Short communicationA longitudinal study of electronic cigarette use and onset of conventional cigarette smoking and marijuana use among Mexican adolescents
Introduction
Electronic nicotine delivery systems, also known as e-cigarettes, have rapidly increased in popularity, providing consumers with a nicotine delivery alternative to cigarettes. In many countries, these products are marketed through various media channels (i.e., radio, television, social media) as a safer, more fashionable alternative to conventional cigarettes and as an effective method for quitting smoking (Kong et al., 2015). E-cigarette proponents view these devices as a less harmful alternative to conventional cigarettes. At the same time, however, tobacco control advocates are concerned that e-cigarettes, which have become increasingly popular among youth (Kong et al., 2015), may also serve as a “gateway” to cigarette smoking among relatively low-risk adolescents who would not have otherwise become cigarette users (Leventhal et al., 2015, Primack et al., 2015). In order to gauge the public health impact of e-cigarettes on public health, it will be important to assess the extent and consequences of e-cigarette use amongst youth who have not previously smoked combustible cigarettes. Furthermore, to assess the potential impact of different regulatory options, it is important to assess similarities and differences in patterns of e-cigarette use and their consequences across countries whose policies contrast in permissiveness towards e-cigarettes, while also considering dominant tobacco use patterns, tobacco control policies, and levels of economic development.
Longitudinal studies in the US, where there are relatively few e-cigarettes regulations, have consistently found that nonsmoker adolescents are more likely to transition to conventional cigarette use if they have experimented with e-cigarettes than if they have not (Leventhal et al., 2015, Primack et al., 2015, Soneji et al., 2017, Unger et al., 2016, Wills et al., 2016b, Wills et al., 2016c). Similarly, studies in the US have found that adolescents who use e-cigarettes are more likely to use marijuana (Unger et al., 2016, Wills et al., 2016a). Adolescent e-cigarette users in the US are often exposed to pro-vaping culture (i.e., vape shops, vaping websites, social media) that promotes opportunities to learn how to use and purchase vaping equipment (Budney et al., 2015a, b; Lee et al., 2016, Unger et al., 2016) that also can be used to vaporize marijuana (Budney et al., 2015b, Morean et al., 2015). A study among middle school students in Connecticut found that students were more likely to vaporize marijuana using e-cigarettes if they were lifetime e-cigarette users (Morean et al., 2015). Likewise, this study found that among students who had tried e-cigarettes, 18% vaporized marijuana using e-cigarettes (Morean et al., 2015).
To inform future e-cigarette regulations, it is important to evaluate whether trajectories of substance use initiation differ across policy environments. The transition from e-cigarettes to conventional cigarettes and marijuana use has only been studied in the US (Leventhal et al., 2015, Primack et al., 2015, Unger et al., 2016, Wills et al., 2016b, Wills et al., 2016c), and to date, there are no studies that have evaluated these trajectories in any Latin American countries. However, in 2015, 10% of early adolescents in Mexico (12.5 years old) had tried e-cigarettes, including 4% who had not tried conventional cigarettes (Thrasher et al., 2016). Although risk factors for e-cigarette initiation among Mexican youth were mostly the same as those for cigarettes, results suggested that e-cigarette recruit low- to medium-risk youth who may not have otherwise initiated nicotine product use (Thrasher et al., 2016), as has been found in the US (Wills et al., 2015).
The aim of this study was to evaluate if e-cigarette trial among Mexican youth who had not previously smoked cigarettes or used marijuana increased the likelihood of trial and use of conventional cigarettes or marijuana use at 20-month follow-up.
Section snippets
Study population
A school-based, longitudinal survey was conducted in 60 public middle schools from the three largest cities in Mexico (Mexico City, Guadalajara, and Monterrey) that were selected using a stratified, multi-stage random sampling scheme. A detailed description of school selection has been published (Thrasher et al., 2016).
The baseline survey was administered in February and March 2015 among all first-year students in selected schools (i.e., usually 12–13 years old), with a response rate of 84% (
Results
Selected characteristics are presented in Table 1. For both analytical samples studied (trial and use of conventional cigarettes and marijuana use), more than half of participants were 13 years or older and did not have parents, friends or siblings that smoked and had not tried alcohol. Moreover, less than 7% of the sample had tried e-cigarettes.
Non-smoking participants who had tried e-cigarettes at baseline were more likely than those who had not to try conventional cigarettes (43% vs. 24%,
Discussion
Consistent with prior studies (Leventhal et al., 2015, Primack et al., 2015, Wills et al., 2016b), our findings suggest that early adolescents who have tried e-cigarettes but not cigarettes were more likely to initiate use of conventional cigarettes when compared to adolescents who had not tried either tobacco product. In this study, we did not find a significant association between trial of e-cigarettes at baseline and e-cigarette use at follow-up. A study in California, found that adolescents
Role of funding source
Nothing declared.
Contributors
PL conceived of the research, statistical analyses, and drafted and revised the manuscript. IB conceived of the research and revised the manuscript PM, RM and JS assisted with data interpretation and critically revised the manuscript. JFT conceived of the research, assisted with data interpretation and critically revised the manuscript. All authors approved of the final manuscript before submission.
Conflict of interest
No conflict declared.
Source of funding
This research was supported by a grant from the Fogarty International Center and the National Cancer Institute of the United States’ National Institute of Health (R01 TW009274). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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