E-cigarette and Waterpipe Use in Two Adolescent Cohorts: Cross-Sectional and Longitudinal Associations With Conventional Cigarette Smoking

Eur J Epidemiol. 2018 Mar;33(3):323-334. doi: 10.1007/s10654-017-0345-9. Epub 2017 Dec 19.

Abstract

Alternative tobacco products are increasing in popularity. An important question is whether their use is associated with or even leads to conventional smoking, but large-scale (European) studies are scarce. In two cohorts of Dutch adolescents (Cohort I n = 6819, mean age = 13.8 SD = 1.1, 48.2% female; Cohort II n = 2758, mean age = 17.3 SD = 1.8, 61.3% female), we investigated use of electronic (e)-cigarettes with nicotine, e-cigarettes without nicotine and waterpipe. Generalized estimating equation modelling was conducted with ever conventional smoking as the dependent variable (0 = no, 1 = yes) and ever alternative tobacco use as the independent variable, correcting for clustering within schools, age, sex and education in both cohorts. In a subsample (n = 2100), the association between alternative tobacco use at baseline and conventional smoking 6 months later was tested, taking into account smoking propensity (based on personality, susceptibility to peer pressure and smoking intentions). Ever use prevalence was 13.7% for e-cigarettes with nicotine, 29.4% for e-cigarettes without nicotine and 22.1% for waterpipe in Cohort I and 12.3, 27.6 and 45.3% respectively in Cohort II. Ever smokers had tried alternative tobacco products more often than never smokers. Among never-smoking adolescents at baseline, alternative tobacco use predicted ever smoking 6 months later (e-cigarettes with nicotine OR 11.90 95% CI 3.36-42.11; e-cigarettes without nicotine OR 5.36 95% CI 2.73-10.52; waterpipe OR 5.36 95% CI 2.78-10.31). This association was strongest for adolescents with a low baseline risk of smoking. Experimenting with alternative tobacco products is common among Dutch youth. Alternative tobacco use predicts (future) smoking, especially among adolescents with a low smoking propensity.

Keywords: Adolescents; E-cigarettes; Longitudinal; Smoking; Smoking propensity; Waterpipe.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Cohort Studies
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Netherlands / epidemiology
  • Prevalence
  • Risk Factors
  • Schools
  • Smoking / epidemiology*
  • Students / statistics & numerical data*
  • Tobacco
  • Water Pipe Smoking / epidemiology*