@article {Willstobaccocontrol-2016-053116, author = {Thomas A Wills and James D Sargent and Frederick X Gibbons and Ian Pagano and Rebecca Schweitzer}, title = {E-cigarette use is differentially related to smoking onset among lower risk adolescents}, elocation-id = {tobaccocontrol-2016-053116}, year = {2016}, doi = {10.1136/tobaccocontrol-2016-053116}, publisher = {BMJ Publishing Group Ltd}, abstract = {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{\textendash}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.}, issn = {0964-4563}, URL = {https://tobaccocontrol.bmj.com/content/early/2016/08/19/tobaccocontrol-2016-053116}, eprint = {https://tobaccocontrol.bmj.com/content/early/2016/08/19/tobaccocontrol-2016-053116.full.pdf}, journal = {Tobacco Control} }