The Defense Department should pay closer attention to the rise in vaping among young Americans given new research that shows a strong link between e-cigarettes and traditional smoking in teens, a Washington, D.C., think tank suggests.

CNA, a nonprofit research organization that operates the Center for Naval Analyses, released a report Tuesday indicating that young vapers were 2.5 times more likely to smoke or chew tobacco than expected, given that overall tobacco use -- including cigarettes and chewing tobacco -- fell among teens fell from 1999 to 2014.

Reviewing results of the National Youth Tobacco Survey from the early 2000s before e-cigarettes were introduced in the United States, and the most recent survey in 2014, CNA researchers found a very low rate of cigarette use among adolescents who had never vaped, but extremely high use of tobacco products among those who used e-cigarettes.

"The results were so surprising that at first we thought they couldn’t possibly be right," said Elizabeth Clelan, a research scientist at CNA. "However, when we looked further, we found that not only were vapers more likely to smoke than expected, they also smoked a significantly greater number of cigarettes per day than fellow smokers who had never tried e‐cigarettes."

The study showed that 46 percent of the teens who reported vaping also said they had used traditional cigarettes or chew at least once in the 30 days before taking the survey. Of the 6,000 teens surveyed who said they didn't vape, just 5 percent reported traditional tobacco use.

According to the Centers for Disease Control and Prevention, roughly 3 million middle and high school students reported using e-cigarettes in 2015.

About 1.6 million students said they had smoked traditional cigarettes, while 1.4 million had smoked a cigar, 1.2 million had used a hookah and 1.1 million chewed, dipped or used some other form of smokeless tobacco.

The research may suggest that vaping serves as a "gateway" to tobacco use, with vapers becoming addicted to nicotine and switching to tobacco, but the correlation is not conclusive, CNA researcher Justin Ladner said.

Still, the findings should raise serious questions about the habit of vaping for military officials seeking to recruit the next generation of troops, he added.

The report recommended that the Pentagon track e-cigarette use among its potential recruits and young enlisted population to understand vaping's effects on health and other lifestyle choices.

"If just a box were added to the DD Form 2807-2, we could track when military recruits come in if they are using e-cigarettes and we could follow these people to see if there is any long-term health effects and we could begin to get a better sense of the level of vaping that is occurring in the military population," Clelan said.

The Food and Drug Administration earlier this year extended its regulatory authority to include electronic cigarettes and devices that deliver nicotine through vaporizers, similar to its control of traditional tobacco products.

Because the products are relatively new, there has been very little research on the long-term health effects of e-cigarettes, although questions have been raised about the chemical content of the liquids used in vapors, with concerns that propylene glycol, a key ingredient, degrades into toxic chemicals like formaldehyde, a carcinogen, when heated.

One thing that is known, however, is that they can pose a safety risk, with a potential for their lithium ion batteries to explode. A dozen incidents resulting in injury to sailors has prompted the Navy Safety Center to recommend banning their use altogether in the fleet.

The CNA researchers noted that while research appears to indicate that e-cigarettes can help adults give up traditional tobacco products, their findings show  this is not the case among youth. They added that more research is needed and the Defense Department could play a significant role in collecting data and distributing educational information about the potential harms of e-cigarettes.

"Our review of the literature makes clear that the potential health effects of vaping are poorly understood by many people and that this lack of knowledge may lead to suboptimal decision-making," they wrote. "Improving education is likely to play a crucial role in maintaining adolescent health, and it is in DOD’s interest to play a leading role in this regard."

Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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