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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to

National study links e-cigarettes to tobacco use among young adults

Previous studies had shown correlation, not potential causation

By Andy Marso | September 08, 2015

A study to be published in an upcoming issue of JAMA Pediatrics is the first to find a causal link between young people using e-cigarettes and then moving on to tobacco products.

The study, funded by the National Cancer Institute, followed a national sample of 700 16- to 26-year-old non-smokers. When first surveyed, all of them said they did not think they would smoke a traditional cigarette within the next year, even if offered one by a friend.

Researchers found about 38 percent of those in the study who were e-cigarette users began smoking traditional cigarettes within a year, while only 10 percent of those who were not e-cigarette users did.

“These differences remained statistically significant and robust even when we controlled for multiple known risk factors for initiating cigarette smoking, such as age, sex, race, ethnicity, socioeconomic status, sensation seeking, parental smoking and friend smoking,” said Brian Primack, a University of Pittsburgh physician who was one of the lead researchers.

Previous studies had shown a correlation between youth e-cigarette use and tobacco use, but the most recent study is the first to isolate e-cigarette use as the potential cause.

The study comes at a crucial time for e-cigarettes, which use heat but no flame to vaporize a combination of water, nicotine and flavorings.

The study authors said their findings “support regulations to limit sales and decrease the appeal of e-cigarettes to adolescents and young adults.”

The U.S. Food and Drug Administration is more than a year into a process of determining how to regulate e-cigarettes and their liquids, which can vary widely in the amount of nicotine and type of additives they contain.

Public health advocates have called for strict, tobacco-esque regulations, saying the products themselves are addictive and harmful and provide a “gateway” to traditional tobacco use.

Industry advocates say e-cigarettes provide a safer alternative to smoking that can help some people quit.

The study authors said their findings “support regulations to limit sales and decrease the appeal of e-cigarettes to adolescents and young adults.”

Primack is director of the University of Pittsburgh’s Center for Research on Media, Technology and Health. His department teamed with the Dartmouth-Hitchcock Norris Cotton Cancer Center to analyze the study results.

E-cigarettes are gaining popularity with young people quickly. Primack and James Sargent, a professor of pediatrics at Dartmouth’s Geisel School of Medicine, theorized that their appeal stems in part from the fruity flavors of e-cigarette liquids and television commercials, some of which feature Hollywood actors.

“It is important to continue surveillance of both e-cigarettes and tobacco products among young people so policymakers can establish research-informed regulations to help prevent e-cigarettes from becoming gateway products on the road to youth smoking,” Sargent said.