Researchers followed 10,000 nonsmokers ranging in age from 12 to 17 years old for one year to see how their use of other tobacco products influenced the odds that they would become smokers.
Results showed that teens who tried non-cigarette products such as e-cigarettes, hookah pipes and other non-cigarette tobacco products are more likely to take up cigarette smoking than their peers who never sample these products.
By the end of the study year, about 5 percent had tried a cigarette and roughly 2 percent, had smoked within the past month, the study found.
Among the small proportion of teens who had tried e-cigarettes at the start of the study, however, 19 percent had become smokers a year later, as had about 18 percent of hookah users.
“Each type of non-cigarette tobacco product we studied - whether e-cigarettes, cigars, or smokeless tobacco - independently contributed to smoking risk,” said senior study author Dr. Benjamin Chaffee of the University of California, San Francisco School of Dentistry.
“These products have different properties, but in terms of predicting future smoking among kids, the risk seems to be the same,” Chaffee said by email to Reuters Health.
Vaping - a term for using e-cigarettes and similar devices - was the most popular alternative to traditional cigarettes. About 4 percent of teens had vaped at the start of the study, followed by 3 percent who had smoked a hookah, or water pipe, researchers report in JAMA Pediatrics.
The non-cigarette alternatives examined in the study contain nicotine, an addictive and very difficult drug to quit. Many advocates for tobacco control fear that e-cigarettes will create a new generation of nicotine addicts who may eventually switch to conventional cigarettes.
Despite the large size of the study population, one limitation is the relatively small number of tobacco product users by year-end, particularly the 2 percent of youth who admitted sampling one or more of these items in the past month. This may have weakened some connections between cigarette smoking and other tobacco products, the authors note.
E-cigarettes and other non-cigarette products are – except for smokeless tobacco products -a relatively new phenomenon in tobacco and nicotine use.
Researchers are beginning to focus on the health and social issues that may be associated with e-cigarettes and other non-cigarette alternatives use among teens, young adults and children. Many of the studies have found an association between these types of products and progressive use of regular cigarettes.
Health experts agree that parents should warn their children about the dangers of all types of tobacco products. Many include a notice to parents to also discuss the addictive nature of e-cigarettes and similar products with their kids.