Initiation Sequence of E‐Cigarette and Cigarette Smoking Among US Adolescents: A National Study

Abstract

Background and Objectives: The primary objectives were to: (1) examine the initiation sequence of e-cigarette use and cigarette smoking; (2) assess other substance use as a function of the initiation sequence of e-cigarettes and cigarettes; and (3) investigate the role of early e-cigarette initiation among US secondary school students. Methods: Data were collected via self-administered questionnaires from independent 2015 and 2016 nationally representative cross-sectional samples of 8th grade, 10th grade, and 12th grade students (N = 36 410). Results: The lifetime initiation sequence included: (1) e-cigarette use before cigarette smoking (1.7%); (2) e-cigarette use and cigarette smoking in same grade (4.2%); (3) cigarette smoking before e-cigarette use (6.1%); (4) e-cigarette use only (12.6%); (5) cigarette smoking only (3.6%); and (6) no e-cigarette use or cigarette smoking (71.8%). The risk of substance use was highest among dual users (regardless of initiation sequence), followed by cigarette smokers, e-cigarette users, and no e-cigarette use or cigarette smoking. The most prevalent initiation sequence of e-cigarette use involved initiating other substances before e-cigarettes, especially among older adolescents. Early initiation of e-cigarette use was associated with increased odds of substance use behaviors for all three age groups. Discussion and Conclusions: Adolescents who report a history of both e-cigarette use and cigarette smoking should be considered at high risk for substance-related problems. Early initiation of e-cigarette use is a signal for other substance use. Scientific Significance: Youth substance use prevention programs and prospective studies must take into account polysubstance use when addressing the relationships between e-cigarette use and cigarette smoking.

Initiation Patterns and Trends of E-Cigarette and Cigarette Use Among U.S. Adolescents

“…One study found that among those who had initiated both cigarette and e-cigarette use, most initiated cigarette use before e-cigarette use. The same study also showed that the initiation pattern of e-cigarettes/cigarettes differentiates risk of other substance use among 12th graders [17]. Another study found that most e-cigarette users had initiated other substances, including cigarette use, before initiation of e-cigarettes [18].…”

Prospective associations of e-cigarette use with cigarette, alcohol, marijuana, and nonmedical prescription drug use among US adolescents

“…Because the longitudinal MTF study first assesses individuals at age 18 when many individuals have already initiated alcohol use, we were unable to assess individuals who initiate alcohol at earlier ages. Previous research examining the order of initiation of substances found the most prevalent initiation sequence of e-cigarette use involved initiating other substances before e-cigarettes (McCabe et al, 2019), and that most current e-cigarette users had a history of alcohol or other substance use (Gilbert et al, 2020). Additionally, a prospective study of younger adolescents aged 12-17 found an association of e-cigarette use with subsequent alcohol use (Silveira et al, 2018).…”

Vaping-Related Acute Parenchymal Lung Injury

“…3,4 For the last five years, vaping prevalence has increased steadily such that vaping has surpassed cigarettes as the most common way to consume nicotine among youth, and presently one quarter of high school seniors are regularly vaping. [5][6][7] Originally patented by a pharmacist in China in 2003, vaping has gained in popularity internationally, and there has been an exponential growth in the number of devices, brands, and flavors on the market. 8,9 Vaping was introduced to the US markets in 2007 but only recently has there been increasing interest among public health groups and medical professionals as to the potential health effects of vaped products.…”