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Am J Med. 2018 Apr;131(4):443.e1-443.e9. doi: 10.1016/j.amjmed.2017.11.005. Epub 2017 Dec 11.

Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults.

Author information

1
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; University of Pittsburgh Honors College, University of Pittsburgh, Pittsburgh, Pa. Electronic address: bprimack@pitt.edu.
2
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
3
C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH.
4
C. Everett Koop Institute at Dartmouth, Geisel School of Medicine, Hanover, NH; Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH; Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH.
5
VA Pittsburgh Healthcare System, Pittsburgh, Pa.
6
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa; Center for Research on Media, Technology, and Health, University of Pittsburgh School of Medicine, Pittsburgh, Pa; VA Pittsburgh Healthcare System, Pittsburgh, Pa.

Abstract

BACKGROUND:

Although electronic cigarettes (e-cigarettes) may help some smokers quit, some young adult never-smokers are now using e-cigarettes recreationally, potentially increasing their risk for initiation of smoking. We aimed to determine the association between baseline e-cigarette use and subsequent initiation of cigarette smoking among initially never-smoking young adults.

METHODS:

We conducted a prospective cohort study with assessments at baseline (March 2013) and follow-up (October 2014). We used sampling frames representing 97% of the US population to recruit a nationally representative sample of never-smoking young adults aged 18 to 30 years. The independent variable was baseline ever use of e-cigarettes. The main outcome measure was initiation of traditional cigarette smoking between baseline and 18-month follow-up.

RESULTS:

Baseline surveys were completed by 1506 never-smoking young adults, of whom 915 (60.8%) completed follow-up. There were no demographic differences between responders and nonresponders. After applying survey weights-which accounted for both nonresponse and overcoverage or undercoverage-2.5% of the represented population of never-smokers (801,010 of 32,040,393) used e-cigarettes at baseline. Cigarette smoking was initiated by 47.7% of e-cigarette users and 10.2% of nonusers (P = .001). In fully adjusted multivariable models, e-cigarette use at baseline was independently associated with initiation of smoking at 18 months (adjusted odds ratio, 6.8; 95% confidence interval, 1.7-28.3). Results remained similar in magnitude and statistically significant in all sensitivity analyses.

CONCLUSIONS:

Baseline e-cigarette use was independently associated with initiation of traditional cigarette smoking at 18 months. This finding supports policy and educational interventions designed to decrease use of e-cigarettes among nonsmokers.

KEYWORDS:

Electronic nicotine delivery devices; Harm reduction; Nicotine; Priority/special populations

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