Trajectories of E-Cigarette and Conventional Cigarette Use Among Youth

Pediatrics. 2018 Jan;141(1):e20171832. doi: 10.1542/peds.2017-1832. Epub 2017 Dec 4.

Abstract

Background: Electronic cigarette (e-cigarette) use is common among youth, and there are concerns that e-cigarette use leads to future conventional cigarette use. We examined longitudinal associations between past-month cigarette and e-cigarette use to characterize the stability and directionality of these tobacco use trajectories over time.

Methods: High school students (N = 808, 53% female) completed surveys across 3 waves (2013, 2014, and 2015) in 3 public schools in Connecticut. Using autoregressive cross-lagged models, we examined bidirectional relationships between past-month cigarette and e-cigarette use over time. Models were adjusted for covariates related to tobacco use (ie, sex, race/ethnicity, socioeconomic status, and use of other tobacco products).

Results: Past-month e-cigarette use predicted future cigarette use (wave 1-2: odds ratio [OR] = 7.08, 95% confidence interval [CI] = 2.34-21.42; wave 2-3: OR = 3.87, 95% CI = 1.86-8.06). However, past-month cigarette use did not predict future e-cigarette use (wave 1-2: OR = 2.02, 95% CI = 0.67-6.08; wave 2-3: OR = 1.90, 95% CI = 0.77-4.71). Additionally, frequency of cigarette and e-cigarette use increased over time. By wave 3, 26% of cigarette users and 20.5% of e-cigarette users reported using 21-30 days out of the past month.

Conclusions: E-cigarette use was associated with future cigarette use across 3 longitudinal waves, yet cigarette use was not associated with future e-cigarette use. Future research needs to examine mechanisms through which e-cigarette use leads to cigarette use. E-cigarette regulation and prevention programs may help prevent future use of cigarettes among youth.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Ethnic Groups / statistics & numerical data*
  • Female
  • Forecasting
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Predictive Value of Tests
  • Risk Assessment
  • Sex Factors
  • Smoking / adverse effects
  • Smoking / epidemiology*
  • Smoking / psychology
  • Students / psychology*
  • Students / statistics & numerical data
  • Tobacco Products / adverse effects
  • Tobacco Products / statistics & numerical data*
  • United States
  • Vaping / adverse effects*