Electronic Cigarette Use and Progression from Experimentation to Established Smoking

Chaffee BW, Watkins SL, Glantz SA. Pediatrics. 2018;141(4):e20173594. [CrossRef]

In previous studies of youth who have never smoked cigarettes, those who tried electronic cigarettes (e-cigarettes) were more likely to initiate conventional cigarette smoking compared with e-cigarette never users. The authors evaluated associations between e-cigarette use and progression to established smoking among adolescents who had already tried cigarettes. Participants (age 12–17 years) in the nationally representative Population Assessment of Tobacco and Health survey who had smoked a cigarette (≥1 puff) but not yet smoked 100 cigarettes (N = 1295), were examined for 3 outcomes at 1-year follow-up as a function of baseline e-cigarette use:

1. Having smoked ≥100 cigarettes (established smoking);
2. Smoking during the past 30 days;
3. Both having smoked ≥100 cigarettes and past 30-day smoking (current established smoking).

Survey-weighted multivariable logistic regression models were fitted to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for smoking risk factors. Versus e-cigarette never use, having ever used e-cigarettes was positively associated with progression to established cigarette smoking (19.3% vs 9.7%), past 30-day smoking (38.8% vs 26.6%), and current established smoking (15.6% vs 7.1%). Among adolescent cigarette experimenters, using e-cigarettes was positively and independently associated with progression to current established smoking, suggesting that e-cigarettes do not divert from, and may encourage, cigarette smoking in this population.