Article Text

PDF
E-cigarette use is differentially related to smoking onset among lower risk adolescents
  1. Thomas A Wills1,
  2. James D Sargent2,
  3. Frederick X Gibbons3,
  4. Ian Pagano1,
  5. Rebecca Schweitzer4
  1. 1University of Hawaii, Cancer Center, Honolulu, Hawaii, USA
  2. 2Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  3. 3Center for Health, Intervention & Prevention, University of Connecticut, Storrs, Connecticut, USA
  4. 4Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, Hawaii, USA
  1. Correspondence to Dr Thomas A Wills, Epidemiology Program, University of Hawaii Cancer Center, 701 Ilalo Street, 5th floor, Honolulu, HI 96813, USA; twills{at}cc.hawaii.edu

Abstract

Objective E-cigarette use has been linked to onset of cigarette smoking among adolescents, but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower versus higher on propensity to smoke.

Methods School-based survey with a longitudinal sample of 1136 students (9th–11th graders, mean age 14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on 3 psychosocial factors known to predict smoking (rebelliousness, parental support and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower versus higher on T1 propensity to smoke.

Results The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR=0.88, p=0.01) indicated a significantly larger effect for smoking onset among lower risk youth.

Conclusions The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower risk adolescents to smoking, which has public health implications.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.