{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:27:06Z","timestamp":1787790426372,"version":"build-2784847793"},"posted":{"date-parts":[[2025,3,5]]},"group-title":"Public and Global Health","reference-count":11,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T00:00:00Z","timestamp":1741132800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2025,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>The prevalence of e-cigarette use in adolescents is concerning, particularly because of high rates of vapers transitioning to combustible tobacco. It is unclear why young, never smoker, e-cigarette vapers decide to start smoking cigarettes, but the transition may be influenced by perceptions of health risks and accessibility. We designed a social media questionnaire to assess factors driving switches from vaping to smoking, smoking to vaping, and multi-inhalant use. Among respondents (n=864) who switched from vaping to smoking (n=104), primary reasons included: 1. perception that smoking was healthier (44%); and 2. greater accessibility of cigarettes (40%). For switchers from smoking to vaping (n=178), predominant motivations included: 1. having friends or family who vape (40%); and 2. perception that vaping was healthier (36%). Among multi-inhalant users (n=223), key factors driving this behavior included: 1. increased enjoyment (47%); and 2. greater variety (42%). Our findings imply that there is no single, dominant reason driving switching from vaping to smoking. Further, tobacco users are receiving mixed messaging, leading many to believe that combustible tobacco is the healthier option. Public health interventions are needed to prevent initiation of e-cigarette vaping by youth and education of the public about health effects across tobacco products.<\/jats:p>","DOI":"10.1101\/2025.03.04.25323341","type":"posted-content","created":{"date-parts":[[2025,3,5]],"date-time":"2025-03-05T13:30:17Z","timestamp":1741181417000},"source":"Crossref","is-referenced-by-count":2,"title":["Factors driving switching from vaping of e-cigarettes to smoking tobacco and initiation of multi-inhalant use"],"prefix":"10.64898","author":[{"given":"Enny","family":"Banjo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoya","family":"Ahadian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita","family":"Kasaraneni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarala","family":"Perera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Emory","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5091-2660","authenticated-orcid":false,"given":"Laura E.","family":"Crotty Alexander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"issue":"8","key":"2025030712101040000_2025.03.04.25323341v1.1","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jamapediatrics.2017.1488","article-title":"Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis","volume":"171","year":"2017","journal-title":"JAMA Pediatr"},{"key":"2025030712101040000_2025.03.04.25323341v1.2","doi-asserted-by":"crossref","unstructured":"Zhong, J. ; Cao, S. ; Gong, W. ; Fei, F. ; Wang, M. , Electronic Cigarettes Use and Intention to Cigarette Smoking among Never-Smoking Adolescents and Young Adults: A Meta-Analysis. Int J Environ Res Public Health 2016, 13, (5).","DOI":"10.3390\/ijerph13050465"},{"key":"2025030712101040000_2025.03.04.25323341v1.3","doi-asserted-by":"crossref","unstructured":"Islam, T. ; Eckel, S. ; Liu, F. ; Barrington-Trimis, J. ; Harlow, A. F. ; Benowitz, N. ; Leventhal, A. ; McConnell, R. ; Cho, J. , Effects of dual use of e-cigarette and cannabis during adolescence on cigarette use in young adulthood. Tob Control 2023.","DOI":"10.1136\/tc-2022-057542"},{"key":"2025030712101040000_2025.03.04.25323341v1.4","doi-asserted-by":"crossref","unstructured":"Pisinger, C. ; Rasmussen, S. K. B. , The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review. Int J Environ Res Public Health 2022, 19, (20).","DOI":"10.3390\/ijerph192013687"},{"key":"2025030712101040000_2025.03.04.25323341v1.5","doi-asserted-by":"crossref","unstructured":"Gunge, D. ; Marganski, J. ; Advani, I. ; Boddu, S. ; Chen, Y. J. E. ; Mehta, S. ; Merz, W. ; Fuentes, A. L. ; Malhotra, A. ; Banks, S. J. ; Crotty Alexander, L. E. , Deleterious Association of Inhalant Use on Sleep Quality during the COVID-19 Pandemic. Int J Environ Res Public Health 2021, 18, (24).","DOI":"10.3390\/ijerph182413203"},{"issue":"11","key":"2025030712101040000_2025.03.04.25323341v1.6","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1164\/rccm.201904-0890LE","article-title":"Use of Electronic Cigarettes with Conventional Tobacco Is Associated with Decreased Sleep Quality in Women","volume":"200","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"2025030712101040000_2025.03.04.25323341v1.7","doi-asserted-by":"crossref","first-page":"2536","DOI":"10.1038\/s41598-022-06445-8","article-title":"Dual use of e-cigarettes with conventional tobacco is associated with increased sleep latency in cross-sectional Study","volume":"12","year":"2022","journal-title":"Sci Rep"},{"key":"2025030712101040000_2025.03.04.25323341v1.8","unstructured":"Environment., D. o. P. H. , Healthy Kids Colorado Survey information. 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