E-cigarette use is differentially related to smoking onset among lower risk adolescents (original) (raw)
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Tobacco Control, 2016
Objective Use of electronic cigarettes (e-cigarettes) is prevalent among adolescents, but there is little knowledge about the consequences of their use. We examined, longitudinally, how e-cigarette use among adolescents is related to subsequent smoking behaviour. Methods Longitudinal school-based survey with a baseline sample of 2338 students (9th and 10th graders, mean age 14.7 years) in Hawaii surveyed in 2013 (time 1, T1) and followed up 1 year later (time 2, T2). We assessed e-cigarette use, tobacco cigarette use, and psychosocial covariates (demographics, parental support and monitoring, and sensation seeking and rebelliousness). Regression analyses including the covariates tested whether e-cigarette use was related to the onset of smoking among youth who had never smoked cigarettes, and to change in smoking frequency among youth who had previously smoked cigarettes. Results Among T1 never-smokers, those who had used e-cigarettes at T1 were more likely to have smoked cigarettes at T2; for a complete-case analysis, adjusted OR=2.87, 95% CI 2.03 to 4.05, p<0.0001. Among ever-smokers at T1, using e-cigarettes was not related to significant change in their frequency of smoking at T2. Uptake of e-cigarette use among T1 never-users of either product was predicted by age, Caucasian or Native Hawaiian (vs Asian-American) ethnicity, lower parental education and parental support, higher rebelliousness, and perception of e-cigarettes as healthier. Conclusions Adolescents who use e-cigarettes are more likely to start smoking cigarettes. This result together with other findings suggests that policies restricting adolescents' access to e-cigarettes may have a rationale from a public health standpoint. BACKGROUND Adolescent use of electronic cigarettes (e-cigarettes) is an emerging public health issue. 1 2 The prevalence for ever use among US high school students increased from 1-3% in 2010-2011 to 10-20% in 2013-2014. 3 4 Similar increases have occurred in European and Asian countries. 5 6 Recent US studies of regional samples have shown prevalence rates in the range from 25% to 29%, 7-9 and e-cigarette use has surpassed cigarette use in some studies. 4 10 These findings have sparked a debate about adolescent e-cigarette use. 1 11-13 E-cigarettes could produce a public health benefit if they help smokers to quit smoking tobacco cigarettes. 12 13 Alternatively, being exposed to e-cigarettes marketing 14-16 and e-cigarette use in smoke-free areas 34
Risk factors for exclusive e-cigarette use and dual e-cigarette use and tobacco use in adolescents
Pediatrics, 2015
To describe electronic cigarette (e-cigarette) use and cigarette use among adolescents and determine whether established risk factors for smoking discriminate user categories. School-based survey of 1941 high school students (mean age 14.6 years) in Hawaii; data collected in 2013. The survey assessed e-cigarette use and cigarette use, alcohol and marijuana use, and psychosocial risk and protective variables (eg, parental support, academic involvement, smoking expectancies, peer smoking, sensation seeking). Analysis of variance and multinomial regression examined variation in risk and protective variables across the following categories of ever-use: e-cigarette only, cigarette only, dual use (use of both products), and nonuser (never used either product). Prevalence for the categories was 17% (e-cigarettes only), 12% (dual use), 3% (cigarettes only), and 68% (nonusers). Dual users and cigarette-only users were highest on risk status (elevated on risk factors and lower on protective f...
E-cigarette use is associated with other tobacco use among US adolescents
International Journal of Public Health, 2018
Objectives-To examine whether tobacco initiation via e-cigarettes increases the likelihood of subsequent tobacco use among a large representative sample of US adolescents. Methods-This study is a retrospective longitudinal analysis from a representative sample of US middle and high school students (n = 39,718) who completed the 2014 and 2015 National Youth Tobacco Survey. The adjusted odds ratios of lifetime and current use of tobacco use were estimated by logistic regression analysis while controlling for important socioecological factors associated with tobacco use. Results-E-cigarette initiators were more likely to report current use of cigarettes (AOR 2.7; 1.9-4.0, p < 0.001), cigars (AOR 1.7; 1.2-2.4, p < 0.01), or smokeless tobacco (AOR 3.1; 2.2-5.4, p < 0.001), and lifetime use of the same products as well. Also, lifetime and current use of ecigarettes significantly increased the likelihood of cigarettes, cigars, and smokeless tobacco use. Conclusions-Initiation of tobacco via e-cigarette, lifetime, and current use of e-cigarettes are associated with higher odds of lifetime and current use of cigarettes, cigars, and smokeless tobacco. Collectively this suggests e-cigarettes may lead to an increased use of tobacco among adolescents.
E-cigarettes, Cigarettes, and the Prevalence of Adolescent Tobacco Use
Pediatrics, 2016
Adolescent e-cigarette use has increased rapidly in recent years, but it is unclear whether e-cigarettes are merely substituting for cigarettes or whether e-cigarettes are being used by those who would not otherwise have smoked. To understand the role of e-cigarettes in overall tobacco product use, we examine prevalence rates from Southern California adolescents over 2 decades. The Children's Health Study is a longitudinal study of cohorts reaching 12th grade in 1995, 1998, 2001, 2004, and 2014. Cohorts were enrolled from entire classrooms in schools in selected communities and followed prospectively through completion of secondary school. Analyses used data from grades 11 and 12 of each cohort (N = 5490). Among 12th-grade students, the combined adjusted prevalence of current cigarette or e-cigarette use in 2014 was 13.7%. This was substantially greater than the 9.0% adjusted prevalence of current cigarette use in 2004, before e-cigarettes were available (P = .003) and only slig...
E-cigarette susceptibility as a predictor of youth initiation of e-cigarettes
Nicotine & Tobacco Research, 2016
Introduction: Identifying youth at risk for future e-cigarette use is critical for informing prevention efforts. Prior research established measures of susceptibility to conventional cigarettes, and this study aimed to examine whether items adapted for e-cigarette susceptibility predicted subsequent e-cigarette use among never e-cigarette users. Methods: Longitudinal school-wide survey data were collected from middle and high school students in Fall 2013 (wave 1) and Spring 2014 (wave 2). Among never e-cigarette users at wave 1 (n = 1720), e-cigarette susceptibility was measured by two items assessing anticipation of experimenting with e-cigarettes in the future and willingness to use an e-cigarette if offered by a best friend. Logistic regression models examined susceptibility as a predictor of e-cigarette initiation and past 30-day use 6 months later at wave 2. Models were clustered by school and controlled for sex, age, race, SES, and other substance use (alcohol, marijuana, and other tobacco). Results: In total, 8.9% (n = 153) of youth initiated e-cigarettes and 3.7% (n = 63) reported past 30-day use at wave 2. E-cigarette susceptibility was a significant independent predictor of subsequent initiation (OR = 4.27, 95% CI = 3.12-5.85) and past 30-day e-cigarette use (OR = 5.10, 95%CI = 3.38-7.68) 6 months later. Susceptible youth were more likely to be male, older, and have used alcohol, marijuana, or other tobacco products. Conclusions: These findings provide initial support for adapting two susceptibility items to identify adolescents at risk for future e-cigarette use. Identifying strategies that are effective for targeting susceptible youth and preventing future e-cigarette use will be critical areas for future research. Implications: More than a quarter of the sample who reported both a willingness to try e-cigarettes if offered by a best friend and anticipation of experimenting with e-cigarettes in the future went on to try e-cigarettes within the academic year, suggesting that targeting this group will be critical for preventing youth e-cigarette initiation. There were notable demographic differences between susceptible and non-susceptible youth, suggesting targeting e-cigarette prevention efforts to male students who have used other substances may be especially important for preventing future e-cigarette use. Research is needed to determine the most effective prevention strategies to reach susceptible youth.
JAMA, 2015
IMPORTANCE Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. OBJECTIVE To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). DESIGN, SETTING, AND PARTICIPANTS Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. EXPOSURE Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. MAIN OUTCOMES AND MEASURES Six-and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). RESULTS Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. CONCLUSIONS AND RELEVANCE Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.
E-cigarette use and willingness to smoke: a sample of adolescent non-smokers
Tobacco control, 2015
There is little evidence on the consequences of using electronic cigarettes (e-cigarette) in adolescence. With a multiethnic sample of non-smokers, we assessed the relation between e-cigarette use and social-cognitive factors that predict smoking of combustible cigarettes. School-based cross-sectional survey of 2309 high school students (mean age 14.7 years). Participants reported on e-cigarette use and cigarette use; on smoking-related cognitions (smoking expectancies, prototypes of smokers) and peer smoker affiliations; and on willingness to smoke cigarettes. Regression analyses conducted for non-cigarette smokers tested the association between e-cigarette use and willingness to smoke cigarettes, controlling for demographics, parenting, academic and social competence, and personality variables. Structural equation modelling (SEM) analysis tested whether the relation between e-cigarette use and willingness to smoke was mediated through any of the three smoking-related variables. No...
Tobacco Use Status and Temptation to Try E-Cigarettes among a Sample of Appalachian Youth
International Journal of Environmental Research and Public Health, 2021
E-cigarettes are commonly used tobacco products among youth populations, including Appalachian youth. However, knowledge of the extent to which tobacco use status relates to temptation to try e-cigarettes is limited. Data from the Youth Appalachian Tobacco Study (n = 1047) were used. Temptation to try e-cigarettes was derived from a 12-item situational inventory. Tobacco use status was defined as never, ever non-e-cigarette, and ever e-cigarette use. A factorial ANOVA was used to estimate the adjusted association between tobacco use status and the e-cigarette use temptation scale. Two-way interaction terms between tobacco use status and gender, and tobacco use status and race/ethnicity, were plotted to depict effect modification. Approximately 10% of youth were ever non-e-cigarette users and 24% were ever e-cigarette users. Never and ever non-e-cigarette user middle schoolers had higher temptation to try e-cigarettes than their high school counterparts. The same relationship was fou...
Frequency of E-cigarette Use, Health Status, and Risk and Protective Health Behaviors in Adolescents
Journal of addiction medicine
E-cigarettes (ECs) are increasingly popular among adolescents, who perceive them as "safer" than cigarettes. Although research has examined risk factors for adolescent EC use, little is known about how EC use correlates with health status and protective health behaviors. In all, 2488 adolescents (mean age = 17.31 years, SD = 0.67; 46% male) completed a survey on EC and cigarette use, physical and mental health, physical activity, diet, sleep, and alcohol and other drug (AOD) use. Logistic regression compared EC-only users to dual EC/cigarette users, cigarette-only users, and nonusers on these health factors. Among EC-only users, separate ordinary least-squares regression models assessed the effects of health status/behavior variables on frequency of past-year EC use, controlling for demographics and smokeless tobacco use. User groups were similar on physical health and engagement in protective health behaviors (physical activity, sleep duration/quality, healthy diet), but ...
Addictive behaviors, 2018
The primary objective of this study was to identify risk factors associated with becoming susceptible to e-cigarette use over the course of a year among e-cigarette-naive adolescents considering a comprehensive model of risk factors (risk perceptions, social influences and norms, affective risk factors, and other behavioral risk factors). Data came from the Texas Adolescent Tobacco and Marketing Surveillance system (TATAMS), a longitudinal cohort study of students who were in the 6th, 8th, and 10th grades (n = 3907) during the 2014-2015 academic year. Weighted generalized linear mixed models assessed multiple predictors' associated with the transition to susceptibility to e-cigarettes at 12 months. Among 6th graders, family influence, use of other substances, and positive affect were important. Adolescents transitioning from 8th grade to high school presented the greatest number of risk factors (e.g., social and normative influences). Only sensation seeking increased the risk of...