Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence

Abstract

IMPORTANCE Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco.OBJECTIVE To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). DESIGN, SETTING, AND PARTICIPANTSLongitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. EXPOSURE Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. MAIN OUTCOMES AND MEASURESSix-and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3).RESULTS Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI,) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI,), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI,) averaged across the 2 follow-up periods.CONCLUSIONS AND RELEVANCE Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.

Exposure to Advertisements and Electronic Cigarette Use Among US Middle and High School Students

“…For example, a longitudinal study of 14-year-old adolescents found that e-cigarette users who did not use combustible tobacco at baseline were more likely to initiate combustible tobacco use at 1-year follow-up. 22 Similar results were observed in another longitudinal cohort study in US adolescents and young adults, in which the use of e-cigarettes at baseline was associated with progression to traditional cigarette smoking. 23 This evidence suggests the importance of public health strategies to address tobacco advertising exposure among youth.…”

Use and Perceived Risk of Electronic Cigarettes Among North Carolina Middle and High School Students

“…Other recent studies of adolescent populations in California [5,11], Connecticut [22], and Florida [23] demonstrate similarly escalating use of e-cigarettes, which has eclipsed the use of combustible cigarettes among school-aged youth. Additionally, the high prevalence of e-cigarette use in our study sample may reflect the fact that historically North Carolina adolescents have consistently used tobacco products at rates higher than the national average [17,24,25].…”

“…Students reported their sex, race (white, African American, Asian, other), ethnicity (Hispanic, non-Hispanic), and grade (6)(7)(8)(9)(10)(11)(12).…”

Another Article About E‐Cigarettes: Why Should I Care?

“…In theory, a product that can deliver nicotine like a cigarette without the toxins found in smoke could be used instead of cigarettes would be a welcome invention 5, 6, 7. However, concerns have been raised about whether e‐cigarettes are an effective cessation aid or if they would actually reduce successful quitting by adult smokers, whether they are safe to use, and if they may be a gateway into smoking for youth 8, 9, 10. Most recently the popularity of the Juul e‐cigarette among high school and college students who have no intention of smoking has raised concerns about the risk of nicotine addiction in non‐smokers and its long‐term health effects 11…”