Adolescent Electronic Cigarette Use: Associations With Conventional Cigarette and Hookah Smoking

doi:10.1016/j.amepre.2015.02.013

American Journal of Preventive Medicine

Volume 49, Issue 2, August 2015, Pages 199-206

https://doi.org/10.1016/j.amepre.2015.02.013 Get rights and content

Introduction

The emerging trends and rapid growth of electronic cigarettes (e-cigarettes) among adolescents are being monitored closely. The trends are critical as policy to prevent uptake among adolescents is considered. The purpose of this study is to describe the prevalence of e-cigarette use and potential correlates for use. Associations between e-cigarettes, cigarettes, and hookah are assessed.

Methods

This study used data from the 2013 Florida Youth Tobacco Survey. Prevalence estimates were calculated in 2014 and differences were determined based on CIs. Adjusted logistic regression models were used to identify correlates of e-cigarette use among participants based on demographic and other tobacco products used.

Results

There were no sex differences in middle school, whereas male high school students reported higher use than their female counterparts. Cigarette smoking and hookah use were significantly associated with ever and current e-cigarette use among both middle and high school students.

Conclusions

Although e-cigarettes are being assessed as a potential replacement product for traditional tobacco, evidence from this study indicates the possibility of multiple product use among adolescents. E-cigarettes are not only associated with traditional cigarettes, but also with hookahs, a similar emerging product that offer tobacco flavors that may appeal to adolescents. Notably, many e-cigarette users also reported no cigarette or hookah use.

Introduction

Findings from the 2012 National Youth Tobacco Survey (NYTS) were recently released in a special issue of this journal.¹ For the non-conventional tobacco products, ever electronic cigarette (e-cigarette) use (6.8%) was less prevalent compared to hookah use (8.9%), but more youth were aware of e-cigarettes (50.3%) compared to hookahs (41.2%).² Corey et al.³ reported that the percentage of high school students who had tried e-cigarettes rose from 4.7% in 2011 to 10.0% in 2012.³ Similarly, current use of e-cigarettes rose from 1.5% in 2011 to 2.8% in 2012.³

Although national rates are imperative in understanding the current state of tobacco use, state surveys are also important given the differences in policies, enforcement, and general culture of tobacco use among youth populations. In 2012, the Florida Youth Tobacco Survey (FYTS)⁴ reported that 8.4% of high school students had tried e-cigarettes, which represents a 40% increase since 2011 (6.0%). Similarly, current use of e-cigarettes by high school students was 3.5%, an increase from 3.1% in 2011,⁴ which was higher than the national level.

The prevalence of e-cigarette use among middle school students is lower than that among high school students; however, the increasing trend is the same. According to the NYTS, ever use of e-cigarettes among middle school students increased from 1.4% in 2011 to 2.7% in 2012,³ and current e-cigarette use increased from 0.6% in 2011 to 1.1% in 2012. In Florida, middle school students’ ever use of e-cigarettes increased from 3.0% in 2011 to 3.9% in 2012, representing a 30% increase, whereas current e-cigarette prevalence increased from 1.5% to 1.8%,⁴ representing a 20% increase, both higher than national rates.

Concerns with increasing e-cigarette use among youth are not only the risk for nicotine addiction, but also the potential initiation of other tobacco products, including but not limited to conventional cigarettes and hookahs. Dutra and Glantz⁵ reported from the 2011 and 2012 NYTS that ever e-cigarette use was positively associated with ever and current conventional cigarette use. Not only was e-cigarette use associated with experimental cigarette use, but e-cigarette users also had higher odds of established smoking and lower odds of smoking abstinence. Given this finding, it appears that e-cigarettes may be used in conjunction with other tobacco products, establishing a pattern of dual product use among youth rather than product substitution.

The purpose of this study is to estimate the 2013 prevalence of e-cigarette use and associated factors among Florida youth. Demographic correlates of e-cigarette use are assessed, as well as the relationship between e-cigarette and cigarette or hookah use. Hookah use is important to assess because it is an alternative tobacco product, currently less regulated than cigarettes in the U.S., and appealing to youth for its flavors, all similarities with e-cigarettes. Hookah use has been shown to be increasing in the state of Florida⁶ and e-cigarette use prevalence needs to be monitored to assess whether it is following the same pattern.

Section snippets

Study Sample

This study used data from the 2013 FYTS.⁷ The FYTS is a statewide, anonymous, self-completed, school-based paper survey that has been administered annually to a random sample of Florida public middle and high school students since 1998. The FYTS used a two-stage cluster probability sample design. First, a random sample of public middle schools and high schools (grades 6–12) was selected for participation in the survey. Second, within each selected school, a random sample of classrooms was

Results

Weighted to represent the Florida public school student population, slightly more than half (51.0%) of the sample included male students; 48.9% of students were in middle school and 51.1% were in high school. Overall, in terms of race/ethnicity, the sample was weighted to represent 27.6% Hispanics, 44.0% non-Hispanic whites, 22.7% non-Hispanic blacks, and 5.8% from other racial/ethnic backgrounds.

The total ever cigarette smoking prevalence was 20.9%; more than one fourth (27.6%) of high school

Discussion

The findings of this study demonstrate the continued increase in popularity of e-cigarettes. Consistent with previous research on e-cigarette use among youth in the U.S.,³ the prevalence of either lifetime or current use of e-cigarettes found in this study are the highest levels reported to date. This trend is consistent for both ever and current use of e-cigarettes. Given the uncertainty of the health risks associated with e-cigarette use, these patterns of increasing prevalence of use among

Acknowledgments

Funding for the Florida Youth Tobacco Survey is provided by the Florida Department of Health, Bureau of Tobacco Free Florida.

No financial disclosures were reported by the authors of this paper.

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Adolescent Electronic Cigarette Use: Associations With Conventional Cigarette and Hookah Smoking

Introduction

Methods

Results

Conclusions

Introduction

Section snippets

Study Sample

Results

Discussion

Acknowledgments

Am J Prev Med

Notes from the field: electronic cigarette use among middle and high school students – United States, 2011-2012

MMWR Morb Mortal Wkly Rep

Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study

JAMA Pediatr