Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check.

Introduction:
This paper examines the relationship between vaping and smoking initiation among US youth and young adults. The authors use multiple data sets to explore the question of whether vaping promotes smoking initiation in the USa. They conduct a trend line analysis of deviations from long-term trends in smoking starting from when vaping became more prevalent.

Key Points:

* The authors found a substantial increase in youth vaping prevalence beginning in about 2014.
* Time trend analyses showed that the decline in past 30-day smoking prevalence accelerated by two to four times after 2014.
* Indicators of more established smoking rates, including the proportion of daily smokers among past 30-day smokers, also decreased more rapidly as vaping became more prevalent.
* The inverse relationship between vaping and smoking was robust across different data sets for both youth and young adults and for current and more established smoking.
* While trying electronic cigarettes may causally increase smoking among some youth, the aggregate effect at the population level appears to be negligible given the reduction in smoking initiation during the period of vaping’s ascendance.

Main Message:
The main message of this paper is that vaping is not promoting smoking initiation among US youth and young adults. In fact, the study found that the decline in smoking prevalence accelerated after vaping became more popular. This suggests that vaping may be replacing smoking or serving as a substitute for cigarettes among some youth. however, the authors caution that trying electronic cigarettes may causally increase smoking among some youth, so further research is needed to understand the potential risks and benefits of vaping. Overall, the study provides evidence that vaping is not leading to an increase in smoking initiation among young people in the USa.

Levy DT, Warner KE, Cummings KM, et al. Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check. Tobacco control. 2019;28(6):629-635. doi:10.1136/tobaccocontrol-2018-054446