Teens who use flavored e-cigarettes more likely to start smoking

Claire McCarthy, MD

Senior Faculty Editor, Harvard Health Publishing

Follow me on Twitter @drClaire

When I talk to teens in my practice about cigarettes, what I hear from lots of them is that the smell is what keeps them from smoking. They don’t want to smell like cigarette smoke, and they don’t want that taste in their mouth, either.

But what if the smell, and the taste, were good? What if they tasted like bubble gum, or chocolate?

In a study published in the journal Pediatrics, researchers looked at data from the 2014 National Youth Tobacco Survey. They found that among teens that had never smoked cigarettes, 58% of those who had used flavored e-cigarettes planned to start.

That number was 20% for teens who had never used e-cigarettes. It was 47% among those who had used non-flavored cigarettes, which is a high number too. Clearly, teens that use e-cigarettes are more likely to start smoking.

But when the e-cigarettes were flavored, the teens were less likely to think of tobacco as dangerous.

E-cigarettes and tobacco are different, of course. E-cigarettes do not have many of the carcinogens that cigarettes do, and could be useful for smokers who are trying to quit. But for teens that have never smoked, it’s a different story. The “vapor” of e-cigarettes doesn’t have to contain nicotine, but it can (it does contain chemicals such as formaldehyde that could have long-term health consequences) — and nicotine is addictive. Using e-cigarettes is physically close enough to smoking cigarettes that moving from smoking one to smoking the other could easily happen.

The use of e-cigarettes among youth has grown tremendously over the past few years — and e-cigarettes are being marketed to them. We don’t know what the consequences of this will be. It could be that we will end up with more smokers — or that we’ll end up with fewer if teens decide to stick with e-cigarettes, especially if they choose to stick with the nicotine-free kind. But we can’t just sit back and wait to see what happens.

Recently the Food and Drug Administration extended its tobacco regulations to include e-cigarettes and other nicotine delivery systems, which among other things, requires that there be warning labels and that you have to be at least 18 years old to buy them. This is a good start, and will help us look more carefully at how e-cigarettes are being marketed, too.

We need to do more research to understand the short-term and long-term effects of e-cigarettes on our youth. We need more information in order to make the best policy and parenting decisions.

All of us who are raising or interacting with teens need to talk with them more about e-cigarettes. We need to understand how teens think about them, and why they might choose to use them; when it comes to teens, listening is really important. And along with listening, we need to help teens understand the risks involved. We can’t let them get distracted or seduced by marketing and flavoring; we need to help them make the best choices for their health.

Related Information: How to Quit Smoking


  1. mjk

    the electronic cigarette (vapers) community are scary people. their level of hyper-vigilance to protect and maintain an image of salvation is alarming. the fact, and the truth, is that electronic cigarettes are toxic and dangerous. what’s so scary about it is that the electronic cigarette community cannot and will not acknowledge it. they’re terrified of having to give up their drug addiction.

    electronic cigarettes are not the salvation they want the world to believe.

    i used electronic cigarettes for 46 months and have adverse effects from very early on. they were mild to severe adverse effects. in the last year of my use, before throwing all of my electronic cigarette material in the trash, i had to seek medical attention five times (three by ambulance). i was suffering from chronic and acute formaldehyde and nicotine poisoning.

    i know electronic cigarettes to be MORE dangerous than tobacco, but in their own way.

    the number one health risk is believing that electronic cigarettes are salvation. they are not. the electronic cigarette community represents electronic cigarettes as “95% safer or healthier than tobacco” and i find that to be totally and completely false. i also find the opposite to be true; they are toxic and dangerous and, in my case, were nearly lethal.

    if you want to safeguard teenagers and young adults you’ll need to combat the image of salvation that the electronic cigarette community represent.

    i don’t know if i can post links here but i submit to this blog a reference indicating that e-cigarette calls were more likely than conventional cigarette calls to report adverse health effects.

    Journal of Medical Toxicology

    December 2016, Volume 12, Issue 4, pp 350–357
    Exposure Calls to U. S. Poison Centers Involving Electronic Cigarettes and Conventional Cigarettes—September 2010–December 2014

  2. Debra

    I felt compelled to write a little at length in hopes of enlightening you and any other physicians that might like to know more about real people who use e cigs.
    I agree that the flavors may entice teens – but those teens would be the ones who would have bought cigarettes anyways if they hadn’t tried
    e cigs. I do not think teens would switch from e cig to regular cigarettes. For one- the cost difference.
    Two- cigarettes are harsh.

    As an adult who uses the e cig- I want you to know that it helped me to stop cigarettes after 35 years of smoking by my own hand… and a lifetime of nicotine exposure due to parents being smokers. Add nine months to my addiction due to my mom smoking through pregnancies.

    No other method or attempt to quit was successful due to the following:
    At the 3 month mark- I would recognize that my body chemistry was not capable of righting it’s self to a normal balance no matter what tricks I tried to “be normal”. Yes I tried anti depressants but the side effects were horrid and I did not get relief. Every time that I quit, the result as the same at the 3 month mark. No exaggeration- I would think that death sounded better than feeling so despondent. Though I did not want THE cigarette- I couldn’t function anymore with out the boost of that chemical bath to the brain. I did quit through two pregnancies- so this led me to think about the hormones with in the body. Increased Oxytocin allowed me to feel like a normal person?

    I am not a physician or a scientist- but I am certain that the lifelong exposure to nicotine caused my brain and any other part of me that produces proper chemistry to malfunction. Maybe my body has always counted on nicotine and other chemicals instead of my body producing its own supply of either Serotonin, Dopamine, Endorphins or Ghrelin?

    Using the e cig has improved my health and chemistry. This means I had the power to start living my life healthier too. Instead of curling up in a ball and panicking because it was my job to wash my own face and also care for my family when I was nicotine free- I learned about magnesium, vitamin D3 and positive thinking. I also actively volunteer places because I no longer smell like old tobacco. I can hug my grandchild with out seeing her make a twisty yuck face. My sons used to make that face.

    I have been using the e cig since summer 2010- after a 6 month break from all nicotine that wasn’t from a food source. I made it through an extra 3 months past my “HELP ME” stage by sheer will power and determination to live- but I was physically and emotionally deteriorating.
    Physical and emotional symptoms due to a physical disorder.

    I write these private things in order to emphasize that nicotine “addiction” is more than a “habit”- It is quite possibly a medication for people like me.

  3. Mike Morris

    I find this complete and udder trash brought to you in part by hype… Ecigs have great flavors not to target kids but adult ex smokers like myself who still crave nicotine but want the farthest thing from tobacco flavors as possible.
    And sorry to say but kids are going to be curious and try things they shouldn’t, but if they would try vape and think wow I want to smoke regular cigarettes then they’re not only not being parented but just plain dumb.

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