August 21, 2016

Stanton A. Glantz, PhD

The evidence that e-cigs are expanding the cigarette market by recruiting kids just keeps piling up

Thomas Willis and colleagues just published “E-cigarette use is differentially related to smoking onset among lower risk adolescents” in Tobacco Control.  They followed 1136 youth forward in time for a year and found that e-cigarettes were attracting youth at low risk of smoking to initiate use with e-cigarettes and that kids who started with e-cigarettes were much more likely to be smoking cigarettes a year later than kids who did not start with e-cigarettes.
 
More important, they found that the effects were biggest in the low risk kids.  In particular, if blows away the assertion made by e-cig enthusiasts that kids who start with e-cigs would be smoking conventional cigarettes anyway.
 
Here is their “What this paper adds” block from the paper:
 

▸ E-cigarette use has been shown to be associated with onset of cigarette smoking among adolescents, but it is not clear whether this might just mean that adolescents who were susceptible to smoking are more likely to use both substances.
 
▸ We tested this proposition with an empirically derived score for propensity to smoke cigarettes and found that the effect of e-cigarettes for smoking onset was stronger among participants who initially were at lower risk for smoking.
 
▸ The findings demonstrate that e-cigarette use is not just a marker for high-risk adolescents and show that e-cigarettes are a risk factor for smoking onset.

 
And the abstract:
 

Objective E-cigarette use has been linked to onset of cigarette smoking among adolescents, but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower versus higher on propensity to smoke.
 
Methods School-based survey with a longitudinal sample of 1136 students (9th–11th graders, mean age
14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on 3 psychosocial factors known to predict smoking (rebelliousness, parental support and willingness to smoke), and cigarette smoking status. Analyses based on T1 never smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower versus higher on T1 propensity to smoke.
 
Results The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR=0.88, p=0.01) indicated a significantly larger effect for smoking onset among lower risk youth.
 
Conclusions The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of  high risk for smoking. This study provides evidence that ecigarettes are recruiting lower risk adolescents to smoking, which has public health implications.

 
The full citation is Wills TA1, Sargent JD2, Gibbons FX3, Pagano I1, Schweitzer R4.  E-cigarette use is differentially related to smoking onset among lower risk adolescents. Tob Control. 2016 Aug 19. pii: tobaccocontrol-2016-053116. doi: 10.1136/tobaccocontrol-2016-053116. [Epub ahead of print].  It is available here.

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