A recent study from the University of Michigan, published in the journal Drug and Alcohol Dependence, reveals a significant and concerning link between vaping and the initiation of smoking cigarettes, as well as the use of cannabis and other drugs among U.S. teens and young adults.

Compared to prior studies on vaping which has focused on adolescents ages 12 to 17 within relatively short timeframes, this study stands out by examining a broader age range of 12 to 25-year-olds over an extended period of eight years. The findings indicate that individuals who vape are at a significantly higher risk of starting to smoke cigarettes, use marijuana, or engage in other drug use during this period. The study used data of adolescents (ages 12-17) and young adults (ages 18-25) from waves 1-6 of the Population Assessment of Tobacco and Health Study (2013-2021).

For adolescents aged 12 to 17, the study revealed the following startling statistics over the study period:

• Those who both vaped and used other tobacco products were 54 times more likely to start smoking, eight times more likely to start using marijuana, and three times more likely to begin using other drugs.
• Those who vaped exclusively 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 adults aged 18 to 25, the risks were also pronounced:

• Those who vaped and used other tobacco products were 22 times more likely to start smoking, nine times more likely to start using marijuana, and three times more likely to begin using other drugs.
• Those who vaped exclusively 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 exceptionally high likelihood of cigarette initiation following vaping or other tobacco use was particularly alarming. “The really high odds of cigarette initiation regardless of what type of nicotine or tobacco products you’re using is important,” stated author, Rebecca Evans-Polce. “I think it really highlights that to the extent that you can prevent initiation of vaping and other tobacco products, too, you’ll also go really far in preventing cigarette initiation over the long term.”

The study also highlighted a growing connection between nicotine or tobacco use and the subsequent initiation of marijuana use. Over the eight years of the study, marijuana use became increasingly common among both adolescents and young adults, with the risk particularly heightened for those who vaped and used other tobacco products.

Overall, these findings emphasize the urgent need to develop prevention strategies targeting young adults, not just adolescents. Vaping should not be seen as a benign or “low level” substance use and preventing the initiation of may also reduce the likelihood of these individuals starting to smoke cigarettes, use marijuana, or engage in other drug use.

RJ Evans-Polce et al. Longitudinal associations of e-cigarette use with cigarette, marijuana, and other drug use initiation among US adolescents and young adults: Findings from the population assessment of tobacco and health study (Waves 1–6). Drug and Alcohol Dependence (2024). https://doi.org/10.1016/j.drugalcdep.2024.111402