Do young users of noncigarette tobacco products progress to conventional cigarettes?

Bottom Line: The use of electronic cigarettes, hookahs, noncigarette combustible tobacco or smokeless tobacco by adolescents were each associated with starting to smoke conventional cigarettes within a year.

Why The Research Is Interesting: Noncigarette tobacco products, such as electronic cigarettes, hookahs, noncigarette combustible tobacco and smokeless tobacco, are popular among young people and it's important to understand whether they encourage smoking of conventional cigarettes.

Who and When: National questionnaire data for 10,384 adolescents (ages 12 to 17) who reported never having smoked a conventional cigarette at baseline (2013-2014) and completed one-year follow-up (2014-2015)

What (Study Measures): Use of electronic cigarettes, hookahs, noncigarette combustible tobacco or smokeless tobacco at baseline (exposures); conventional cigarette use at followup (outcome)

How (Study Design): This is a cohort study, which is a type of observational study. Because researchers are not intervening for purposes of the study they can use statistics to control for some of the differences between groups that could explain the study findings, but they cannot control for all of those differences.

Authors: Benjamin W. Chaffee, D.D.S., M.P.H., Ph.D., of the University of California, San Francisco, and coauthors

Results: Although electronic cigarettes are the most common form of noncigarette tobacco used by young people, any use of all forms of noncigarette tobacco was associated with a greater risk of future conventional cigarette smoking. Adolescents who started using tobacco with noncigarette products were more likely to have smoked conventional cigarettes within one year than young people who had never used tobacco. Adolescents who used multiple tobacco products were even more likely to start smoking conventional cigarettes.

Study Limitations: The study accounted for known risk factors of youth smoking but other unknown factors may have influenced study results.

Study Conclusions: Strategies aimed at preventing young people from starting to smoke conventional cigarettes should be extended to other tobacco products.

Related Material: Links to related studies previously published by The JAMA Network:

• Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents
• Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults
• Association of e-Cigarette Vaping and Progression to Heavier Patterns of Cigarette Smoking
• Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults
• e-Cigarette Use and Subsequent Tobacco Use by Adolescents
• Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence

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