Electronic Cigarette Use and Progression from Experimentation to Established Smoking

Abstract

BACKGROUND: It has been shown that never-smoking adolescents who try electronic cigarettes (e-cigarettes) are at increased risk of subsequent conventional cigarette smoking. We evaluated associations between e-cigarette use and progression to established smoking among adolescents who had already tried cigarettes.

METHODS: Among participants (age 12–17 years) in the nationally representative Population Assessment of Tobacco and Health survey who had smoked a cigarette (≥1 puff) but not yet smoked 100 cigarettes (N = 1295), we examined 3 outcomes at 1-year follow-up as a function of baseline e-cigarette use: (1) having smoked ≥100 cigarettes (established smoking), (2) smoking during the past 30 days, and (3) both having smoked ≥100 cigarettes and past 30-day smoking (current established smoking). Survey-weighted multivariable logistic regression models were fitted to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for smoking risk factors.

RESULTS: Versus e-cigarette never use, having ever used e-cigarettes was positively associated with progression to established cigarette smoking (19.3% vs 9.7%), past 30-day smoking (38.8% vs 26.6%), and current established smoking (15.6% vs 7.1%). In adjusted models, e-cigarette ever use positively predicted current established smoking (OR: 1.80; 95% CI: 1.04–3.12) but did not reach statistical significance (α = .05) for established smoking (OR: 1.57; 95% CI: 0.99–2.49) and past 30-day smoking (OR: 1.32; 95% CI: 0.99–1.76).

CONCLUSIONS: Among adolescent cigarette experimenters, using e-cigarettes was positively and independently associated with progression to current established smoking, suggesting that e-cigarettes do not divert from, and may encourage, cigarette smoking in this population.

• Abbreviations:

  CI — 

  confidence interval

  e-cigarette — 

  electronic cigarette

  NYTS — 

  National Youth Tobacco Survey

  OR — 

  odds ratio

  PATH — 

  Population Assessment of Tobacco and Health

What’s Known on This Subject:

In previous studies of youth who have never smoked cigarettes, those who tried electronic cigarettes (e-cigarettes) were more likely to initiate conventional cigarette smoking compared with e-cigarette never users. In cross-sectional studies, e-cigarette use is associated with established youth smoking.

What This Study Adds:

Among youth who already experimented with cigarettes but were not yet established smokers, having used e-cigarettes was prospectively associated with onset of current established cigarette smoking. For these youth, e-cigarettes appear to encourage progression to established smoking.

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