Instead of worrying about banning electronic cigarettes in every park, sidewalk, and beach in the country, anti-smoking groups should get back to the business of trying to reduce smoking: that means focusing on promoting smoke-free workplaces in the states that still don't offer such protection and embracing e-cigarettes as a smoking cessation and harm reduction strategy.

Whether e-cigarette use precedes smoking or smoking precedes e-cigarette use is a critical question, but it is one which needs to be answered through longitudinal research. We need studies that follow the trajectory of teen tobacco/e-cigarette use over time. That is the only way to determine which comes first.

The authors admit this in the paper. They write: "This is a cross-sectional study, which only allows us to identify associations, not causal relationships."

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