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Longitudinal bidirectional association between youth electronic cigarette use and tobacco cigarette smoking initiation in Thailand
  1. Roengrudee Patanavanich1,
  2. Methavee Worawattanakul1,
  3. Stanton Glantz2
  1. 1Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
  2. 2Retired, San Francisco, California, USA
  1. Correspondence to Dr Roengrudee Patanavanich, Department of Community Medicine, Mahidol University Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand; kade.patanavanich{at}gmail.com

Abstract

Introduction This study quantifies the longitudinal association between e-cigarette use and subsequent conventional cigarette initiation and vice versa among Thai youths.

Methods Data from a longitudinal survey of 6045 Thai seventh grade students with baseline in 2019 and the 12-month follow-up in 2020 were analysed using complex survey multivariate logistic regressions to assess whether e-cigarette use was associated with subsequent cigarette smoking (ever, current and dual product users at follow-up) among baseline never smokers.

Results Consistent with prior findings from other countries, among those who had never smoked cigarettes at baseline, ever e-cigarette users were more likely to try cigarette smoking (adjusted OR 4.44; 95% CI 2.23 to 8.86; p<0.001), or become dual users (adjusted OR 5.31; 95% CI 2.63 to 10.74; p<0.001) 1 year later. Baseline current e-cigarette users were more likely to become ever smokers (adjusted OR 5.37; 95% CI 1.82 to 15.90; p=0.005), current smokers (OR 3.92; 95% CI 1.69 to 9.14; p=0.003) and dual product users (adjusted OR 6.96; 95% CI 1.54 to 31.38; p=0.015) at the 12-month follow-up than non-e-cigarette users. Similarly, among never e-cigarette users at baseline, ever cigarette smoking were more likely to try e-cigarettes (adjusted OR 3.38; 95% CI 1.66 to 6.88; p=0.002), currently use e-cigarettes (adjusted OR 2.75; 95% CI 1.47 to 5.13; p=0.003) and currently use both e-cigarettes and cigarettes (adjusted OR 4.87; 95% CI 2.92 to 8.13; p<0.001) at the follow-up than never smokers. Among never e-cigarette users at baseline, current-cigarette smoking were more likely to try e-cigarettes (adjusted OR 6.21; 95% CI 2.58 to 14.95; p<0.001), currently use e-cigarettes (adjusted OR 2.80; 95% CI 1.27 to 6.14; p=0.014) and currently use both e-cigarettes and cigarettes (adjusted OR 7.70; 95% CI 3.45 to 17.19; p<0.001) at the follow-up than never smokers.

Conclusions This longitudinal study in Asian low-income and middle-income countries supports the prospective association of youth e-cigarette use with subsequent smoking initiation and youth cigarette use with subsequent e-cigarette initiation that is similar to that observed in high-income Western countries.

  • electronic nicotine delivery devices
  • low/middle income country
  • addiction

Data availability statement

Data are available on reasonable request. All data used to prepare this paper are available from the cited sources. The Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study dataset can be requested directly from the Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study Cohort in Secondary School Students’ Project, Department of Psychiatry, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.

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Data availability statement

Data are available on reasonable request. All data used to prepare this paper are available from the cited sources. The Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study dataset can be requested directly from the Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study Cohort in Secondary School Students’ Project, Department of Psychiatry, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand.

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Footnotes

  • Twitter @ProfGlantz

  • Contributors RP (guarantor) developed the idea for the study, analysed the data and wrote the first draft of the manuscript. MW assisted with data preparation. SG assisted with revising and refining the analysis and manuscript.

  • Funding This work was supported by the Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand. The funding agencies played no role in study design; collection, analysis, and interpretation of data; writing the report; or the decision to submit for publication.

  • Competing interests SG serves as a consultant to the World Health Organization. The other authors declare that there are no competing interests.

  • 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.