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E-cigarette use and willingness to smoke: a sample of adolescent non-smokers
  1. Thomas A Wills1,
  2. James D Sargent2,
  3. Rebecca Knight1,
  4. Ian Pagano1,
  5. Frederick X Gibbons3
  1. 1Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii USA
  2. 2Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
  3. 3Department of Psychology, University of Connecticut, Storrs, Connecticut, USA
  1. Correspondence to Dr Thomas A Wills, Prevention and Control Program, University of Hawaii Cancer Center, 701 Ilalo Street, Room 528, Honolulu, HI 96813, USA; twills{at}cc.hawaii.edu.

Abstract

Objective 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.

Methods 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.

Results Non-smokers who had used e-cigarettes (18% of the total sample) showed more willingness to smoke cigarettes compared with those who had never used any tobacco product; the adjusted OR was 2.35 (95% CI 1.73 to 3.19). SEM showed that the relation between e-cigarette use and willingness to smoke was partly mediated through more positive expectancies about smoking, but there was also a direct path from e-cigarette use to willingness.

Conclusions Among adolescent non-smokers, e-cigarette use is associated with willingness to smoke, a predictor of future cigarette smoking. The results suggest that use of e-cigarettes by adolescents is not without attitudinal risk for cigarette smoking. These findings have implications for formulation of policy about access to e-cigarettes by adolescents.

  • Addiction
  • Electronic nicotine delivery devices
  • Public policy

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