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Combining e-cigarettes with traditional cigarettes puts young adults at greater risk of stroke

New research shows that combining traditional cigarettes with e-cigarettes almost doubles the risk of stroke compared to those who smoke cigarettes alone.

The number of youths and young adults smoking e-cigarettes has steadily increased over recent years as the popularity of the product grows. According to the Centres for Disease Control and Prevention, over 9 million adults in the US currently use e-cigarettes and usage amongst high school students has increased from 12% to 21%.

E-cigarettes have previously been considered a safe way to stop smoking however, scientists continue to learn about the long-term effects of e-cigarettes on health. Nicotine (found in 99% of e-cigarettes in the US) is already known to harm the development of the adolescent brain, which continues to grow and develop until the age of twenty-five. A recent outbreak of lung injuries due to e-cigarette use in the US has prompted the government to look at these products more closely. With information about the dangers of e-cigarettes growing, researchers continue to investigate the long-term effects on health.

A recent study published in The American Journal of Preventative Medicine shows interesting results. Data from over 160,000 participants aged between 18-44 years were analysed to investigate the association between e-cigarette use and the risk of stroke.

Young adults who smoke both e-cigarettes and traditional cigarettes are nearly two times (1.83) as likely to have a stroke compared to those who only smoke cigarettes. This group is also nearly three times as likely to have a stroke compared to non-smokers. To put it simply, the adjusted odds ratios reported in the research show that:

  • If you smoke cigarettes alone you are 1.59 times more likely to have a stroke than a non-smoker.
  • If you have previously smoked traditional cigarettes and switch to e-cigarettes you are 2.54 times more likely to have a stroke compared to a non-smoker.
  • If you smoke a combination of traditional and e-cigarettes you are 2.91 times more likely to have a stroke compared to a non-smoker.

When compared to non-smokers, those who smoke only e-cigarettes and have never smoked a traditional cigarette were found to have no increased risk of stroke. It is thought that this may be due to the young age, better socioeconomic status, and normal cardiovascular health that is often seen in this group. However, if a young adult has any history of smoking cigarettes the risk of stroke is seen to be considerably higher when using e-cigarettes, even compared to those who smoke traditional cigarettes alone.

Although long considered ‘safe’, mounting research describing the detrimental effects of smoking e-cigarettes continues to grow as does the understanding of these products. This highlights the need for continued research into the effect of e-cigarette use and its safety as a choice to support smoking cessation.


Written by Helen Massy, BSc.



Parekh, Tarang et al. (2020). Risk of Stroke With E-Cigarette and Combustible Cigarette Use in Young Adults. American Journal of Preventive Medicine, Published online, January 6, 2020

Centers for Disease Control and Prevention. QuickStats: Age-Adjusted Percentage of Adults Who Had Ever Used an E-cigarette, by Race and Ethnicity — National Health Interview Survey, United States, 2014 and 2018. MMWR Morb Mortal Wkly Rep 2019;68:1102. DOI:

Centers for Disease Control and Prevention. (2020). Quick Facts on the Risks of E-cigarettes for Young People. [online] Available at: [Accessed 13 Jan. 2020]. (2020). Stroke | National Heart, Lung, and Blood Institute (NHLBI). [online] Available at: [Accessed 13 Jan. 2020].

Pew Research Center. (2020). Before recent outbreak, vaping was on the rise in U.S., especially among young people. [online] Available at: [Accessed 13 Jan. 2020].

Image by Hanjörg Scherzer from Pixabay



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