Visual Study: The Link Between Vaping and Smoking in Kids

By Charles Li MD

February 08, 2019

  • Electronic cigarettes have overtaken all other forms of tobacco for today's youth.

  • While vaping is likely safer than smoking, one concern that some doctors have is the link between vaping and smoking.

  • Kids who vape are 4x more likely to eventually smoke.

Kids Today Prefer Vaping to Smoking

Statistics on nicotine and kids

Electronic cigarettes have taken the world by storm, particularly in today's youth. While cigarette smoking has been declining for many years, vaping has dramatically grown in prevalence due to good marketing and fewer health concerns.

Among today's youth who use nicotine, over half (58%) begin with electronic cigarettes. The remaining 42% is split between traditional cigarettes and other tobacco products, including hookah and cigars.

Given how new electronic cigarettes are, public health experts are still trying to get a handle on the risks of electronic cigarettes.

One of the Biggest Risks of Vaping is Smoking

At this point, the best characterized risk of vaping remains the risk of smoking cigarettes. Smoking, as many may know, is likely one of the worst things you can do for your health. It increases your risk of heart disease and cancer, the two biggest killers in America.

Many doctors are concerned that kids who vape today may eventually turn into smokers.

In order to characterize this link between vaping and smoking in kids, researchers at Boston University analyzed data from the Population Assessment of Tobacco and Health study. They followed 6163 kids starting at age 13 to see whether they smoked, and whether kids who "vaped" were more likely to eventually smoke within 2 years.

Source: Association of Electronic Cigarette Use With Subsequent Initiation of Tobacco Cigarettes in US Youths.

The Risk of Smoking in Kids who Vape

Data on the Risk of Smoking among Vaping

The data showed that kids who vape indeed had a much higher chance of eventually smoking cigarettes. When all other factors were controlled for, researchers estimated that kids who vape had approximately 4.1x the risk of smoking cigarettes within 2 years compared to their classmates who did not vape.

Similarly, kids who used other forms of tobacco, including hookah and cigars, had a 3.8x increase in their risk of eventually smoking cigarettes.

One thing to keep in mind with this data is that this is only a correlation. It's very possible that teens who vape had personalities that also make them more likely to smoke cigarettes. It's impossible to know for sure how much of link is "causal" without doing a trial, which would be difficult for this topic.

The Percent of Kids Who Smoke Cigarettes

Data on the percent of kids who smoke cigarettes

While the risks do seem significant, the absolute percentage of kids who eventually smoke cigarettes is not large for any group.

In the data above, researchers split kids into high risk and low risk based on their personalities, socioeconomic status, and predicted propensity for smoking cigarettes.

They found that overall, high risk kids who vaped were 3x more likely to smoke cigarettes compared to their counterparts who did not vape.

Surprisingly, low risk kids were nearly 10x more likely to smoke cigarettes if they vaped. However, the absolute percentage was only 10%.

We of course hope that no kids today will become smokers, but it is encouraging that 90% of low risk youth and 82% of high risk youth who vape will not smoke cigarettes.

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