First tobacco product tried and current use of cigarettes and electronic cigarettes among adolescents from Guatemala City

Salud Publica Mex. 2023 Jan 2;65(1, ene-feb):46-53. doi: 10.21149/13972.


Objective: To assess how first experimenting with ciga-rettes or e-cigarettes is associated with current use in Gua-temala, a middle-income country with weak tobacco control and no e-cigarette regulations.

Materials and methods: We surveyed students from private schools in Guatemala City, limiting analyses to ever users (n=1 026). Multinomial logistic models regressed current product use on first product used, adjusting for sociodemographics and friends and family use.

Results: The most common first product used was e-cigarettes (56%), followed by flavored cigarettes (24%) and regular cigarettes (20%). At the time of the survey, 4% were exclusive smokers, 37% were exclusive e-cigarette users, 18% dual users, and 40% had ever tried either but were not current users. Compared to those who first tried cigarettes, students who first tried e-cigarettes were less likely to be current smokers (RR=0.19 [CI: 0.11,0.31]) or dual users (RR=0.26 [CI: 0.14,0.49]) and students who first tried flavored cigarettes were more likely to be current smokers (RR=1.66 [CI=1.13,2.42]).

Conclusions: In our sample, Guatemalan adolescents from private schools more frequently experiment and continue to use e-cigarettes than cigarettes. There is urgent need to implement e-cigarette restrictions in addition to tobacco control policy implementation.

MeSH terms

  • Adolescent
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems*
  • Flavoring Agents
  • Guatemala
  • Humans
  • Tobacco
  • Tobacco Products*
  • Tobacco Use


  • Flavoring Agents