Electronic cigarette use and uptake of cigarette smoking: A longitudinal examination of U.S. college students
Introduction
Electronic cigarettes (e-cigarettes) are a class of tobacco products that use a heating element to aerosolize a liquid, often containing nicotine, for user inhalation. Despite limited research regarding the health effects associated with acute and long term use of e-cigarettes, these products are rapidly growing in popularity among adolescents (e.g., middle and high school students; Bunnell et al., 2015) and adults (King et al., 2013, McMillen et al., 2015). However, longitudinal use patterns of e-cigarettes are not well understood among college/university students.
Examining e-cigarette use in college populations is important for several reasons. First, approximately half of young adults in the U.S. attend a college or university (U.S. Census Bureau, 2014) and according to the limited data available, e-cigarette use is increasing among college students (Littlefield et al., 2015, Pearson et al., 2012, Regan et al., 2013, Sutfin et al., 2015). Second, college students historically have been at the forefront of substance use trends that ultimately become more prevalent in broader populations (Johnston, O'Malley, Bachman, & Schulenberg, 2009), suggesting that the characteristics of college e-cigarette users of today could be indicative of who may be most likely to use these products in the future. Third, e-cigarettes have become more widely available and accessible nationwide (Lee & Kim, 2014), particularly in retail outlets near college campuses (Wagoner et al., 2014). Lastly, although several longitudinal studies using high school students (Barrington-Trimis et al., 2016, Leventhal et al., 2015, Wills et al., 2016a), one using Hispanic young adults (Unger, Soto, & Leventhal, 2016), and one using an adolescent and young adult sample (Primack, Soneji, Stoolmiller, Fine, & Sargent, 2015) have demonstrated that e-cigarette use is predictive of initiating cigarette smoking, no such studies have examined this association in a large, diverse sample of college students. Given the numerous public health ramifications of e-cigarette use leading to later onset of cigarette smoking (the current leading preventable cause of death in the U.S.; USDHHS, 2014), longitudinal studies are important for informing appropriate regulations for these products. That is, if young adults who use e-cigarettes are in fact more likely to transition to cigarette smoking, accessibility to e-cigarettes may need to be reduced in these populations, possibly by increasing the minimum purchasing age for tobacco products (including e-cigarettes) to 21, as Hawaii and California have already done (Aliferis, 2016).
A better understanding of the factors that are associated with initiation of e-cigarette use may also inform e-cigarette regulation. However, factors predictive of the onset of e-cigarette use are not well understood, despite being examined extensively for conventional cigarettes and other substances. For example, the extent to which numerous factors associated with the uptake of conventional tobacco products such as anxiety and depression (McKenzie et al., 2010, Patton et al., 1998), peer deviance (Brook, Whiteman, Czeisler, Shapiro, & Cohen, 1997), stressful life events (Byrne, Byrne, & Reinhart, 1995), and impulsivity (Mitchell, 1999) also predict the uptake of e-cigarette use has not been explored thoroughly.
The present study examined the extent to which e-cigarette use among never cigarette smokers at time 1 of the study was predictive of cigarette smoking status at time 2 (one year later), while controlling for other relevant variables that independently may predict the uptake of cigarettes. A secondary purpose of this study was to examine if several factors previously predictive of the onset of cigarette smoking (anxiety, depression, peer deviance, stressful life events, impulsivity, and the use of other tobacco products and marijuana) predicted the onset of e-cigarette use among initial never users of either cigarettes or e-cigarettes.
Section snippets
Participants
The sample for the current study was a subset of the Spit for Science (S4S) project, a university-wide longitudinal study aimed at assessing genetic and environmental influences on substance use and emotional health in college students (Dick et al., 2014). This study was approved by the Institutional Review Board (IRB) at Virginia Commonwealth University (VCU). Starting in the fall of 2011, all freshmen aged 18 and older were invited to participate in the S4S project by filling out an online
Overview/cross classification analysis
Among those who initially identified as never users of either e-cigarettes or cigarettes (total = 2163), 7.1% initiated cigarette smoking, 5.7% initiated e-cigarette use, and 3.5% initiated use of both e-cigarettes and cigarettes at time 2. Alternatively, among those who reported ever only trying e-cigarettes at time 1 (total = 153), 24.2% reported having tried cigarettes at time 2. Finally, 29.3% of individuals who initially had only ever tried cigarettes (total = 651) reported uptake of
Discussion
The primary purpose of these longitudinal analyses were to examine the relationship between e-cigarette use at time 1 and the uptake of cigarette smoking at time 2 while controlling for numerous covariates previously demonstrated to be predictive of cigarette smoking. Results demonstrated that initial never smokers who had ever used or were currently using e-cigarettes had a greater probability of having tried cigarettes by time 2. Furthermore, ever use of e-cigarettes at time 1 increased
Role of funding sources
Funding: Spit for Science: The VCU Student Survey has been supported by Virginia Commonwealth University, P20AA107828, R37AA011408, K02AA018755, and P50 AA022537 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and UL1RR031990 from the National Center for Research Resources (NCRR) and National Institutes of Health Roadmap for Medical Research. Research reported in this publication was also supported by the National Institute on Drug Abuse (NIDA) of the National Institutes of
Contributors
Authors Tory Spindle, Marzena Hiler, and Megan Cooke conducted statistical analyses and literature searches and completed the first draft of the manuscript. Danielle Dick and Kenneth Kendler designed the Spit for Science study protocol and are current CO-PI's on the project. Danielle Dick, Kenneth Kendler, and Thomas Eissenberg also contributed to the final draft of the manuscript by providing comments and feedback.
Conflict of interest
The authors have no conflicts of interest to declare.
Acknowledgements
We would like to thank the VCU students for making this study a success, as well as the many VCU faculty, students, and staff who contributed to the design and implementation of the project.
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