High School students who have smoked electronic cigarettes are more likely to progress to smoking regular tobacco products, according to a longitudinal repeated assessment involving 2530 students.

The trial included students with an average age of 14 from 10 Los Angeles public high schools who reported that they never smoked tobacco. They were assessed at baseline, as well as 6 and 12 months later.

At the 6-month follow-up, a group of 222 e-cigarette users was more likely to move onto regular cigarettes. Traditional tobacco was more prevalent in this contingent than in the 2308 who never tried e-cigarettes (30.7% vs 8.1%, respectively). The pattern continued at 12 months (25.2% vs 9.3%).

Product-specific analysis showed that baseline e-cigarette use was associated with use of not only regular cigarettes, but with cigar and hookah use as well.

Investigators were careful to note that more research is needed to determine if the association is causal.

Citation: Leventhal A, Strong D, Kirkpatrick M, et al. Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA. 2015;314(7):700-707.