According to a recent study published by Audrain-McGovern et al,1  electronic cigarette (e-cigarette) use and the risk of initiating marijuana use is 3.63 times higher among current adolescent e-cigarette users (odds ratio 3.63; 95% confidence interval 2.69–4.90).1  Accumulating evidence suggests that e-cigarette use is a risk factor for future transition to the use of marijuana.1,2  This finding is important because the short- and long-term health impact of adolescent e-cigarette use is more harmful than we think.1,2 

Meanwhile, the industry, the tobacco research community, and online information are promoting the e-cigarette as a less harmful tobacco cessation tool. E-cigarette use is also promoted in the most recent science and technology report by the UK government.3  Adolescents are indeed confused and puzzled about the mixed evidence regarding e-cigarettes, and therefore, before more leeway is given to advertise the harm-reduction benefits of e-cigarettes, we believe that the first step would be to establish whether vaping products are indeed safer tobacco cessation devices or harm-reduction tools.3,4  Moreover, with currently available evidence-based (including clinical guidelines and position statements of credible medical organizations) information, we need to ensure that adolescents are able to make informed decisions on the basis of current best evidence.4  It is our moral obligation that we should not promote e-cigarettes to our children and adults (those who never wanted to smoke tobacco). At the same time, it is important to promote the proven nontobacco nicotine products, such as nicotine replacement therapy (gum or inhalers), to smokers (those who are sincerely wanting to quit).

In both the studies by Audrain-McGovern et al1  and Dai et al,2  the authors confirmed that e-cigarette use predicts subsequent marijuana use among adolescents.1,2  Therefore, effective strategies to reduce easy online access to e-cigarettes for youth are an important public health emergency because adolescents who initiate substance use at an earlier age have higher risks for addiction and adverse health outcomes in the future.2  It is also important to educate adolescents about the potential health risks of e-cigarette use.

The harms that e-cigarettes currently pose to adolescents and young adults who are nonsmokers (those who never wanted to smoke) far outweigh the potential benefits.5  Therefore, emerging research on e-cigarette use and potential harm1,2  should be appropriately reflected in future clinical guidelines and position statements of credible medical organizations because adolescents and their parents and caregivers often access this information to address their lifestyles and health-related concerns. It is also important that pediatricians take an active leadership role to prevent the targeting of children through the online marketing of e-cigarettes.

1.
Audrain-McGovern
J
,
Stone
MD
,
Barrington-Trimis
J
,
Unger
JB
,
Leventhal
AM
.
Adolescent e-cigarette, hookah, and conventional cigarette use and subsequent marijuana use
.
Pediatrics
.
2018
;
142
(
3
):
e20173616
2.
Dai
H
,
Catley
D
,
Richter
KP
,
Goggin
K
,
Ellerbeck
EF
.
Electronic cigarettes and future marijuana use: a longitudinal study
.
Pediatrics
.
2018
;
141
(
5
):
e20173787
3.
House of Commons Science and Technology Committee
.
E-cigarettes: seventh report of session 2017–19
.
4.
Bandara
AN
,
Mehrnoush
V
.
Electronic cigarettes: adolescent health and wellbeing [published correction appears in Lancet. 2018;392(10150):820]
.
Lancet
.
2018
;
392
(
10146
):
473
5.
Soneji
SS
,
Sung
HY
,
Primack
BA
,
Pierce
JP
,
Sargent
JD
.
Quantifying population-level health benefits and harms of e-cigarette use in the United States
.
PLoS One
.
2018
;
13
(
3
):
e0193328

Competing Interests

CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.