E-cigarette use and relations to tobacco and alcohol use among adolescents.

Electronic cigarette (EC) use is currently subject to a debate concerning safety, regulation need, and probable contribution to smoking cessation. An important gap in this debate is the lack of distinction between minors and adults. This is problematic because other principles of prevention apply to long-term users (such as most adult smokers) and experimental or probable users (more common in minors). This commentary focuses on two less discussed aspects of the EC debate: 1) whether EC use is likely to be additive to conventional cigarette and other tobacco use among minors, and 2) if EC use is likely to contribute to an overall increase in alcohol consumption and other drug use among minors. We find the results by Hughes et al. and others indeed suggestive of both. We conclude that EC use is likely to be additive to other tobacco use and increase the risk for alcohol use, therefore serving as another potential route to hazard for even mildly risk-prone minors. Policies to restrict the access and use of EC among minors are encouraged.