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Using certain e-cigarette devices can lead to smoking more cigarettes

A USC study finds that teens who vape — especially those who use modifiable e-cigarette devices — end up smoking far more cigarettes than those who don’t.

vaping device leads to cigarette use
The type of device used for vaping may indicate higher or lower risk factors, with vape pen users generally using fewer cigarettes, says Jessica Barrington-Trimis. (Illustration/Pascal Kiszon, iStock)

A new USC study finds that teens who vape end up as heavier users of combustible cigarettes than smokers who never used e-cigarettes.

The study, which appears in Pediatrics, found that participants using a pen-like e-cigarette device smoked 2.83 times as many cigarettes as those who had never used e-cigarettes. Participants who used a modifiable e-cigarette device (often called “mods”) smoked far more cigarettes — 8.38 times as many.

Mods have components that can be modified — such as the battery, temperature and power — which can change the relative amount of nicotine delivery and size of the vape cloud. Vape pens, however, generally deliver a consistent and often lower level of nicotine.

“The type of device that participants use may be an important risk factor for higher levels of cigarette smoking,” said Jessica Barrington-Trimis, assistant professor of preventive medicine at the Keck School of Medicine of USC. “Device type may be an important target for regulation to reduce the burden of tobacco-related disease stemming from e-cigarette use.”

Vaping young adults are more likely to use combustible cigarettes

Barrington-Trimis and her colleagues collected data from 1,312 young adults participating in the Southern California Children’s Health Study on specific characteristics of e-cigarette use from the past 30 days, between 2015 and 2016. The researchers followed up with the participants one year later.

They found that young adults who vaped were more likely to smoke combustible cigarettes after one year, and the amount they smoked depended on the e-cigarette device they used. Researchers concluded that young adults using modifiable e-cigarette devices smoked more than six times as many cigarettes a year later.

The researchers recommended that targeted regulation of mod e-cigarettes could help reduce heavy smoking patterns but added that additional research is needed to discover the reasons for these differences.


In addition to Barrington-Trimis, other study authors are Zhi Yang, Sara Schiff, Jennifer Unger, Tess Boley Cruz, Robert Urman, Junhan Cho, Adam M. Leventhal, Kiros Berhane and Rob McConnell, all of the Keck School; and Jonathan Samet of the University of Colorado.

The study was funded by the National Cancer Institute of the National Institutes of Health and the Food and Drug Administration Center for Tobacco Products (grants P50CA180905 and U54CA180905), the National Institute on Drug Abuse of the National Institutes of Health (grant K01DA042950) and the Tobacco-Related Disease Research Program (grant 27-IR-0034).

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Using certain e-cigarette devices can lead to smoking more cigarettes

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