Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

E-cigarettes & Risk of Tobacco Cigarette Initiation

JAMA Netw Open; 2019 Feb 1; Berry, et al

E-cigarette use is associated with increased risk of tobacco cigarette initiation and use, particularly among low-risk US youths, a new study found. The prospective cohort study used data from waves 1 through 3 of the Population Assessment of Tobacco and Health Study (2013-2016) to assess youths aged 12-15 years who had never used cigarettes, e-cigarettes, or other tobacco products at wave 1. The primary outcome was ever cigarette use and current cigarette use at wave 3. Researchers found:

  • The sample included 6,123 respondents (49.5% female, 54.1% non-Hispanic, white; mean age 13.4 years).
  • Of these, 8.6% reported e-cigarettes as their first tobacco product, while 5.0% reported using another noncigarette product first, and 3.3% reported using cigarettes first.
  • Youths whose first tobacco product was an e-cigarette were more likely to initiate cigarettes over 2 years of follow-up.
  • Over the 2 years between 2013-2014 and 2015-2016, 21.8% of new cigarette ever use and 15.3% of current cigarette use among US youths aged 12-15 years may be attributable to prior e-cigarette use.


Berry KM, Fetterman JL, Benjamin EJ, et al. Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths. JAMA Netw Open. 2019;2(2):e187794. doi:10.1001/jamanetworkopen.2018.7794.