Noncigarette tobacco product use is associated with future cigarette smoking

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More than 2 million middle- and high-school students tried e-cigarettes in 2016, the U.S. Centers for Disease Control and Prevention reported past year, making this the most popular form of tobacco use among young people.

Teens who use e-cigarettes, hookah, chewing tobacco and other cigarette alternatives are nearly twice as likely to eventually smoke cigarettes than teens who never use those alternatives.

A new study adds to a growing body of evidence linking the use of electronic cigarettes and other non-cigarette tobacco products to future use of conventional cigarettes in teens.

"Cigarette "ever" use is a meaningful outcome given that nicotine dependence can manifest in adolescents soon after their first puff, but other smoking milestones, such as daily smoking, can take years to develop", the report said. Youths who had ever used e-cigarettes, hookah, non-cigarette combustible tobacco, or smokeless tobacco at baseline had higher cigarette ever use at follow-up (19.1, 18.3, 19.2, and 18.8 percent, respectively). Data were included for 10,384 participants (aged 12 to 17 years at baseline) from waves 1 (Sept. 12, 2013, to December 14, 2014) and 2 (Oct. 23, 2014, to October 30, 2015) of the Population Assessment of Tobacco and Health study.

None of the participants had ever smoked traditional cigarettes prior to the start of the study.

The researchers studied cigarette-smoking initiation among more than 10,000 participants in the PATH study. They followed up with the same teens a year later to ask again if they'd smoked a cigarette in the previous 30 days or year.

"The estimated health risks of non-cigarette tobacco products should include the additional health consequences of future cigarette use", study authors wrote. For example, smokeless tobacco use is higher among rural white adolescents, while cigarillo use is seen more often among lower-income African-American teens, she said.

A study in Pediatrics suggested teenagers are more likely to start smoking after viewing tobacco marketing online. "And even if kids use these products and don't convert to cigarette smoking, it's not the only relevant health concern".

Study Limitations: The study accounted for known risk factors of youth smoking but other unknown factors may have influenced study results.

In 2016, the Food and Drug Administration announced its intention to begin regulating all tobacco products, including e-cigarettes, hookahs and cigars, as it does cigarettes. Polyuse of two or more noncigarette tobacco products was associated with greater odds of cigarette smoking.

"As role models for public health in San Antonio, we're excited to improve the tobacco-free status and resources of UT Health San Antonio to help our faculty, staff, students, and visitors have the healthiest lives possible", Dr. Amelie G. Ramirez said.