E-Cigarette Use in Teens a Precursor to Daily Tobacco Use, Study Shows

person smoking electronic cigarette

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Key Takeaways

  • Adolescents and young adults who use e-cigarettes are much more likely to try tobacco products and become daily smokers.
  • The perception that vaping is safe continues to be prevalent, making cessation efforts more difficult.
  • About half of teens who vape have expressed a desire to quit, but tools tailored to their needs are not widely available.

Teens using e-cigarettes, also known as vaping, is strongly associated with later daily cigarette smoking, according to a 2021 study in Pediatrics.

Researchers looked at a group of 12- to 24-year-olds participating in a large-scale study of tobacco and health, to identify the predictors of becoming a daily cigarette smoker over the course of four years.

They found the risk of progressing to cigarettes was three times higher for those who used e-cigarettes, particularly among those under age 18.

This likely will reverse the decline in cigarette smoking among U.S. adults, researchers concluded.

Wanting to Quit

Even as adolescents might gravitate from vaping to using traditional tobacco products, many have reported wanting to quit. A survey published last year in JAMA Pediatrics found about half of teens who use electronic nicotine products expressed the desire to stop, but evidence-based cessation programs geared specifically toward this age group is not widely available.

Another survey, published in Addictive Behaviors, found that the biggest reason many wanted to stop is health-related, which means they’re already feeling negative effects from the habit.

This could become a larger issue if the growth rate of vaping continues. According to a report from the U.S. Department of Health and Human Services, e-cigarette use among teens doubled from 2017 to 2019.

Unlike adults, adolescents can face intense peer pressure that makes quitting much more difficult, according to Osita Onugha, MD, a thoracic surgeon and assistant professor of thoracic surgical oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California.

“It is so difficult for them to quit because there is some level of both chemical and social addiction,” he says. “The chemical addiction is what stimulates the cravings for people to continue smoking. However, the ‘coolness’ of smoking around friends and the perceived ‘rebel’ they appear to be may make it difficult to give up the social status that some young adults have with their peers."

Peer pressure and teen smoking have been connected for decades, and a meta-analysis published in Psychological Bulletin found that young people aged 10 to 19 have double the risk of smoking if they have friends who use tobacco products. But vaping is giving that old problem a new twist, and a potentially extensive one.

Aaron Weiner, PhD

There needs to be much more awareness about the risks of e-cigarettes, and especially an acknowledgment that they’re not a ‘safer’ alternative, which tends to be a widespread belief.

— Aaron Weiner, PhD

Challenges Unique to Teens

Although the use of tobacco products has been linked to a breadth of health issues for all ages, nicotine may have a particularly toxic effect on adolescent brains, since they are still developing. A study in Brain Research noted that nicotine is a neurotoxin that could significantly affect three parts of the brain: the midbrain, hippocampus, and cerebral cortex.

Even at the lowest dose of nicotine, negative effects remained for at least a month, and the issues were more prominent in females.

“Our results indicate that in adolescence, even a brief period of continuous or intermittent nicotine exposure elicits lasting alterations in biomarkers associated with cellular damage,” says a co-author of that study, Theodore Slotkin, PhD, a scientist in the Department of Pharmacology and Cancer Biology at Duke University in Durham, North Carolina.

Dr. Slotkin adds that nicotine even in teens at one-tenth the level of a regular adult smoker would cause damage that might linger long after a few puffs.

“The exquisite sensitivity of the teenage brain means neurotoxicity may contribute to lasting neurobehavioral damage, even in occasional smokers,” he says.

Next Steps

Like tobacco, the move toward effective cessation will require a multilayered approach that addresses all of the factors that teens face, and especially confronts the perception that vaping is either harmless or doesn’t lead to tobacco usage, says Aaron Weiner, PhD, a Chicago-based clinical psychologist and addiction treatment specialist.

“There needs to be much more awareness about the risks of e-cigarettes, and especially an acknowledgment that they’re not a ‘safer’ alternative, which tends to be a widespread belief,” he states.

“Another issue to face will be the perception that an occasional cigarette isn’t a big deal if a teenager sticks to vaping most of the time,” Weiner adds. “If we don’t highlight the danger of e-cigarette use, we’re at risk of losing the progress we’ve made on lowering tobacco addiction.”

What This Means For You

Despite the perception among some people that vaping is a way to avoid smoking. many teenage e-cigarette users are shifting toward tobacco products. Focusing on reducing teen e-cigarette usage now is crucial for addressing addiction concerns, since usage among this age group continues to climb.

6 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Pierce JP, Chen R, Leas EC, White MM, Kealey S, Stone MD, Benmarhnia T, Trinidad DR, Strong DR, Messer K, Use of e-cigarettes and other tobacco products and progression to daily cigarette smoking. Pediatrics. Feb 2021;147(2):e2020025122. doi:10.1542/peds.2020-025122

  2. Smith TT, Nahhas GJ, Carpenter MJ, et al. Intention to quit vaping among United States adolescentsJAMA Pediatr. doi:10.1001/jamapediatrics.2020.2348

  3. Amato MS, Bottcher MM, Cha S, Jacobs MA, Pearson JL, Graham AL, “It’s really addictive and I’m trapped:” A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. Addictive Behaviors. Volume 112, 2021, 106599, ISSN 0306-4603. doi:10.1016/j.addbeh.2020.106599

  4. Cullen, K. A., Gentzke, A. S., Sawdey, M. D., Chang, J. T., Anic, G. M., Wang, T. W., Creamer, M. R., Jamal, A., Ambrose, B. K., & King, B. A. e-cigarette use among youth in the United States, 2019. JAMA. Published November 5, 2019;322(21):2095–2103. doi:10.1001/jama.2019.18387

  5. Liu, J., Zhao, S., Chen, X., Falk, E., & Albarracín, D. The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuationPsychological Bulletin, 2017;143(10):1082–1115. doi:10.1037/bul0000113

  6. Abreu-Villaça Y, Seidler FJ, Tate CA, Slotkin TA. Nicotine is a neurotoxin in the adolescent brain: critical periods, patterns of exposure, regional selectivity, and dose thresholds for macromolecular alterationsBrain Research. 2003;979(1-2):114-128. doi:10.1016/S0006-8993(03)02885-3