Youth & Young Adults Gateway


The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes

Saul Shiffman, Mark A Sembower, Janine L Pillitteri, Karen K Gerlach, Joseph G Gitchell
Published online: 15 Jan 2015

Non-smoking teens’ interest in e-cigarettes was very low. Adult smokers’ interest was significantly higher overall and for each flavour. 

Teen interest did not vary by flavour, but adult interest did.

Past-30-day adult e-cigarette users had the greatest interest in e-cigarettes, and their interest was most affected by flavour. 

Non-smoking teens who had never tried e-cigarettes had the lowest interest, followed by adults who had never tried e-cigarettes


The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications

Robert J. Shapiro, Siddhartha Aneja
Published online: Jul 2019

In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analysed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking. We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking. We further found that e-cigarettes are highly effective in helping people stop smoking cigarettes.

Finally, we analysed the impact of the sharp increase in e-cigarette use and the accelerating decline in cigarette smoking on healthcare costs and economic productivity. We found that while e-cigarette users incur lower healthcare costs than cigarette smokers or ex-smokers, the longer lifespans of e-cigarette users and ex-smokers who used e-cigarettes to quit smoking result in higher lifetime healthcare costs. However, we also found that the value of the additional years of life associated with using e-cigarettes instead of smoking is much greater than the additional healthcare costs. Lastly, we found that the increase in e-cigarette use and the associated reduction in smoking rates results in large productivity benefits, mainly from lower rates of illness.


Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study

Lion Shahab, Emma Beard, Jamie Brown
Published online: 17 Mar 2020

In conclusion, this matched control analysis of NYTS data from 2014 to 2017 suggests that for adolescents initiation with e-cigarettes is associated with a reduced risk of subsequent cigarette smoking compared with initiators with other combustible and non-combustible tobacco products use, and propensity score matched adolescents without initial e-cigarette use. This suggests that, over the time period considered, e-cigarettes were unlikely to have acted as an important gateway towards cigarette smoking and may, in fact, have acted as a gateway away from smoking for vulnerable adolescents; this is consistent with the decrease in youth cigarette smoking prevalence over the same time period that youth e-cigarette use increased between 2014 and 2017.


Has increased youth e-cigarette use in the USA, between 2014 and 2020, changed conventional smoking behaviors, future intentions to smoke and perceived smoking harms?

Tianze Sun, Carmen C.W. Lim, Daniel Stjepanović, Janni Leung, Jason P. Connor, Coral Gartner, Wayne D. Hall, Gary C.K. Chan
Published online: Dec 2021


The prevalence for regular smoking decreased among youth who regularly use ECs. For example, among regular EC users, smoking prevalence decreased from 27.8% to 6.7% (−21%; 99.67% CI:[−32.3%, −9.9%]) in the NYTS between 2014 and 2020 and from 31.8% to 10.6% (−21.2%, 99.67% CI:[−35.0%, −7.3%]) in the MTF between 2014 and 2018. Intent to smoke in the future and perceiving smoking as harmless decreased or remained unchanged during the same period. For example, among regular EC users, there was no significant change in intention to smoke next year in the NYTS between 2014 and 2018; intention to smoke in the next 5 years decreased significantly from 30.7% to 11.2% (−19.5%, 99.67% CI:[−37.7%, −1.3%]) in the MTF.


In two national samples of US youth, smoking prevalence declined by a sizeable relative percentage. Intent to smoke in the future and harm perceptions of smoking declined or remained unchanged while EC use increased. Results provide little evidence that EC use has increased conventional cigarette smoking among youth.

Is Adolescent E-Cigarette Use Associated With Subsequent Smoking? A New Look

Ruoyan Sun, PhD, David Mendez, PhD, Kenneth E Warner, PhD
Published online: NOV 2021


The association between ever e-cigarette use and subsequent cigarette smoking decreased substantially in magnitude when adding more control variables, including respondents’ sociodemographic characteristics, exposure to tobacco users, cigarette susceptibility, and behavioral risk factors. Using the most recent data (waves 4-4.5 and waves 4.5-5), this association was not significant in the most complete model (Model 4). Using wave 4.5-5 data, the adjusted odds ratio (aOR) for ever e-cigarette use at initial wave and subsequent past 12-month smoking declined from 4.07 (95% confidence interval [CI, 2.86-5.81) in Model 1, adjusting only for sociodemographic characteristics, to 1.35 (95% CI, 0.84-2.16) in Model 4, adjusting for all potential risk factors. Similarly, the aOR of ever e-cigarette use and past 30-day smoking at wave 5 decreased from 3.26 (95% CI, 1.81-5.86) in Model 1 to 1.21 (95% CI, 0.59-2.48) with all covariates (Model 4).


Among adolescent never cigarette smokers, those who had ever used e-cigarettes at baseline, compared with never e-cigarette users, exhibited modest or non-significant increases in subsequent past 12-month or past 30-day smoking when adjusting for behavioral risk factors.