U-M study: E-cigarettes could unravel decades of tobacco control
New research finds that UK teens who vape are 33% more likely to smoke cigarettes
Teens who regularly use e-cigarettes are equally as likely as their peers from the 1970s to take up cigarette smoking, despite a substantial reduction in the prevalence of teenage cigarette use over the last 50 years, according to a study co-led by the University of Michigan.
U-M researchers, in collaboration with Penn State University and Purdue University, concluded that teenagers who had never used e-cigarettes had an approximately less than 1 in 50 chance of weekly cigarette use, whereas those who had previously used e-cigarettes had more than a 1 in 10 chance. More importantly, teenagers who reported consistent e-cigarette use had nearly a 1 in 3 chance of also reporting current conventional cigarette use.
The study illustrates shifts in the likelihood of youth cigarette use over time and the impacts of e-cigarettes on this trend. The results were derived from three longitudinal studies collected by the Centre for Longitudinal Studies at the University College of London, following teens from three different U.K. birth cohorts.
The research was published in the journal Tobacco Control and was supported by the National Cancer Institute, part of the National Institutes of Health, and a seed grant from the Criminal Justice Research Center at Penn State University, while data collection by the Centre for Longitudinal Studies was supported by funding from the Economic and Social Research Council.
"The use of e-cigarettes and the proliferation of e-cigarettes have really disrupted those awesome trends and improvements. For kids who have never used e-cigarettes, we do see those historic declines in risk," said Jessica Mongilio, a research fellow at the U-M School of Nursing and one of the lead researchers on the study. "But for kids who do use e-cigarettes, it's almost as if all of those policies and all of those perceptions have done nothing, and they've got a really high risk of smoking cigarettes."
Over the past few decades, cigarette smoking has evolved from a once glamorous status symbol to an unhealthy and socially discouraged practice, according to the researchers. This evolution was, in large part, driven by aggressive campaigning that labeled cigarette smoking as a public health risk.
By the late 1990s and into the early 2000s, cigarette smoking was structurally and socially stigmatized, embedded in national federal regulations and health policy. In recent years, cigarette smoking in youths dropped to an all-time low, according to research from the Centers for Disease Control.
E-cigarettes, colloquially known as vapes, often sold in bright colorways and in fruity flavors, have quickly emerged as a perceived "safer" alternative to the conventional cigarette. They stand to threaten decades of advocacy, health policy and cultural aversion toward smoking in both the U.K. and United States, the researchers say.
The Millennium Cohort Study, or MCS, tracked teens born in England, Scotland, Wales and Northern Ireland in 2000 and 2001 and who were children when e-cigarettes were first commercialized. The British Cohort Study tracked individuals born in 1970, who were teenagers during the 1980s when cigarette use was fairly common and in their 40s when e-cigarettes were commercially available. Finally, the National Child Development Study tracked individuals born in 1958, who were young children when cigarette use was at its cultural peak.
"We took data from different cohorts, essentially different generations of people who live in the U.K., and looked at their probability of smoking cigarettes at least once a week, based on some well-known risk and protective factors," Mongilio said. "For the most recent cohort, we also examined how use of e-cigarettes changed those probabilities.”
According to Mongilio and her collaborators, it's not entirely clear whether e-cigarette use directly caused cigarette use, but it’s clear their incidences are strongly related. Still, the MCS cohort will be continuously surveyed over time to further understand how the use of e-cigarettes during the critical developmental teen years will affect their health in the long term.
Ultimately, with the findings of this study, the researchers hope to demonstrate the profound impact of e-cigarettes on today's youth in an attempt to exact meaningful legislative, social and economic change.
"The more you can build evidence—the bigger the pile of support—the harder you can make it to ignore. This will lead toward policy changes and toward increased regulations for e-cigarettes and for producers of e-cigarettes," Mongilio said. "I think we're in a place where change is possible and to have increased regulations and enforcement of those regulations for companies that are producing e-cigarettes."
Study: Risk of adolescent cigarette use in three UK birth cohorts, before and after e-cigarette (DOI: doi:10.1136/tc-2024-059212)
Story written by Sarah Akaaboune, Michigan News
Journal
Tobacco Control
DOI
UK teens who currently vape as likely to start smoking as their peers in the 1970s
Likelihood of smoking 1.5% among teens who don’t vape, but 33% among those who do
UK teens who currently vape are as likely to take up smoking as their peers in the 1970s, despite a substantial fall in the prevalence of teenage smoking over the past 50 years, suggests a long term intergenerational study published online in the journal Tobacco Control.
The likelihood of starting to smoke among teens who don’t vape was around 1.5%, but 33% among those who do, the findings indicate.
It’s not entirely clear if the rise in popularity of e-cigarettes (vapes) among teens threatens the steady decline in the prevalence of cigarette smoking in this age group, say the researchers, as the published research is somewhat equivocal.
And if historic declines are slowing, it’s not clear how the risk of cigarette smoking among today’s young people—especially those who vape—compares to that of previous generations who came of age before notable tobacco control legislation and the advent of e-cigarettes, they add.
To try and find out, they drew on intergenerational data from three nationally representative birth cohorts of UK teens* born in 1958 (National Child Development Study; NCDS), 1970 (The British Cohort Study; BCS), and 2001 (Millennium Cohort Study; MCS).
As well as baseline surveys at either birth or 9 months, MCS participants provided data at ages 3, 5, 7, 11, 14, 17 and 23; BCS participants at ages 5, 10, 16, 26, 30, 34, 38, 42, 46 and 51; and NCDS participants at ages 7, 11, 16, 23, 33, 42, 46, 50, 55 and 62.
The prevalence of teen smoking was assessed in 1974 among 11,969 NCDS participants, in 1986 among 6222 BCS participants, and in 2018 among 9733 MCS participants. The odds of smoking among 16 and 17 year olds were estimated, based on a common set of childhood risk and protective factors; teen vaping was included as a predictor in the MCS.
Risk/protective factors included whether they had ever drunk alcohol by age 16 or 17; how engaged they were with education at school; the extent of externalising behaviours reported by the mother or main caregiver at ages 10 or 11; and parental occupation, education, and smoking behaviour— including during pregnancy.
Analysis of the intergenerational data revealed a steep decline in the prevalence of cigarette smoking among teens, falling from 33% in 1974, to 25% in 1986, and to 12% in 2018. Around half of the MCS participants hadn’t vaped by the time they were 17; 41% said they had previously vaped; and 11% reported current vaping.
The decline in prevalence of teen smoking can be attributed to a mix of tobacco control legislation, better public understanding of the health consequences of smoking, and a shift away from the perception of smoking as socially acceptable, suggest the researchers.
Risk/protective factors also changed over time. For example, the percentage of teens who had started drinking by the age of 16 or 17 fell from 94% in the NCDS to 83% in the MCS.
The average age at which mothers left education also rose from 15.5 in the NCDS to 17 in the MCS. Similarly, the prevalence of parental smoking fell from over 70% in the NCDS to 27% in the MCS; and fewer mothers continued smoking while pregnant in the MCS than in the NCDS and the BCS.
Many risk factors for teen smoking were similar across the cohorts—drinking before the age of 17 and greater externalising behaviours, for example—as were some child level protective factors—greater engagement with education, for example.
To illustrate the likelihood of cigarette smoking for an ‘average’ teen (16-17) over time, the researchers worked out predicted probabilities of cigarette smoking with all risk factors included from the intergenerational data.
This probability was 30% in the NCDS and 22% in the BCS. Among those who had never vaped in the MCS this was around 1.5%, but 33% for the teens who reported current vaping.
“This probability is especially concerning given the recent increases in e-cigarette use prevalence among UK youth, despite some initial assurances that e-cigarettes would have little appeal to [them],” say the researchers.
The researchers acknowledge that they were unable to account for some sociodemographic characteristics, including race and ethnicity, due to insufficient sample sizes in the earlier cohorts. And they emphasise that estimates of the associations between vaping and smoking in the MCS aren’t causal and shouldn’t be interpreted as such, especially as the temporal sequencing of smoking and vaping isn’t explicit.
Nevertheless they conclude: “While our research shows that the historic decline in the likelihood of youth cigarette smoking has continued in this recent cohort of UK youth, overall, we find that this is not the case among e-cigarette users.
“Youth who had never used e-cigarettes had an estimated less than 1 in 50 chance of reporting weekly cigarette use at age 17, while those who had previously used e-cigarettes had over a 1 in 10 chance. Youth who reported current e-cigarette use had an almost 1 in 3 chance of also reporting current cigarette use.
“As such, the decline in the likelihood of cigarette smoking is waning for youth who have used e-cigarettes—about half of our sample—and has reversed for those currently using e-cigarettes.
“Among contemporary youth, efforts to reduce cigarette smoking should focus both on those who are currently using e-cigarettes and on the prevention of e-cigarette use among youth, to maintain the promising declines in youth nicotine use in years to come.”
Journal
Tobacco Control
Method of Research
Observational study
Subject of Research
People
Article Title
Risk of adolescent cigarette use in three UK birth cohorts before and after e-cigarettes
Article Publication Date
29-Jul-2025
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