Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check

Abstract

BackgroundThe 2018 National Academies of Sciences, Engineering, and Medicine Report found substantial evidence that electronic cigarette use (vaping) by youth is strongly associated with an increased risk of ever using cigarettes (smoking) and moderately associated with progressing to more established smoking. However, the Report also noted that recent increases in vaping have been associated with declining rates of youth smoking. This paper examines the temporal relationship between vaping and youth smoking using multiple data sets to explore the question of whether vaping promotes smoking initiation in the USA.MethodsUsing publicly available, nationally representative data on smoking and vaping among youth and young adults, we conducted a trend line analysis of deviations from long-term trends in smoking starting from when vaping became more prevalent.ResultsThere was a substantial increase in youth vaping prevalence beginning in about 2014. Time trend analyses showed that the decline in past 30-day smoking prevalence accelerated by two to four times after 2014. Indicators of more established smoking rates, including the proportion of daily smokers among past 30-day smokers, also decreased more rapidly as vaping became more prevalent.ConclusionsThe inverse relationship between vaping and smoking was robust across different data sets for both youth and young adults and for current and more established smoking. While trying electronic cigarettes may causally increase smoking among some youth, the aggregate effect at the population level appears to be negligible given the reduction in smoking initiation during the period of vaping’s ascendance.

Associations of Socioeconomic Status, Parental Smoking and Parental E-Cigarette Use with 10–11-Year-Old Children’s Perceptions of Tobacco Cigarettes and E-Cigarettes: Cross Sectional Analysis of the CHETS Wales 3 Survey

“…Hence, this provides no evidence that smoking was becoming renormalised during this time and suggests that any gateway effects were not having a population level impact on smoking rates. Similar findings have been reported among older adolescents and young adults in the United States (US) [34]. However, newer generation high nicotine devices are gaining popularity among North American youth, while there is some evidence that smoking has also increased [35].…”

Smoking trends in Mexico, 2002–2016: before and after the ratification of the WHO’s Framework Convention on Tobacco Control

“…Nevertheless, it is not clear whether e-cigarette use has kept some people from quitting cigarettes,45 since e-cigarette use is relatively recent and is relatively low among current smokers (4.7%) and former smokers (1.1%). Indeed, the introduction of e-cigarettes has been associated with a decline in youth and young adult smoking prevalence in other countries where e-cigarette use is more prevalent 46. To evaluate how e-cigarettes influence smoking patterns in Mexico, further research is needed, particularly on how lighter smokers use e-cigarettes.…”

Evidence that an intervention weakens the relationship between adolescent electronic cigarette use and tobacco smoking: a 24-month prospective study

“…In contrast, the present study was over 24 months and showed effects for ever smoking, any recent tobacco smoking and regular cigarette smoking (see 15 for similar results). Together, these studies suggest that it is unlikely that the high rates of dual use of e-cigarettes and smoking observed in the US [5][6][7][8] and UK [9][10][11] in cross-sectional surveys of adolescents are entirely attributable to cigarette users subsequently taking up e-cigarettes. In our sample, at follow-up approximately one-third (177/585=30.3%) of those who used both e-cigarettes and cigarettes reported using e-cigarettes first (a further 191/585=32.6% reported using cigarettes first, and the remainder 217/585=37.1% could not remember which they tried first).…”

“…A focus of attention has been on the role of e-cigarettes in smoking initiation. Recent cross-sectional surveys of cohorts in both the USA [5][6][7][8] and UK [9][10][11] have shown that adolescents' rates of ever use of e-cigarettes increased at the same time that rates of cigarette use decreased. In contrast, longitudinal surveys in adolescents show use of e-cigarettes to be associated with subsequent smoking initiation.…”