E-cigarette Use and Subsequent Smoking Frequency Among Adolescents

Abstract

Background: E-cigarette use is associated with cigarette initiation among adolescents. However, it is unclear whether e-cigarette use is associated with more frequent cigarette use following initiation. Also, the extent to which cigarette or dual cigarette and e-cigarette users transition to exclusive e-cigarette use or to non-use of either product is not yet known. Methods: Data were pooled from three prospective cohort studies in California and Connecticut (baseline: 2013–2014; follow-up: 2014–2016; N=6258). Polytomous regression models evaluated the association of baseline e-cigarette use (never/ever) with cigarette use frequency at follow-up (experimental: initiation, but no past 30-day use; infrequent: 1–2 of the past 30 days; frequent: 3–5 or more of the past 30 days). Polytomous regression models also evaluated transitions between baseline ever or past 30-day single or dual product use and past 30-day single or dual product use at follow-up. Results: Among baseline never-smokers, e-cigarette users had greater odds of subsequent experimental (OR=4.58; 95% CI: 3.56, 5.88), infrequent (OR=4.27; 95% CI: 2.75, 6.62) or frequent (OR=3.51; 95% CI: 1.97, 6.24) cigarette use; the three OR estimates were not significantly different. Baseline past 30-day exclusive cigarette use was associated with higher odds at follow-up of exclusive cigarette or dual product use, compared with exclusive e-cigarette use. Conclusions and relevance: Tobacco control policy to reduce adolescent use both of e-cigarettes and cigarettes is needed to prevent progression to more frequent tobacco use patterns, and to reduce combustible cigarette use (with or without concurrent e-cigarette use) to lessen the adverse public health impact of e-cigarettes.

Prevalence of tobacco smoking and electronic cigarette use among adolescents in Italy: Global Youth Tobacco Surveys (GYTS), 2010, 2014, 2018

“…Studies from North America and UK showed that ever exclusive vapers were 3-fold more likely than never smokers who did not vape, to subsequently experimenting cigarettes, or becoming current smokers, after adjusting for many confounders. [21][22][23][24][25] On the other hand, other Authors are critical on the causal relationship between vaping and subsequent smoking, reporting that electronic cigarette use and tobacco experimentation have common liability, i.e., exclusive electronic cigarette experimenters would have initiated smoking anyway, because they were already favourably disposed towards tobacco use. [26] Against this hypothesis, in the two English cohort studies, electronic cigarette-only users with firm intention not to smoke and/or those with no smokers among their friendsthat is, young people not thought to be at high risk of smoking -had a greater likelihood of cigarette experimentation.…”

Adolescents' E-Cigarette Use: Increases in Frequency, Dependence, and Nicotine Exposure Over 12 Months

“…E-cigarette use, or vaping, among adolescents has become a public health concern, with 20.9% of high school seniors reporting past-month vaping in 2018 [1], and 900,000 middle and high school students reporting daily or near-daily use [2]. Adolescents' use of e-cigarettes is associated with an increased risk of subsequent cigarette initiation [3] and frequent use [4], an increased risk of nicotine dependence [5], and exposure to potentially toxic chemicals [6e14]. Despite harm reduction claims by e-cigarette companies, in cross-sectional studies, e-cigarette use among adolescent and young adult dual users (i.e., cigarette smokers who also vape) is associated with smoking a greater number of cigarettes per day [15], more frequent smoking [16], and fewer attempts to quit smoking [17].…”

E-cigarette Product Characteristics and Subsequent Frequency of Cigarette Smoking

“…The results were consistent with previous findings also revealing that e-cigarette use in the past 30 days at baseline (versus no use) was associated with greater frequency of smoking at subsequent follow-up. 22,23 In addition, we provide new evidence indicating that the type of device used (mod versus penlike device) is strongly associated with frequency of cigarette smoking at follow-up, whereas other product characteristics (including use of nicotine and use of e-cigarettes for dripping) were not associated with frequency of cigarette smoking.…”

“…E-cigarettes are drawing in at least some low-risk youth unlikely to have otherwise smoked combustible cigarettes, 3,4 and a growing number of studies reveal that among both youth and young adults, e-cigarette users (versus never users) are more likely to (1) subsequently initiate combustible cigarette use 5-21 and (2) follow a trajectory into more regular smoking similar to smokers who did not first use e-cigarettes. 22,23 Yet, it is unclear whether there are e-cigarette product characteristics that may impact these transitions. If so, such characteristics could be prime targets for regulation to reduce the overall adverse public health burden of e-cigarettes in adolescent and young adult populations.…”