Risky business: a longitudinal study examining cigarette smoking initiation among susceptible and non-susceptible e-cigarette users in Canada

Abstract

ObjectivesGiven that many adolescent e-cigarette users are never-smokers, the possibility that e-cigarettes may act as a gateway to future cigarette smoking has been discussed in various studies. Longitudinal data are needed to explore the pathway between e-cigarette and cigarette use, particularly among different risk groups including susceptible and non-susceptible never-smokers. The objective of this study was to examine whether baseline use of e-cigarettes among a sample of never-smoking youth predicted cigarette smoking initiation over a 2-year period.DesignLongitudinal cohort study.Setting89 high schools across Ontario and Alberta, Canada.ParticipantsA sample of grade 9–11 never-smoking students at baseline (n=9501) who participated in the COMPASS study over 2 years.Primary and secondary outcome measuresParticipants completed in-class questionnaires that assessed smoking susceptibility and smoking initiation.ResultsAmong the baseline sample of non-susceptible never-smokers, 45.2% of current e-cigarette users reported trying a cigarette after 2 years compared with 13.5% of non-current e-cigarette users. Among the baseline sample of susceptible never-smokers, 62.4% of current e-cigarette users reported trying a cigarette after 2 years compared with 36.1% of non-current e-cigarette users. Overall, current e-cigarette users were more likely to try a cigarette 2 years later. This association was stronger among the sample of non-susceptible never-smokers (AOR=5.28, 95% CI 2.81 to 9.94; p<0.0001) compared with susceptible never-smokers (AOR=2.78, 95% CI 1.84 to 4.20; p<0.0001).ConclusionsFindings from this large, longitudinal study support public health concerns that e-cigarette use may contribute to the development of a new population of cigarette smokers. They also support the notion that e-cigarettes are expanding the tobacco market by attracting low-risk youth who would otherwise be unlikely to initiate using cigarettes. Careful consideration will be needed in developing an appropriate regulatory framework that prevents e-cigarette use among youth.

Electronic cigarette marketing and smoking behaviour in adolescence: a cross-sectional study

“…Two mechanisms can be taken into consideration that could explain how exposure to e-cigarette advertisements leads to an increase of tobacco smoking [ 16 ]. One indirect possibility is that through increasing e-cigarette use, the risk for conventional smoking increases [ 11 , 39 ]. There are public health concerns that e-cigarette use may contribute to the development of a new population of cigarette smokers, and act as a “gateway” to future cigarette smoking [ 11 , 39 – 42 ].…”

“…One indirect possibility is that through increasing e-cigarette use, the risk for conventional smoking increases [ 11 , 39 ]. There are public health concerns that e-cigarette use may contribute to the development of a new population of cigarette smokers, and act as a “gateway” to future cigarette smoking [ 11 , 39 – 42 ]. It is not yet fully understood whether e-cigarettes have the potential to cause physical and psychological dependence, but it is assumed that increasing familiarity with nicotine in adolescents used to nicotine consumption might lead to transition to conventional combustible cigarettes because higher doses of nicotine are required to produce the same initial effect [ 11 , 43 ].…”

“…It has become clear that the way that strict regulations for e-cigarette marketing actions are implemented might affect not only adolescent vaping behaviour but also the use of combustible cigarettes, as our results indicate. E-cigarettes are expanding the tobacco market by attracting adolescents who would be unlikely to initiate using cigarettes [ 39 , 47 ]. Hence, e-cigarettes and their advertisements could have the potential to interfere with previous tobacco control efforts, and also increase the renormalisation of smoking.…”

Are e-cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? A time-trend population-based analysis for 2004-2017

“…Some individual-level cohort studies have found a possible causal relationship between prior experience with e-cigarettes and subsequent smoking initiation,18 27–29 including a recent study conducted in Taiwan showing that any e-cigarette use among non-smoking youth at baseline more than doubled the odds that they would initiate cigarette smoking 2 years later 30. Moreover, two Asia-based papers report a significant association between e-cigarette use and heavy smoking among adolescents in Korea31 and Hong Kong 32.…”

E-cigarette Use for Smoking Reduction and Cessation in a Four-year Follow-up Study Among Young Swiss Men: Some may Benefit, but they are Few.

“…There are recent longitudinal studies on the general population. Many looked at the potential for ECs to introduce young people to smoking (42)(43)(44), con rming reviews that ECs expanded the nicotine market by attracting young people who may later use CCs (11,45). A general population study of adults (18+) in the USA by Benharmina et al (38) showed that ECs may increase the likelihood of tobacco abstinence among those attempting to quit.…”