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Daily Dose: Vaping Among Early Adolescent Cigarette Smokers


Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On April 21, 2023, we reported on a study published in the journal Tobacco Control that examined whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes or deepens early patterns of tobacco smoking in comparison with early smokers who do not use e-cigarettes.

The study

A total of 1893 youth who smoked tobacco cigarettes by early adolescence (before age 15) were selected from the ongoing UK Millennium Cohort Study (n=1090) and the US Population Assessment of Tobacco and Health (PATH) Study (n=803). Participants in both cohorts were regularly surveyed about their use of e-cigarettes and how often they smoked conventional cigarettes before they reached the age of 18 years.

The findings

Among early adolescent smokers, the prevalence of early use of e-cigarettes was nearly the same in the MCS (57%) and the PATH (58%) cohorts.

Among youths who smoked tobacco cigarettes by early adolescence (before age 15), the odds of later adolescent smoking (before age 18) were significantly higher for those who used e-cigarettes relative to those who had not used e-cigarettes, both in the UK (adjusted OR 1.45, 95% CI 1.05-2.01) and the US (aOR 2.55, 95% CI 1.59-4.08) cohorts.

In both cohorts, multinomial models indicated that early smokers who used e-cigarettes were more likely to be frequent smokers relative to not smoking (aORUK 2.01, 95% CI 1.33-3.05; aORUS 5.11, 95% CI, 2.73-9.55) and infrequent smoking (aORUK 1.67, 95% CI 1.06-2.63; aORUS 2.11, 95% CI, 1.03-4.34). For the purposes of the study, frequent smoking was defined as "usually smoked more than six cigarettes per week" in the MCS cohort or ≥27 cigarettes in the previous month in the PATH cohort.

A note from authors

"Among youth who started smoking early in adolescence, early e-cigarette adopters were more likely to become entrenched into tobacco use and in heavier smoking than those who smoked but had not used e-cigarettes. Tobacco control efforts aimed at adolescents should incorporate the risks posed by e-cigarettes for early smoking youth."

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