Use of E-cigarettes and Other Tobacco Products and Progression to Daily Cigarette Smoking

Pediatrics. 2021 Feb;147(2):e2020025122. doi: 10.1542/peds.2020-025122. Epub 2021 Jan 11.

Abstract

Objectives: To identify predictors of becoming a daily cigarette smoker over the course of 4 years.

Methods: We identified 12- to 24-year-olds at wave 1 of the US Population Assessment of Tobacco and Health Study and determined ever use, age at first use, and daily use through wave 4 for 12 tobacco products.

Results: Sixty-two percent of 12- to 24-year-olds (95% confidence interval [CI]: 60.1% to 63.2%) tried tobacco, and 30.2% (95% CI: 28.7% to 31.6%) tried ≥5 tobacco products by wave 4. At wave 4, 12% were daily tobacco users, of whom 70% were daily cigarette smokers (95% CI: 67.4% to 73.0%); daily cigarette smoking was 20.8% in 25- to 28-year-olds (95% CI: 18.9% to 22.9%), whereas daily electronic cigarette (e-cigarette) vaping was 3.3% (95% CI: 2.4% to 4.4%). Compared with single product triers, the risk of progressing to daily cigarette smoking was 15 percentage points higher (adjusted risk difference [aRD] 15%; 95% CI: 12% to 18%) among those who tried ≥5 products. In particular, e-cigarette use increased the risk of later daily cigarette smoking by threefold (3% vs 10%; aRD 7%; 95% CI: 6% to 9%). Daily smoking was 6 percentage points lower (aRD -6%; 95% CI: -8% to -4%) for those who experimented after age 18 years.

Conclusions: Trying e-cigarettes and multiple other tobacco products before age 18 years is strongly associated with later daily cigarette smoking. The recent large increase in e-cigarette use will likely reverse the decline in cigarette smoking among US young adults.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cigarette Smoking / epidemiology*
  • Cigarette Smoking / trends*
  • Electronic Nicotine Delivery Systems*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Population Surveillance
  • Smoking / epidemiology
  • Smoking / trends
  • Tobacco Products*
  • United States / epidemiology
  • Vaping / epidemiology*
  • Vaping / trends*
  • Young Adult