There is a certain perceived assurance e-cigarettes (e-cigs) are safe and harmless to your health. Unlike combustible cigarettes, the vapor is often odorless, making it difficult to detect once the e-cig device has been put away. While the number of people smoking traditional cigarettes has been dropping,1 the number of teens using e-cigs, also known as vaping, has steadily risen. Since 2011, teens have been smoking less and vaping more, and research demonstrates teens who vape may also be more prone to smoke.2

Tobacco Headlines Don’t Tell the Whole Story

Smokeless e-cigarettes are the most popular nicotine- or tobacco-based product used by high school and middle school students. The 2016 Surgeon General Report stated e-cigs are a major public health concern, as use from 2011 to 2015 in high school students had risen an astounding 900 percent.3

According to the most recent published National Youth Tobacco Survey, an estimated 3 million teens are vaping,4 representing a slight 11.3 percent decline in numbers of students smoking e-cigs since 2015, as compared to the 900 percent increase in the previous four years.5 Reports of declining e-cigarette use are based on this slim drop in numbers.

The 2016 National Youth Tobacco Survey also found many were using multiple tobacco products in the prior 30 days before the survey. While e-cigarettes were the most commonly used product for the third consecutive year, the current use of combustible cigarettes had not changed significantly.6 It’s important to realize that there’s no safe level of exposure to tobacco products, smokeless or combustible.

The U.S. Centers for Disease Control and Prevention (CDC) calls tobacco use the leading cause of preventable death.7 CDC acting director Dr. Anne Schuchat commented in a press release:8 “Far too many young people are still using tobacco products, so we must continue to prioritize proven strategies to protect our youth from this preventable health risk.”

Vaping May Have Lasting Effects on Health

In a yearlong follow-up of Los Angeles high school students, researchers discovered teens who use e-cigs are more likely to start smoking regular cigarettes.9 Stanton Glantz, tobacco control researcher from the University of California, San Francisco, has worried e-cigs were a gateway habit, leading teens to smoking traditional cigarettes, hookah and cigars.10 This study appears to confirm his concerns.

These results were supported by another study of more than 1,400 Connecticut high school students conducted over two years, during which researchers asked the students about their e-cig use and traditional tobacco cigarettes within the previous 30 days.11 Not surprisingly, they found those who reported smoking cigarettes during the first survey had a high likelihood of reporting during the second and third surveys as well. This was also true for students smoking e-cigarettes.

Another finding in the data was those who were only smoking e-cigs in the first survey were more likely to be smoking traditional combustible cigarettes by the third survey.

These results were not duplicated in those smoking only traditional cigarettes in the first survey. In other words, students were likely to move from vaping to traditional combustible cigarettes, but not vice versa. Researchers also found the overall use of both products increased over time. The authors outline some of the risks with e-cigs to teens when they wrote:12

“For example, adolescents may be more likely to use e-cigarettes before conventional cigarettes because of factors unique to e-cigarette products, such as perceptions that e-cigarettes are less harmful than conventional cigarettes, the widespread availability of unique e-cigarette liquid flavors that may be especially appealing to youth and limited enforcement or restrictions on youth access to e-cigarettes.”

Authors of a third study wrote e-cigarette users in their dataset were an intermediate risk for becoming smokers, speculating e-cigarettes may raise the possibility of recruiting adolescents who otherwise would be less susceptible to tobacco products.13Another danger associated with smoking e-cigs is the ease of hiding the activity. As Dr. Sanjay Gupta points out in the video, students are hiding their activity in the classroom, hallways and bathrooms, and many parents likely do not know that they’re vaping.

Tobacco use is the leading cause of preventable death in the U.S. and Canada.14Since smoking e-cigs leads to a higher potential of moving to traditional tobacco products, it’s critical to communicate the dangers of use with your adolescents and middle school students.

Cigarettes, e-cigarettes, cigars, dipping tobacco and hookah all qualify as tobacco products.15 The CDC states smoking causes more deaths each year than HIV, illegal drug use, alcohol, motor vehicle accidents and firearm-related accidents combined.16Tobacco use is linked to these and many other conditions:17,18

Cardiovascular disease

Peripheral vascular disease

Low birth weight babies

Erectile dysfunction


Rheumatoid arthritis



Chronic obstructive pulmonary disease




Preterm birth



Type 2 diabetes


Gum disease


Slowed healing