The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors

Kim, Sooyong; Selya, Arielle

doi:10.1093/ntr/ntz157

Cited by 60 publications

(70 citation statements)

References 41 publications

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“…We rated studies as specific if they adjusted for more than basic demographic factors. In a recent cross-sectional study, accounting for shared risk factors fully explained the relationship between e-cigarette use and current smoking, demonstrating the importance of adjusting for potential confounders such as alcohol and drug use, peer smoking and risk-taking behaviour 33. In addition, some potential confounders, like impulsivity, are difficult to fully capture via self-report and are often assessed relatively crudely.…”

Section: Discussionmentioning

confidence: 99%

Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

Khouja

Suddell

Peters³

et al. 2020

Tob Control

175

119

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ObjectiveThe aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking.Data sourcesPubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.Study selectionAll studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an OR could be calculated were included (excluding reviews and animal studies).Data extractionIndependent extraction was completed by multiple authors using a preprepared extraction form.Data synthesisOf 9199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity (I2=88%).ConclusionsAlthough the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

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Section: Discussionmentioning

confidence: 99%

Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

Khouja

Suddell

Peters³

et al. 2020

Tob Control

175

119

View full text Add to dashboard Cite

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“…The strengths of this paper include the novelty of the counterfactual projections utilized, which offer a valuable contrast to biased analyses [13–15] which dominate this field. Data were taken from sources with large sample sizes and nationally representative weights, producing results generalizable to the US adolescent population.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it has been suggested that ECs may have a causal effect on subsequent conventional cigarette smoking among adolescents [11]. Meta‐analyses [11,12] have associated EC use with future cigarette use in adolescents, but methodological research has shown bias in these effect estimates [13–15], motivating novel analyses.…”

Section: Introductionmentioning

confidence: 99%

“…For example, youth who use ECs are highly similar to those who use conventional cigarettes with respect to a variety of risk factors [22,23]. In fact, shared risk factors largely account for the apparent effect of ECs on conventional smoking among adolescents [13]. Therefore, it remains challenging to isolate the causal effect of ECs on nicotine use patterns among US adolescents.…”

Section: Introductionmentioning

confidence: 99%

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Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018

Foxon

Selya

2020

Addiction

Self Cite

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Background and Aims Recent nicotine use trends raise concerns that electronic cigarettes (ECs) may act as a gateway to cigarettes among adolescents. The aims of this study were to examine prevalence trends of exclusive EC use, exclusive cigarette use and dual use to determine the corresponding ages of initiation and to investigate hypothetical trends in total nicotine use and cigarette use in the absence of ECs among US adolescents. Design Observational study using data from the National Youth Tobacco Survey (NYTS) to statistically model trends in the prevalences of each user group and their initiation ages. Projections from counterfactual models based on data from 1999 to 2009 (before EC introduction) were compared with actual trends based on data from 1999 to 2018. Rigorous error analyses were applied, including Theil proportions. Setting USA. Participants and measurements Adolescents aged 12–17 years who were established exclusive cigarette users (≥ 100 cigarettes smoked and ≤ 100 days vaped), established exclusive EC users (< 100 cigarettes smoked and > 100 days vaped) and established dual users (≥ 100 cigarettes smoked and > 100 days vaped), based on cumulative life‐time exposure (n ≈ 12 500–31 000 per wave). Findings Exclusive cigarette use prevalence declined from 1999 to 2018, while exclusive EC use and dual use prevalences increased since their introduction in 2009. The age of cigarette initiation began a slight increase after 2014, whereas the age for EC use remained approximately constant and was higher than that of cigarettes. The counterfactual comparison results were consistent with ECs not increasing the number of US adolescent nicotine users, and in fact diverting adolescents from cigarettes. Conclusions Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk.

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“…On the other hand, e-cigarette use among adolescents and/or novice users remains controversial, due to fears of a "gateway" effect whereby e-cigarettes cause youth to become nicotine-dependent and increase their risk of later conventional cigarette smoking (21). However, given recent research supporting a common-liability hypothesis which postulates that the apparent relationship between e-cigarette use and smoking is attributable to a pre-existing liability for nicotine use (23,24), the question of primary prevention becomes relevant (27). That is, for youth who have a propensity to use a nicotine product, it is important to direct them to a less harmful product.…”

Section: Discussionmentioning

confidence: 99%

Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

Selya¹

2020

Preprint

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Abstract Background: Electronic cigarettes (“e-cigarettes”) have altered nicotine use trends, and their impacts are controversial. Given their reduced risk profile relative to conventional cigarettes, e-cigarettes have potential for harm reduction. The current study presents a simulation-based analysis of an e-cigarette harm reduction policy. Methods: A system dynamics simulation model was constructed, with separate aging chains for cigarette smokers and e-cigarette users. These structures work together with a policy module to close the gap between actual (simulated) and a goal number of cigarette smokers, chosen to reduce the nicotine-attributable death rate to the accidental death rate. The policy is two-fold, first removing existing regulations on e-cigarettes (e.g. flavor bans) and second providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing smoking behavior and thus progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the nicotine-related mortality accordingly with an increase in nicotine users due to e-cigarettes.Results: The base-case model replicated the historical exponential decline in conventional cigarette smoking and the exponential increase in e-cigarette use since their introduction circa 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Policy scenarios that included realistic, practical obstacles to implementation delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the same time point in the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.

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The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors

Cited by 60 publications

References 41 publications

Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis

Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018

Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

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