Vaping linked to higher risk of cigarette smoking and drug use in teens, young adults

American teenagers and young adults who vape are much more likely to start smoking cigarettes or start using cannabis or other drugs, according to a new University of Michigan study.

Most vaping studies focus on teenagers (12-17) over a short period of about two years. Less is known about vaping in young adults (18-25) or the risk of starting to use other substances such as cigarettes, marijuana, or other drugs. To that end, researchers looked at data from 12- to 25-year-olds over an eight-year period. They found that those who vaped were more likely to start smoking cigarettes, use marijuana, or start other drugs during the study period.

We found that this risk was persistent over time and was a risk for both adolescents and young adults. The risk of starting to use cannabis was the same regardless of whether someone used e-cigarettes or other tobacco products.”

Rebecca Evans-Polce, study author, research assistant professor, UM School of Nursing

Findings for children aged 12 to 17 during the study period:

• Those who vaped and used other tobacco were 54 times more likely to start smoking, eight times more likely to start using marijuana, and three times more likely to start using other drugs.
• Those who only vaped were 22 times more likely to start smoking, seven times more likely to start using marijuana, and three times more likely to start using other drugs.

For young people aged 18 to 25 during the study period:

• Those who vaped and used other tobacco were 22 times more likely to start smoking, nine times more likely to start using marijuana, and three times more likely to start using other drugs.
• Those who only vaped were 11 times more likely to start smoking, six times more likely to start using marijuana, and twice as likely to start using other drugs.

The high risk for both age groups to start smoking after vaping or using other tobacco products was surprising, Evans-Polce said.

“The really high odds of starting cigarettes regardless of what kind of nicotine or tobacco products you use are significant,” he said. “I think it really highlights that to the extent that you can prevent the initiation of vaping and other tobacco products, you also go a long way toward preventing the initiation of cigarettes in the long term.”

39% of teens report vaping by 12th grade, and 14% of young adults report vaping in the past month, according to the Substance Abuse and Mental Health Services Administration.

Other data show that people start smoking later in life. Historically, people start smoking before their 20s. So the finding that vaping puts young adults at greater risk for cigarette smoking is important when thinking about ways to prevent people from starting to smoke, Evans-Polce said.

The findings also showed that the relationship between nicotine or tobacco use and initiation of marijuana use increased over time. While marijuana use became more common among teens and young adults over the eight years of the study, the risk seemed to increase more dramatically for those who vaped and used other tobacco products.

Overall, the findings point to the need to develop strategies that prevent young adults from starting to vape and not focus solely on teenagers, Evans-Polce said. Vaping prevention can also lead to fewer teens and young adults taking up cigarettes, marijuana, and other drugs.

The study is published in the journal Drug and Alcohol Dependence.