliations, etc.


Media Advisory: To contact corresponding author Brian A. Primack, M.D., Ph.D., call Allison Hydzik at 412-647-9975 or email To contact corresponding editorial author Jonathan D. Klein, M.D., M.P.H., call Debbie Jacobson at 847-434-7084 or email

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