Article Text

Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii
  1. Thomas A Wills1,
  2. Rebecca Knight1,
  3. James D Sargent2,
  4. Frederick X Gibbons3,
  5. Ian Pagano1,
  6. Rebecca J Williams4
  1. 1Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
  2. 2Cancer Control Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
  3. 3Department of Psychology, 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, Prevention and Control Program, University of Hawaii Cancer Center, 701 Ilalo Street, 5th floor, Honolulu HI 96813, USA; twills{at}


Objective Use of electronic cigarettes (e-cigarettes) is prevalent among adolescents, but there is little knowledge about the consequences of their use. We examined, longitudinally, how e-cigarette use among adolescents is related to subsequent smoking behaviour.

Methods Longitudinal school-based survey with a baseline sample of 2338 students (9th and 10th graders, mean age 14.7 years) in Hawaii surveyed in 2013 (time 1, T1) and followed up 1 year later (time 2, T2). We assessed e-cigarette use, tobacco cigarette use, and psychosocial covariates (demographics, parental support and monitoring, and sensation seeking and rebelliousness). Regression analyses including the covariates tested whether e-cigarette use was related to the onset of smoking among youth who had never smoked cigarettes, and to change in smoking frequency among youth who had previously smoked cigarettes.

Results Among T1 never-smokers, those who had used e-cigarettes at T1 were more likely to have smoked cigarettes at T2; for a complete-case analysis, adjusted OR=2.87, 95% CI 2.03 to 4.05, p<0.0001. Among ever-smokers at T1, using e-cigarettes was not related to significant change in their frequency of smoking at T2. Uptake of e-cigarette use among T1 never-users of either product was predicted by age, Caucasian or Native Hawaiian (vs Asian-American) ethnicity, lower parental education and parental support, higher rebelliousness, and perception of e-cigarettes as healthier.

Conclusions Adolescents who use e-cigarettes are more likely to start smoking cigarettes. This result together with other findings suggests that policies restricting adolescents’ access to e-cigarettes may have a rationale from a public health standpoint.

  • Electronic nicotine delivery devices
  • Nicotine
  • Public policy

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  • Contributors TAW designed the parent study, analysed the data, wrote the first draft of the manuscript, and coordinated the submission of the final manuscript. RK designed the study of electronic cigarettes, supervised the data collection and reviewed drafts of the manuscript for accuracy and completeness. JDS assisted with the design of the parent study and conceptualisation of the data analysis, and reviewed drafts of manuscript critically for important intellectual content. FXG assisted with the design of the parent study and reviewed drafts of manuscript critically for important intellectual content. IP assisted with performance of the data analysis and reviewed the manuscript critically for appropriateness and completeness of the statistical analyses. RJW assisted with conceptualisation of the manuscript and reviewed drafts of the manuscript critically for important intellectual content.

  • Funding This research was supported by grants R01 CA153154 and P30 071789-16S2 from the National Cancer Institute.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Institutional Review Boards for University of Hawaii and Hawaii Department of Education.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data will be made available to qualified researchers when the study is completed. Data will be posted on a website and requests to use the data will be reviewed by a committee of three co-investigators.