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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. 1 University of Hawaii, Cancer Center, Honolulu, Hawaii, USA
  2. 2 Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
  3. 3 Center for Health, Intervention & Prevention, University of Connecticut, Storrs, Connecticut, USA
  4. 4 Office 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}


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.

  • Electronic nicotine delivery devices
  • Priority/special populations
  • Addiction

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