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Addiction. 2018 Feb;113(2):325-333. doi: 10.1111/add.14013. Epub 2017 Sep 25.

Evaluating the mutual pathways among electronic cigarette use, conventional smoking and nicotine dependence.

Author information

1
Department of Population Health, University of North Dakota, Grand Forks, ND, USA.
2
Psychology Department, Wesleyan University, Middletown, CT, USA.
3
Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
4
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA.

Abstract

BACKGROUND AND AIMS:

The implications of the rapid rise in electronic cigarette (e-cigarette) use remain unknown. We examined mutual associations between e-cigarette use, conventional cigarette use and nicotine dependence over time to (1) test the association between e-cigarette use and later conventional smoking (both direct and via nicotine dependence), (2) test the converse associations and (3) determine the strongest pathways predicting each product's use.

DESIGN:

Data from four annual waves of a prospective cohort study were analyzed. Path analysis modeled the bidirectional, longitudinal relationships between past-month smoking frequency, past-month e-cigarette frequency and nicotine dependence.

SETTING:

Chicago area, Illinois, USA.

PARTICIPANTS:

A total of 1007 young adult smokers and non-smokers (ages 19-23 years).

MEASUREMENTS:

Frequency of (1) cigarettes and (2) e-cigarettes was the number of days in the past 30 on which the product was used. The Nicotine Dependence Syndrome Scale measured nicotine dependence to cigarettes.

FINDINGS:

E-cigarette use was not associated significantly with later conventional smoking, either directly (β = 0.021, P = 0.081) or through nicotine dependence (β = 0.005, P = 0.693). Conventional smoking was associated positively with later e-cigarette use, both directly (β = 0.118, P < 0.001) and through nicotine dependence (β = 0.139, P < 0.001). The strongest predictors of each product's use was prior use of the same product; this pathway was strong for conventional cigarettes (β = 0.604, P < 0.001) but weak for e-cigarettes (β = 0.120, P < 0.001). Nicotine dependence moderately strongly predicted later conventional smoking (β = 0.169, P < 0.001), but was a weak predictor of later e-cigarette use (β = 0.069, P = 0.039).

CONCLUSIONS:

Nicotine dependence is not a significant mechanism for e-cigarettes' purported effect on heavier future conventional smoking among young adults. Nicotine dependence may be a mechanism for increases in e-cigarette use among heavier conventional smokers, consistent with e-cigarettes as a smoking reduction tool. Overall, conventional smoking and, to a lesser extent, its resulting nicotine dependence, are the strongest drivers or signals of later cigarette and e-cigarette use.

KEYWORDS:

Cigarettes; dual product use; e-cigarettes; mediation; nicotine dependence; structural equation modeling

PMID:
28841780
PMCID:
PMC5760290
[Available on 2019-02-01]
DOI:
10.1111/add.14013

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