Among 1,134 French college students, cannabis use was one of the strongest predictors of ever trying e-cigarettes (2.44 times higher odds), and nearly half of e-cigarette experimenters had never smoked conventional cigarettes.
Read this if you work in substance use prevention or are interested in how different substance use behaviors cluster together.
Cannabis use increased odds of e-cigarette experimentation 2.44x among college students.
What the researchers found
In a survey of 1,134 French college students, 23% had ever used e-cigarettes and 5.7% were current users. Three findings stand out.
First, cannabis use was strongly associated with ever trying e-cigarettes (AOR = 2.44), alongside cigarette smoking (AOR = 3.97) and occasional binge drinking (AOR = 1.83).
Second, nearly half (45.8%) of those who had ever tried e-cigarettes had never smoked conventional cigarettes, challenging the assumption that e-cigarettes are primarily used by smokers trying to quit.
Third, the profile of ever-users differed sharply from current users. Ever-users showed a pattern of sensation-seeking and experimentation with multiple substances. Current users were almost exclusively smokers using e-cigarettes as a cessation tool (AOR = 14.53 for current smoking).
Why it matters
The strong association between cannabis use and e-cigarette experimentation suggests these behaviors cluster together in a broader pattern of substance exploration. This has implications for prevention: programs targeting e-cigarette use may need to address cannabis and other substance use simultaneously.
The numbers in context
1,134 students, mean age 20.8. E-cigarette ever use: 23%. Current use: 5.7%. Combined cigarette + e-cigarette use: 14.5%. 45.8% of e-cigarette experimenters never smoked. Cannabis use AOR for ever e-cigarette use: 2.44.
How the study worked
Multi-center cross-sectional study conducted on two major campuses in France between October 2014 and February 2015. 1,134 students completed anonymous questionnaires about e-cigarette use, conventional smoking, alcohol, cannabis, sports, and eating disorders.
What this study cannot tell us
Cross-sectional design cannot establish whether cannabis use led to e-cigarette experimentation or vice versa. French college students may have different substance use patterns than students in other countries. Self-reported data may underestimate substance use. The study predates the widespread adoption of pod-based e-cigarettes.
How to read the evidence
Moderate evidence from a multi-center cross-sectional study with a reasonable sample size, though the design cannot establish causation.
When this study was published
Published in 2016. The e-cigarette landscape has changed dramatically since this study, with pod-based systems now dominant.
The bigger picture
The clustering of cannabis, alcohol, and e-cigarette use among college students reflects a broader pattern of substance experimentation during young adulthood. Understanding which substances predict initiation of others can help design more comprehensive prevention strategies.
Questions still open
- Do cannabis users try e-cigarettes as an alternative delivery method for cannabis, or are both driven by a common trait like novelty seeking? Would addressing cannabis use reduce e-cigarette initiation? Has the relationship changed since pod-based e-cigarettes became dominant?
Common questions
Are cannabis users more likely to try e-cigarettes?
Do most e-cigarette users already smoke?
Read the original research
Patterns of electronic cigarette use in current and ever users among college students in France: a cross-sectional study.
BMJ open, 6(5), e011344
Citation
Tavolacci, Marie-Pierre; Vasiliu, Anca; Romo, Lucia; Kotbagi, Gayatri; Kern, Laurence; Ladner, Joël. (2016). Patterns of electronic cigarette use in current and ever users among college students in France: a cross-sectional study.. BMJ open, 6(5), e011344. https://doi.org/10.1136/bmjopen-2016-011344
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