1. Adolescents using e-cigarettes in 11th and 12th grade were 6 times more likely to initiate cigarette use at follow up, after age 18, compared to never e-cigarette users.
2. Those adolescents stating no intention of smoking were more likely to initiate combustible product use (hookah, pipes, cigars) at follow up.
Evidence Rating Level: 2 (Good)
Study Rundown: E-cigarettes have enjoyed a fast-growing market share, with adolescent use increasing rapidly over the past few years. Studies show that greater than 40% of e-cigarette users have never smoked a typical cigarette. This study is the first to explore whether e-cigarette use is associated with increased cigarette use among adolescents over a time period in which they become of legal age to purchase cigarettes. Participants were 11th and 12th grade students in Southern California, who answered survey questions about e-cigarette, cigarette, and other combustible tobacco use, as well as peer use, and intention to try cigarettes. At follow-up, all participants were over the legal age for purchasing cigarettes and were asked about cigarette use. Compared to never e-cigarette users, e-cigarette users were 6 times more likely to initiate cigarette use at follow up. Adolescents who were classified as not susceptible to cigarette use were more likely to be using cigarettes at follow up than those considered susceptible. Finally, e-cigarette users were more likely to also use other combustible tobacco products, such as hookah, pipes or cigars at follow up. This study further supports public policy to limit teen access to e-cigarettes, as well as clinical practice that encourages physicians to educate patients on the dangers of e-cigarette use in young adulthood. While this study supports the danger of using e-cigarettes, generalization is limited by the tight geographic region of the sample.
In-Depth [prospective cohort study]: This study included 11th and 12th graders (mean age 17.4 years) from Southern California participating in the Children’s Health Study. Students were asked about cigarette and e-cigarette use, as well as social and environmental characteristics, such as peer smoking behavior and family dynamics. Participants were categorized based on their answers, to ever e-cigarette users (n= 152) and matched never e-cigarette users (n= 149). Cigarette smokers were not included in the sample. Participants were also categorized based on susceptibility to cigarette use, using their social and environmental information. At follow up (median 15.6 months later), 10.5% of never users and 40.4% of ever users reported cigarette use (OR 6.17, 95% CI 3.30-11.6). Adolescents considered less susceptible to cigarette use at initial evaluation had higher odds of initiating cigarette use compared to those in the susceptible group (OR 9.69, 95% CI 4.02-23.4 and OR 2.12, 95% CI 0.79-5.74, respectively). Compared to never users, e-cigarette users also had higher odds of initiating other combustible tobacco product use at follow up (OR 4.98, 95% CI 2.37-10.4). Specifically, this group had increased odds of initiating hookah (OR 2.86, 95% CI 1.21-6.78), cigars (OR 4.39, 95% CI 1.72-11.2), and pipes (OR 8.21, 95% CI 1.20-56.2).
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