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A December 2017 study by the University of Pittsburgh Schools of the Health Sciences, published in the American Journal of Medicine, found that young adults who use e-cigarettes are more than four times as likely to begin smoking tobacco cigarettes within 18 months as their peers who do not vape

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Almost a quarter of people who use vapes are between 18 and 21

These differences were especially large for the group the researchers called low-health literacy smokerspeople with less education who are less likely to be knowledgeable about the risks of smoking

[189] [190] Economics In the United States, cigarette smoking is estimated to cost the economy more than $96.8 billion a year in lost productivity from premature death, [191] and more than $225 billion a year in smoking-attributable healthcare spending as of 2014 based on data from 20102014