Does E-Cigarette Use Lead to Combustible Tobacco Product Use in Adolescents?

August 18, 2015

Does E-Cigarette Use Lead to Combustible Tobacco Product Use in Adolescents?

  1. Alain Joffe, MD, MPH, FAAP

Among ninth graders who did not use combustible tobacco products, e-cigarette use was associated with increased risks for smoking combustible cigarettes, cigars, and hookah during the subsequent year.

  1. Alain Joffe, MD, MPH, FAAP

An estimated 16% of U.S. tenth graders have tried e-cigarettes, of whom 43% have never smoked combustible cigarettes. To determine whether use of e-cigarettes during adolescence increases the likelihood of subsequently using combustible tobacco products (cigarette, cigar, or hookah), investigators analyzed data from a longitudinal study of high school students surveyed in the fall of ninth grade (baseline) and then 6 and 12 months later.

Of 2530 students who had never used combustible tobacco control products at baseline (mean age, 14 years; 53% female; 19% Asian, 44% Hispanic, 16% white), 222 (9%) had used e-cigarettes. At each follow-up period, e-cigarette users at baseline were more likely than nonusers to begin using any combustible tobacco product during the previous 6-month period (31% vs. 8% at 6 months; 25% vs. 9% at 12 months). Adjustment for peer smoking, impulsivity, any previous use of non-nicotine and non-tobacco substances, delinquent behavior, and smoking expectancies — but not for socioeconomic status or other psychosocial variables — attenuated but did not eliminate the significant relationship between baseline e-cigarette use and transition to using combustible cigarettes (adjusted odds ratio, 1.75), cigars (AOR, 2.96), or hookah (AOR, 2.26). Baseline use of cigarettes or hookah but not cigars was associated with e-cigarette initiation across follow-up periods in fully adjusted models.

Comment

This well-executed study provides strong evidence that use of e-cigarettes is prospectively associated with uptake of combustible tobacco product use among ninth graders. Although the authors controlled for numerous key variables related to both e-cigarette use and combustible tobacco product use, the possibility of unknown confounding remains. It would be interesting to know what variables were protective for the 70% of baseline e-cigarette users who did not initiate combustible tobacco product use during the following year.

Editor Disclosures at Time of Publication

  • Disclosures for Alain Joffe, MD, MPH, FAAP at time of publication Grant / Research support Consolidated Health Plans Editorial boards Adolescent Medicine: State of the Art Reviews; JAMA Pediatrics; Neinstein’s Textbook of Adolescent and Young Adult Health Care, Associate Editor

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