Data were included for 10,384 participants (aged 12 to 17 years at baseline) from waves 1 (Sept. 12, 2013, to December 14, 2014) and 2 (Oct. 23, 2014, to October 30, 2015) of the Population Assessment of Tobacco and Health study. "But when you look at these other products too, like smokeless tobacco and cigarillos, they're having the same magnitude of relationship with future smoking", said Shannon Lea Watkins, a postdoctoral fellow at the Center for Tobacco Control Research and Education at the University of California, San Francisco.
At one-year follow-up, 4.6% of all baseline never-smoking youths had tried a cigarette and 2.1% had smoked a cigarette within the past 30 days.
"Any use of all forms of non-cigarette tobacco was independently associated with greater risk of future cigarette smoking", the JAMA study authors concluded.
Previous studies have found evidence to suggest that e-cigarettes (plus other non-cigarette tobacco products) act as a gateway to conventional smoking.
People who received drug therapy at hospitals were more likely to quit smoking than those who did not see physicians, the study showed.
Never-cigarette-smoking youths who initiated tobacco use with noncigarette products including e-cigarettes, hookahs, noncigarette combustible tobacco, or smokeless tobacco were more likely to smoke cigarettes in the following year than those who did not use noncigarette tobacco. Results demonstrated that cigarette use initiation was associated with ever use of e-cigarettes (OR, 2.53; 95%CI, 1.80-3.56), hookah (OR, 1.79; 95%CI, 1.23-2.62), noncigarette combustible tobacco (OR, 1.64; 95%CI, 1.06-2.54), and smokeless tobacco (OR, 1.66; 95%CI, 1.00-2.76).
The newly reported analysis of the PATH data was unique because of its large size and the inclusion of both e-cigarette and non-e-cigarette tobacco products in the assessment of smoking risk. Even though the odds of smoking were higher among youth who had tried other products, the number of smokers contributed by each of these groups was minuscule.
In 2016, the FDA banned the sale of e-cigarettes and other such products to anyone younger than 18. "The estimated health risks of non-cigarette tobacco products should include the addition health consequences of future cigarette use".
"It's not surprising that products like e-cigarettes and cigars have become popular with kids when they are sold in sweet flavors like gummy bear and cherry dynamite", said Vince Willmore, vice president of communications for the Campaign for Tobacco-Free Kids, which was not involved in the research. In all, approximately 12,000 adolescents provided information about their use of tobacco products.