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Association between e-cigarette use initiated after cigarette smoking and smoking abstinence: a cross-sectional study among adolescent established smokers in the USA
  1. Franziska S Saller1,
  2. Israel T Agaku2,
  3. Filippos T Filippidis1
  1. 1 Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
  2. 2 Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
  1. Correspondence to Franziska S Saller, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK; f.saller{at}


Background Recent years have seen a rapid increase in the popularity of electronic cigarettes (e-cigarettes) among adolescents in the USA. Evidence on their role in the continuation of or abstinence from cigarette smoking among young smokers remains scarce.

Objective To examine the relationship between e-cigarette use initiated after cigarette smoking and abstinence from cigarette smoking among US adolescent established smokers.

Methods The data were drawn from the 2015–2018 National Youth Tobacco Survey—a nationally representative survey of US middle and high school students. Multivariable logistic regression was used to assess the association between ever e-cigarette use and past 30-day abstinence from cigarette smoking. The analytical sample comprised ever established cigarette smokers with or without a history of e-cigarette use after smoking initiation.

Results Neither experimental (adjusted OR 0.67, 95% CI 0.39–1.14) nor prior established (adjusted OR 1.56, 95% CI 0.96–2.56) nor current established (adjusted OR 0.65, 95% CI 0.41–1.03) e-cigarette use was statistically significantly associated with subsequent abstinence from cigarette smoking among adolescent ever established smokers. These findings were largely consistent across sensitivity analyses using alternative key definitions, although experimental and current established e-cigarette use was significantly negatively associated with past 6-month abstinence.

Conclusions We found no evidence that e-cigarette use among US adolescents already smoking cigarettes is associated with subsequent abstinence from cigarette smoking; there was some evidence of an inverse association among experimental and current established e-cigarette users. These findings could inform future regulatory and public health efforts regarding youth e-cigarette use and the reduction of youth cigarette smoking in the USA.

  • electronic nicotine delivery devices
  • priority/special populations
  • non-cigarette tobacco products

Data availability statement

Data are available in a public, open access repository at

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  • Contributors FSS, ITA and FTF developed the initial research concept and design. FSS conducted all statistical analyses with the support of ITA and FTF. FSS drafted the manuscript. ITA and FTF have reviewed and edited the manuscript. All authors contributed to data interpretation and have approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.