The Rest of the Story

Here, they find a correlation between e-cigarette use and higher and more sustained levels of smoking. But because this is a cross-sectional study, they cannot determine which came first. In other words, what is the direction of the causal relationship? Does the e-cigarette use precede, and cause, the smoking? Or does the smoking precede, and cause, the e-cigarette use?

If we accept that authors' word - that there is no way from this study to exclude the possibility that youths are initiating smoking with conventional cigarettes and then moving on to e-cigarettes - then it follows that these authors are being dishonest in telling the public that the study shows that:

But what is the clinical meaning of this effect? In order to find that out, one needs to conduct studies with longer-term end points.

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