Use of electronic cigarettes as a predictor of cannabis experimentation: A longitudinal study among German youth

Nicotine Tob Res. 2021 Aug 12;ntab166. doi: 10.1093/ntr/ntab166. Online ahead of print.


Introduction: Experimentation with e-cigarettes is rising among youth, and there are concerns that e-cigarettes could be a new risk factor for initiating substance use. This study aimed to investigate whether e-cigarette use longitudinally predicts experimentation with cannabis.

Methods: During 2017-2019, a prospective cohort study with an observation period of 18 months was conducted with 3,040 students from Germany who had never used cannabis (mean age = 14.8, range: 13-18 years). A multiple poisson regression was used to investigate whether e-cigarette use was an independent predictor of future cannabis use.

Results: Lifetime e-cigarette use was reported by 29.4 % of the survey population (n = 894) at baseline, and 17.4 % (n = 529) initiated cannabis use during the observation period. Among e-cigarette ever users, the initiation rate was 34.5 % compared to 10.4 % of never users. Results were robust to adjustment for age, sex, migrant status, type of school, sensation seeking, peer cannabis use, the use of alcohol and conventional cigarettes (ARR = 1.83; 95 % CI: 1.48-2.25). Further analyses revealed that the association between e-cigarette use and cannabis experimentation was stronger among youth with low sensation seeking scores (ARR = .77, CI: .61-.97) and no conventional cigarette use (ARR = .48, CI: .37-.64) at baseline.

Conclusion: E-cigarette use is associated with a subsequent initiation of cannabis use. This association seems to be stronger for youth who have a lower risk for substance use in general. Future studies need to investigate whether this is only true for experimental or also more frequent cannabis use.

Implications: The study indicates a prospective association between e-cigarette use and initiation of cannabis experimentation independent of other risk factors. It suggests that e-cigarette use is more strongly associated with cannabis initiation for youth with a lower propensity to use substances (low sensation-seekers and non-smokers).