Ann Arbor Times

Teens who regularly use e-cigarettes are as likely to start smoking cigarettes as their peers from the 1970s, according to a new study co-led by the University of Michigan. This finding comes despite a significant decline in overall teenage cigarette use over the past five decades.

Researchers from the University of Michigan, Penn State University, and Purdue University analyzed data from three U.K. birth cohorts tracked by the Centre for Longitudinal Studies at University College London. The study found that teenagers who had never used e-cigarettes had less than a 1 in 50 chance of becoming weekly cigarette smokers. In contrast, those who had previously used e-cigarettes faced more than a 1 in 10 chance, and consistent e-cigarette users had nearly a 1 in 3 likelihood of also using conventional cigarettes.

Jessica Mongilio, research fellow at the U-M School of Nursing and one of the lead researchers on the study, said: “The use of e-cigarettes and the proliferation of e-cigarettes have really disrupted those awesome trends and improvements. For kids who have never used e-cigarettes, we do see those historic declines in risk. But for kids who do use e-cigarettes, it’s almost as if all of those policies and all of those perceptions have done nothing, and they’ve got a really high risk of smoking cigarettes.”

Over recent decades, cigarette smoking shifted from being seen as glamorous to being recognized as an unhealthy habit discouraged by society. This change was driven largely by public health campaigns and federal regulations targeting tobacco use. By the late 1990s and early 2000s, youth cigarette smoking rates dropped significantly due to these efforts.

E-cigarettes—often marketed with bright colors and fruity flavors—have emerged as an alternative perceived by many teens as safer than traditional cigarettes. However, researchers warn that these products may undermine years of progress made through tobacco control measures both in the United Kingdom and United States.

The Millennium Cohort Study (MCS) followed teens born around 2000-2001 across England, Scotland, Wales, and Northern Ireland—children when e-cigarettes became available commercially. The British Cohort Study tracked individuals born in 1970 during their teenage years in the 1980s when cigarette use was common; these participants were adults when e-cigarettes appeared on the market. The National Child Development Study included people born in 1958 who grew up during peak cultural acceptance of cigarette smoking.

“We took data from different cohorts, essentially different generations of people who live in the U.K., and looked at their probability of smoking cigarettes at least once a week, based on some well-known risk and protective factors,” Mongilio said. “For the most recent cohort, we also examined how use of e-cigarettes changed those probabilities.”

While it remains unclear whether using e-cigarettes directly causes increased cigarette use among teens or simply correlates with it, researchers plan to continue tracking participants over time to better understand long-term health impacts.

Ultimately, Mongilio hopes this evidence will support stronger regulation: “The more you can build evidence—the bigger the pile of support—the harder you can make it to ignore. This will lead toward policy changes and toward increased regulations for e-cigarettes and for producers of e-cigarettes,” she said. “I think we’re in a place where change is possible and to have increased regulations and enforcement of those regulations for companies that are producing e-cigarettes.”