Teens Who Try E-Cigarettes Are More Likely To Try Tobacco, Too

By Patti Neighmond

Published March 6, 2014 at 11:46 AM EST

They're both legal. Either, both or none?

While electronic cigarettes may be marketed as alternatives that will keep teenagers away from tobacco, a study suggests that may not be the case.

Trying e-cigarettes increased the odds that a teenager would also try tobacco cigarettes and become regular smokers, the study found. Those who said they had ever used an e-cigarette were six times more likely to try tobacco than ones who had never tried the e-cig.

Researchers from the at the University of California, San Francisco, analyzed data from the 2011 and 2012 National Youth Tobacco Survey, a federal questionnaire administered to students in grades 6 through 12 in middle and high schools nationwide. It asked teenagers whether they smoked electronic or tobacco cigarettes or both.

The survey found that students' use of electronic cigarettes doubled from 3.3 percent to 6.8 percent in 2011 and 2012. But the number of smokers declined only slightly, from 5 percent to 2011 to 4 percent in 2012.

Teenagers who smoked were more likely to use e-cigarettes, and vice versa. In 2012, 57 percent of those who had tried cigarettes had also tried e-cigarettes. And 26 percent of current smokers used e-cigs as well. By contrast, 4 percent of teens who had never smoked had tried e-cigs, and 1 percent said they use them currently.

E-cigarettes don't burn tobacco. Instead, a battery heats up liquid nicotine and turns it into a vapor that's inhaled into the lungs.

Director Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, has called the rise of e-cigarette use among teenagers "alarming," because nicotine is still an addictive drug. Frieden also has expressed concern that electronic cigarettes may be a gateway to tobacco cigarettes.

"The adolescent human brain may be particularly vulnerable to the effects of nicotine because it is still developing," the authors write. Their study was published Thursday in the journal JAMA Pediatrics.

The study is one of the first to try to get a grip on how e-cigarettes affect tobacco use. It couldn't look at whether e-cig use caused tobacco use, or vice versa, or why teenagers decided to use the products. And it doesn't answer the question of whether teenagers used e-cigarettes in order to avoid tobacco.

Although cigarette makers deny they target teenage customers, researchers say the companies aggressively market glamorous and sexy images that appeal to a teenager's sense of rebellion and tendency toward risky behavior. Those same tactics are now being used for e-cigarette ads, tobacco control advocates say.

The electronic versions also come in a variety of flavors like strawberry, watermelon and licorice. There are far more restrictions on tobacco cigarettes including a ban on offering sweet or fruity flavors, as well as restrictions on advertising and sales to minors. The Food and Drug Administraiton is currently considering whether and how much to regulate electronic cigarettes.