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A meta-analysis showed that among adolescent and young adult never-smokers, e-cigarette use was associated with increased odds of initiation of combustible cigarette smoking (odds ratio [OR] 3.50, 95% CI, 2.38-5.16, P = 0.03).[15] Another study showed similar results (adjusted OR [aOR] 6.8, 95% CI, 1.65-28.25).[16] This association was further supported by Azagba and colleagues,[17] who used data from the 201617 CSTADS to demonstrate that Canadian students who used an e-cigarette for more than 21 of the past 30 days had increased odds of both trying combustible cigarettes (aOR 4.83, 95% CI, 3.33-7.01) and smoking regularly (aOR 3.39, 95% CI, 2.16-5.34)

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An inability to quit smoking despite repeated attempts

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