Youth using alternative tobacco products are more likely to smoke one year later

The study analyzed data from a nationally-representative sample of more than 10,000 adolescents, ages 12 to 17. It is the largest study to date to estimate the impact between alternative tobacco use and the subsequent start of conventional cigarette smoking in youth.

Any form of tobacco, including e-cigarettes, was associated with future smoking, the authors reported, especially when adolescents used more than one product. As a result, novel tobacco products have the potential to undermine public health gains in combatting smoking, the researchers said.

The study was published Jan. 2, 2018, in JAMA Pediatrics.

"We found that teens who experimented with tobacco in any form were at greater risk of future smoking," said senior author Benjamin W. Chaffee, DDS, PhD, an assistant professor at the UCSF School of Dentistry.

"In the last few years, research has focused on the potential of e-cigarettes to engage never-smoking adolescents in tobacco use," Chaffee said. "Our findings confirm that the use of the full range of tobacco products, including e-cigarettes, cigars, tobacco water pipes, and smokeless tobacco, is associated with greater odds of future cigarette smoking."

Approximately 90 percent of adult smokers smoked their first cigarette by the time they were 18. Earlier studies have shown that smoking a single cigarette per month during adolescence is tied to daily smoking during adulthood.

Non-Cigarette Tobacco Products Increasingly Popular

In recent years, non-cigarette tobacco products have become increasingly popular among youth, especially e-cigarettes, the most common form of tobacco used by youth. In 2016, nearly 4 million middle and high school students used at least one tobacco product, and 1.8 million of the students reported using two or more products, studies have shown.

The new UCSF study was based on some 10,384 respondents in the Population Assessment of Tobacco and Health (PATH) study, who said they'd never tried a cigarette. The PATH Study is a collaboration between the FDA and the National Institutes of Health. Never-smoking youth were first interviewed from September 2013 to December 2014.