Teenagers who use electronic cigarettes are almost twice as likely to go on to smoke tobacco, a major study shows.
Study Rundown: Use of noncigarette tobacco products by youths has increased recently, and there is concern that this may lead to increase in 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.
Advertising cigarettes and other tobacco products on TV and radio hasn't been allowed since 1971.
About 90 percent of adult smokers first tried cigarettes by the time they turned 18, according to the study.
Previous studies have found evidence to suggest that e-cigarettes (plus other non-cigarette tobacco products) act as a gateway to conventional smoking.
The Center for Tobacco Research and Intervention received a $7 million grant from the National Institutes of Health to fund the study.
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The analysis was based on the 10,384 PATH youth respondents who reported never having smoked a cigarette in wave 1 and whose ever smoking or past 30-day use was reported in wave 2.
The study, published Tuesday in JAMA Pediatrics from researchers at the University of California San Francisco's Center for Tobacco Control Research and Education, comes amid a growing debate around e-cigarettes.
Cigarette use reported in the followup survey was higher among youths who had ever used e-cigarettes (19 percent); hookahs (18.3 percent); non-cigarette combustible tobacco (19.2 percent) or smokeless tobacco (18.8 percent), the researchers found.
"We hear so much talk about e-cigarettes, which are now the most used tobacco product among adolescents, even higher use than cigarettes". The results were adjusted for factors like sociodemographic and environmental smoking risk.
"In policy terms, the findings provide a rationale to treat alternative cigarette products as a group and potentially extend policies that work for one product to others (such as a ban on flavorings)", they wrote. "Regulation of these non-cigarette products should reflect the fact that all of them are associated with greater risk of youth smoking", he said.
"I'm perhaps surprised about how similar the relationships were for each product across the board", Watkins said.
"It's not surprising that products like e-cigarettes and cigars have become popular with kids when they are sold in sweet flavors like gummy bear and cherry dynamite", said Vince Willmore, vice president of communications for the Campaign for Tobacco-Free Kids, which was not involved in the research. It is also prohibited to sell tobacco products in casinos.