E-cigarette use is differentially related to smoking onset among lower risk adolescents

Abstract

Objective E-cigarette use has been linked to onset of cigarette smoking among adolescents but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower vs. higher on propensity to smoke. Methods School-based survey with a longitudinal sample of 1,136 students (9th – 11th graders, mean age 14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on three psychosocial factors known to predict smoking (rebelliousness, parental support, and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower vs. higher on T1 propensity to smoke. Results The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR = 0.88, p = .01) indicated a significantly larger effect for smoking onset among lower-risk youth. Conclusions The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower-risk adolescents to smoking, which has public health implications.

We Agree on the Importance of Contextual and Temporal Accuracy When Studying Novel Tobacco Products

“…This analysis concluded, consistent with earlier smaller longitudinal studies, 5,6 that e-cigarette-only users had risk profiles that made them unlikely to initiate tobacco product use with cigarettes.…”

E-cigarettes and National Adolescent Cigarette Use: 2004–2014

“…14 –18 Never-smoking low-risk youth who use e-cigarettes may be more likely to go on to initiate cigarette smoking compared with never-smoking low-risk youth who are not using e-cigarettes. 39 Two cross-sectional studies in youth 40, 41 indicate that, like adults, 42 youth smokers who are using e-cigarettes want to quit but are less likely to be former smokers. Many e-cigarette users also smoke cigarettes, 43 but this fact does not change the finding that e-cigarettes appear to be attracting some low-risk youth.…”

E-Cigarettes and Adolescents’ Risk Status

“…7 -10 Moreover, recent research with different designs has shown that e-cigarettes are most strongly related to smoking onset among lower-risk adolescents, thus specifically contradicting the confounding hypothesis. 9,12 Data from Demissie et al 3 do raise the possibility of an underlying vulnerability (not previously measured) that produces both e-cigarette use and smoking. As the authors discuss, the risk behaviors they assessed could derive from rejection of conventional social norms 13 or from activation of common neural pathways by nicotine, 14 and such hypotheses need to be tested.…”