Writing in the Sept. 8 edition of JAMA Pediatrics, Dr. Brian Primack and team reported on a portion of the data from a national survey of U.S. teens and young adults, concluding that “use of e-cigarettes at baseline was associated with progression to traditional cigarette smoking.”

In an accompanying editorial, Dr. Jonathan Klein not only agreed, but went on to state:

We do not need more research on this question; we have the evidence base (that e-cigarettes are attracting non-smoking teens to smoking).

The opposite is more likely to be true: that e-cigarettes do not attract nonsmokers to nicotine addiction and that, for both teen and adult smokers, e-cigarettes are a gateway away from smoking.

National survey data reported by the U.S. Centers for Disease Control and Prevention (CDC) and British public health authorities show substantial increases in e-cigarette use in recent years to be associated with record-low levels of teen and adult smoking, and an acceleration of the rate at which the prevalence of smoking is going down in both countries.

The more detailed British data differs from the American data in that they differentiate between experimentation and occasional social use, on one hand, compared to continuing use, on the other. These data show the vast majority of vapers (i.e., e-cigarette users) to be smokers, with use by nonsmokers mainly limited to experimentation and occasional social use. There is not a single reported case, in the U.S. or British data sets, of a nonsmoker initiating consistent nicotine use with e-cigarettes and then transitioning to consistent use of tobacco cigarettes.

The Primack paper provides no data as to the number of participants in their survey that initiated nicotine exposure with tobacco cigarettes; no data differentiating experimentation from continuing use; and no consideration as to whether participants initiating nicotine exposure with e-cigarettes would have experimented with tobacco cigarettes had the vapor devices not been available

The only conclusion that can reasonably be drawn is that teens and young adults who experiment with one nicotine delivery product are more likely to experiment with other such products, compared to teens and young adults not prone to such experimentation. No conclusion can be drawn from this study as to whether e-cigarettes are recruiting nonsmoking teens to nicotine addiction.

Featured Publications