Is vaping a bridge to smoking cigarettes for youth?

E-cigarette use increased rapidly from 2011 to 2015. In 2015, Monitoring the Future showed that 16% of 12th graders, 14% of 10th graders, and 10% of 8th graders used e-cigarettes in the past 30 days, up from about 1% of high school students in 2011.


Now researchers wonder if this increase puts young people at greater risk for smoking regular cigarettes. Several smaller-scale studies have found that vaping (using e-cigarettes) gives youth higher odds of smoking cigarettes.


YSI researcher Richard Miech and colleagues show similar findings in US nationally representative data from 12th graders in the Monitoring the Future study. Their analyses include how harmful students believe cigarette smoking to be. They also assess if vaping is connected to quitting cigarette smoking. Students in the study (347 in number) completed a baseline survey in 2014 and a follow-up survey in 2015.


Youth who had never smoked a cigarette by 12th grade were four times more likely to have smoked a year later if they reported vaping in 12th grade. Among these senior-year vapers, 31% had smoked a year later, compared to 7% among non-vaping seniors. This difference remained after taking into account the students’ sex and race and their parents’ education level. The group of new smokers at follow-up who had vaped in 12th grade reported that they had smoked cigarettes at the level of ‘once or twice’ in the past 12 months. Even among the non-smokers in 12th grade who considered cigarette smoking to be very harmful, vaping in 12th grade strongly predicted cigarette smoking in the following year.


Among 12th grade students who had smoked in the past year but had not recently smoked, vaping in 12th grade predicted having smoked a year later. In this group, senior-year vapers were twice as likely as non-vapers to report smoking in the past 12 months at follow-up.


Vaping also seemed to have an effect on the perception of harm from smoking among non-smoking 12th graders. For students who had never smoked a cigarette by the 12th grade survey, senior-year vaping (compared to not vaping) made them four times more likely to move away from the view that cigarette smoking poses “great risk” of harm. This finding is consistent with a desensitization process.


Contrary to the advertised idea that vaping is used to quit smoking, vaping did not predict quitting smoking at follow-up for those who had smoked recently at the time of the 12th grade survey.


In conclusion, this study adds nationally representative results in the US to the growing body of evidence that supports vaping as a one-way bridge to cigarette smoking among youth. The authors state that vaping as a risk factor for future cigarette smoking is a strong, scientifically-based rationale for restricting youth access to e-cigarettes.


Miech, R., Patrick, M. E., O’Malley, P. M., & Johnston, L. D. (2017). E-cigarette use as a predictor of cigarette smoking: Results from a 1-year follow-up of a national sample of 12th grade students. Tobacco Control. doi: 10.1136/tobaccocontrol-2016-053291.