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E-cigarette use among early adolescent tobacco cigarette smokers: testing the disruption and entrenchment hypotheses in two longitudinal cohorts
  1. Brian C Kelly1,
  2. Mike Vuolo2,
  3. Jennifer Maggs3,
  4. Jeremy Staff4
  1. 1 Sociology, Purdue University, West Lafayette, Indiana, USA
  2. 2 Sociology, Ohio State University, Columbus, Ohio, USA
  3. 3 Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania, USA
  4. 4 Sociology and Criminology, Pennsylvania State University, University Park, Pennsylvania, USA
  1. Correspondence to Dr Jeremy Staff, Sociology and Criminology, Pennsylvania State University, University Park, PA 16802, USA; jus25{at}psu.edu

Abstract

Objective Using longitudinal data from two large-scale cohorts in the UK and USA, we examine whether e-cigarette use steers adolescent early smokers away from tobacco cigarettes (disruption hypothesis) or deepens early patterns of tobacco smoking (entrenchment hypothesis) in comparison with early smokers who do not use e-cigarettes.

Methods Youth who smoked tobacco cigarettes by early adolescence (before age 15) were selected from the ongoing UK Millennium Cohort Study (n=1090) and the US Population Assessment of Tobacco and Health (n=803) study. In regression models, the focal predictor was lifetime use of an e-cigarette by early adolescence and the primary outcome was current tobacco use by late adolescence (before age 18). Logistic and multinomial models controlled for early adolescent risk factors and sociodemographic background, and were weighted for attrition and adjusted for complex survey designs.

Results Among youth who were early cigarette smokers, 57% of UK and 58% of US youth also used e-cigarettes. The odds of later adolescent smoking among early smoking youth were significantly higher among e-cigarette users relative to those who had not used e-cigarettes (adjusted OR (AORUK)=1.45; AORUSA=2.19). In both samples, multinomial models indicated that early smoking youth who used e-cigarettes were more likely to be frequent smokers relative to not smoking (AORUK=2.01; AORUSA=5.11) and infrequent smoking (AORUK=1.67; AORUSA=2.11).

Conclusions Despite national differences in e-cigarette regulation and marketing, there is evidence e-cigarette use among early adolescent smokers in the UK and USA leads to higher odds of any smoking and more frequent tobacco cigarette use later in adolescence.

  • co-substance use
  • electronic nicotine delivery devices
  • priority/special populations

Data availability statement

Data are available upon reasonable request. Data used for these analyses are available to scholars by request from the organisations that oversee the MCS and PATH data sets.

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Data availability statement

Data are available upon reasonable request. Data used for these analyses are available to scholars by request from the organisations that oversee the MCS and PATH data sets.

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Footnotes

  • Contributors BCK led the conception, design, interpretation, drafting and revision of the work. MV contributed to the conception, design, interpretation, drafting and revision of the work. JM contributed to the conception, design, interpretation and revision of the work. JS led the analysis and contributed to the conception, design, interpretation, drafting and revision of the work. BCK is the guarantor. All authors approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This work was supported by the National Institute on Drug Abuse (Grant No R01DA054234; PI: BCK). This research is based on analyses of data from the UK Millennium Cohort Study (MCS), which received core funding from the Economic and Social Research Council UK (ESRC) and a consortium of UK government departments, as well as the Population Assessment of Tobacco and Health, which received funding from the USA by the National Institutes of Health (NIH) and the Food and Drug Administration (FDA).

  • 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.