Vaping Among Teens Linked to Increased Cigarette Use

November 25, 2016 | by Samantha Bonar



Vaping, or e-cigarette use, has been promoted as an aid to smoking cessation, as well as a safer alternative to smoking. A new study has found that, on the contrary, teens who vape are more likely to progress to cigarette smoking.

In the study, which appeared in the Nov. 8 issue of JAMA, Adam M. Leventhal, Ph.D., and colleagues examined the associations between e-cigarette use and subsequent smoking frequency among adolescents.

“Those who vape are significantly more likely to then take up cigarette smoking,” said Brian Tiep, director of pulmonary rehabilitation at City of Hope, who reviewed the study. “It is argued by proponents of ENDS [electronic nicotine delivery system] that vaping is a safer alternative to cigarette smoking, as well as a means of smoking cessation. For children and adolescents taking up vaping, the opposite may be true.”

The study consisted of an analysis of data from surveys administered to 10th-grade students in 10 public high schools in Los Angeles County during the fall (baseline for this report) and spring (six-month follow-up) of 2014 to 2015.

What the study uncovered was alarming.


Brian Tiep, M.D., lung cancer program Brian Tiep, M.D.


Compared with baseline e-cigarette and combustible cigarette usage, smoking frequency increased proportionally with higher levels of vaping.

In short, the more kids vape, the more likely it is that they go on to smoke traditional cigarettes.

"The transition from vaping to smoking may warrant particular attention in tobacco control policy," the authors wrote.

“The modern e-cigarettes were invented as a safer alternative to smoking conventional tobacco cigarettes,” said Tiep, who explained that they consist of a microprocessor, a filament-atomizer, a battery and an e-chamber for “e-juice.” The e-juice is largely propylene glycol, glycerine, nicotine and flavorings.

“These ingredients may become converted into more harmful chemicals as they are heated in the atomizer,” Tiep said. “Also, this bath of heated chemicals sucked into the body — especially in children — is irritating to the lungs. Some of the flavorings are especially harmful, such as diacetyl, formaldehyde, acrolein, acetaldehyde and ethylene glycol.

“They try to market e-cigarettes as alternatives, but they are nicotine-delivery devices,” Tiep continued. “[And] we don’t know what else they’re bringing into our bodies.”

The “pleasant fruity flavor and odor” is specifically marketed to kids, Tiep said, and “this study as well as others reveal an increase of vaping among children/adolescents.” A study from the Centers for Disease Control and Prevention found that, from 2011 to 2012, e-cigarette use among middle and high school students nearly doubled. It tripled between 2012 and 2013.

The U.S. Food and Drug Administration has taken notice. In August, it began regulating e-cigarettes the same as any other tobacco product, requiring warning labels and ingredient lists on the devices. It also banned their sale to those under the age of 18.

According to the Food and Drug Administration, there has been a major drop in the use of traditional cigarettes among youth over the last decade, but their use of other tobacco products, especially e-cigarettes, is rising.

According to the latest Centers for Disease Control and Prevention data, current e-cigarette use among high school students has skyrocketed from 1.5 percent in 2011 to 16 percent in 2015 (a more than 900 percent increase).

In addition, last year the California Department of Health declared e-cigarettes a public health threat. The department is seeking statewide regulation of e-cigarettes, saying they emit cancer-causing chemicals and increase the likelihood of nicotine addiction.

There is a misperception that vaping is harmless, when “it is not actually safe and can lead to a deadly addiction to tobacco cigarettes,” Tiep said. “ENDS is not a single product. Rather it is about 460 brands with 7,700 flavors manufactured by myriad manufacturers with no real quality control. It is no wonder that the FDA this year has decided to regulate them alongside cigarettes, cigars and hookahs.”


Statistics about ENDS Use

  • More than 3 million middle and high school students were current users of e-cigarettes in 2015, up from an estimated 2.46 million in 2014.
  • Sixteen percent of high school and 5.3 percent of middle school students were current users of e-cigarettes in 2015, making e-cigarettes the most commonly used tobacco product among youth for the second consecutive year. 
  • During 2011 to 2015, e-cigarette use rose from 1.5 percent to 16 percent among high school students and from 0.6 percent to 5.3 percent among middle school students.
  • In 2013 to 2014, 81 percent of current youth e-cigarette users cited the availability of appealing flavors as the primary reason for use.


Learn more about our lung cancer treatment and research and our unique patient experience. If you have been diagnosed with lung cancer or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.


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