New Truth Initiative Study Finds That E-Cigarette Use Increases Odds of Youth Using Cigars, Little Cigars or Cigarillos (CLCCS)

Young people who vape are over 3x more likely to try CLCCs, products that pose the same health risks as cigarettes

According to a new Truth Initiative study, young people 15-21 who use e-cigarettes or ever used JUUL have over 3x higher odds of initiating use of cigars, little cigars or cigarillos (CLCCs), compared with those who never vaped. These findings are the latest in a line of reports showing a significant association between vaping and the use of other tobacco products among young people. This is especially concerning given youth e-cigarette use remains at epidemic levels with about one in five high school students (19.6%) reporting e-cigarette use in the past 30 days. Nearly forty percent (38.9%) of those students vape on a regular basis; 22.5% of high school users and 9.4% of middle school users reported daily use.

This study is the first to find that using e-cigarettes strongly predicts future use of cigars, little cigars or cigarillos (CLCCs) and flavored CLCCs—products that present the same health risks as combustible cigarettes. Young people who had ever used JUUL had 3.3x higher odds of using CLCCs for the first time from 2018 to 2019, compared to those who had not used e-cigarettes by 2018. This group had 2.5x higher odds of using flavored CLCCs compared to non-flavored CLCCs. Many CLCCs are available in an array of flavors that appeal to youth—such as mint, menthol, and fruity flavors—which are similar to those found in many e-cigarette brands.

Flavors, including menthol, are a key factor in hooking youth and young adults on tobacco products. In 2020, 82.9% of youth who vape used flavored e-cigarettes, including 84.7% of high school users and 73.9% of middle school users. Menthol, a flavor that is easier to smoke and harder to quit, has perpetuated the tobacco epidemic, with disproportionately higher use by Black Americans and youth. Nearly 9 in 10 Black smokers use menthol cigarettes, and more than 39,000 Black Americans die from tobacco-related cancers each year reflecting the tobacco industry’s decades long menthol advertising efforts aimed at Black communities and communities of color. Young people use menthol tobacco products at disproportionally high rates with 46.1% of high school and 42% of middle school current tobacco users reporting use of menthol cigarettes in the past 30 days. Menthol cigarettes have long been the “starter” cigarette for young people as menthol flavoring masks tobacco and nicotine harshness.

“We have long known that young people who vape are more likely to go on to smoke cigarettes but these new data make it clear that e-cigarette usage can also predict other types of equally dangerous tobacco product use, including cigars, little cigars and cigarillos,” said Robin Koval, CEO and President of Truth Initiative. E-cigarettes like JUUL and its competitors have some of the highest nicotine content among e-cigarettes as well as youth-appealing flavors and as this study shows, create an easy on-ramp to nicotine addiction that can swiftly progress to smoking combustible tobacco which is still the leading cause of preventable death in the U.S. That is how the tobacco industry is initiating a new generation into a lifelong addiction and why Truth Initiative is working to help hundreds of thousands of young people in their journey to quit nicotine.”

This study also found that race and gender are statistically significant predictors of overall CLCC initiation. Non-Hispanic Black respondents had 1.68x higher odds of initiating CLCC use from 2018 to late 2019, compared to white non-Hispanic respondents. Male respondents had almost double (1.91x) the odds of CLCC initiation compared to female respondents.

The link between vaping and use of other tobacco products, such as combustible cigarettes, is well established with evidence from nine separate reports, including a 2020 report published in Addictive Behaviors, which shows that young people between 15-27 who had ever used e-cigarettes were shown to have 7x higher odds of ever using traditional cigarettes and 8x higher odds of becoming a current smoker one year later, compared with those who had never used an e-cigarette.

These new data linking vaping to CLCC use demonstrate the urgency of helping young people quit vaping. Truth Initiative’s innovative programs are doing just that. Nearly 350,000 young people have enrolled in This is Quitting—the proven-effective, free and anonymous text message quit vaping program for teens and young adults from Truth Initiative. This is Quitting, which first launched in January 2019, was created with input from teens, college students and young adults who have attempted to, or successfully, quit e-cigarettes. A randomized clinical trial found that young adults aged 18-24 who used This is Quitting had nearly 40% higher odds of quitting compared to a control group. Teens and young adults can text “DITCHVAPE” to 88709 and get immediate help.