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E-cigarette use by older high school students promotes risk for smoking
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Recent findings published in Pediatrics suggested that 11th and 12th graders who used e-cigarettes were six times more likely to try cigarettes compared with those who never used the devices.
“Notably, the association of e-cigarettes with initiation of cigarette use was much stronger among those classified as not susceptible to becoming smokers,” Jessica L. Barrington-Trimis, PhD, in the department of preventive medicine at the University of Southern California, and colleagues wrote. “These findings suggest that e-cigarette use may promote smoking during the transition to adulthood, even in those considered to be at lower risk because of personal or environmental factors.”
In the Southern California Children’s Health Survey, Barrington-Trimis and colleagues found that 24% of high school students have tried e-cigarettes and that 18.7% have tried regular cigarettes. Three prior studies demonstrated an association between e-cigarette use and cigarette use in adolescents, but did not examine how age influenced this relationship. The researchers sought to assess how this association would change as adolescents transition from high school to adulthood when cigarettes are legal.
As part of their study, Barrington-Trimis and colleagues collected data on e-cigarette use from students in 11th and 12th grades (mean age, 17.4 years). More data were collected an average of 16 months after initial evaluation from those who reported to have never smoked but used e-cigarettes (n = 146) and from students who reported to have never smoked or used e-cigarettes (n = 152).
After 16 months, the investigators determined that 40.4% of e-cigarette users, but only 10.5% of nonusers of e-cigarettes, began to smoke cigarettes. Overall, e-cigarette users were 6.17 times (95% CI, 3.3-11.6) more likely to begin smoking cigarettes compared with those who never tried e-cigarettes. Notably, associations were stronger in those who reported no intention of ever smoking at initial evaluation. E-cigarette users also were more likely to begin using hookahs, cigars or pipes (OR = 4.98; 95% CI, 2.37-10.4).
“Regardless of the mechanisms underlying the associations of e-cigarettes with cigarette use, this research adds much needed data to the emerging evidence that e-cigarettes are associated with increased risk of smoking among adolescents,” the researchers wrote. “Further prospective follow-up of this and other cohorts is needed to determine whether e-cigarette use will increase population rates of cigarette and other combustible tobacco products and their associated burden of disease.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
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