First evidence of an e-cigarette gateway effect to conventional cigarettes in Asian kids

YN Chien and others, including me, recently published “Electronic Cigarette Use and Smoking Initiation in Taiwan: Evidence from the First Prospective Study in Asia” in International Journal of Environmental Research and Public Health.  We used the 2014 and 2016 waves of the Taiwan Adolescent to Adult Longitudinal Study to enroll junior high school students (mean age 13) and follow them up two year later.  We found, among youth who had never smoked a conventional cigarette, that any e-cigarette use at baseline more than doubled the odds that they would have initiated cigarettes two years later (Odds Ratio = 2.14, 95% CI (1.66, 2.75), p < 0.001).  This odds ratio is lower than has been found in the USA, perhaps because in Taiwan e-cigarettes remain de facto illegal.

Here is the full abstract:

A growing literature indicates that electronic cigarette use increases the risk of subsequent initiation of conventional smoking among cigarette-naïve adolescents in several Western countries. This research assesses the same relationship in an Asian country, Taiwan. The Taiwan Adolescent to Adult Longitudinal Study is a school-based survey that was carried out in two waves in 2014 (baseline) and in 2016 (follow-up). It employs probability sampling to create nationally representative samples of students in junior high school (mean age 13, 7th grade at baseline) and in senior high school (mean age 16, 10th grade at baseline). Data from this survey were analyzed via logistic regression to estimate the association between ever use of e-cigarettes at baseline and smoking initiation at follow-up, accounting for susceptibility to smoking, socio-demographic profile, depression status, and peer support. Among the 12,954 cigarette-naïve students surveyed, those with e-cigarette experience at baseline exhibited higher odds of smoking initiation at follow-up (Odds Ratio = 2.14, 95% CI (1.66, 2.75), p < 0.001). For the first time, we confirmed, through a longitudinal survey, a prospective association between ever use of e-cigarettes and smoking initiation in an Asian adolescent population. The restrictive policy on e-cigarettes currently in force in Taiwan is justified to prevent both e-cigarette and cigarette use among adolescents.

The full citation is:  Chien YN, Gao W, Sanna M, Chen PL, Chen YH, Glantz S, Chiou HY.   Electronic Cigarette Use and Smoking Initiation in Taiwan: Evidence from the First Prospective Study in Asia. Int J Environ Res Public Health. 2019 Mar 30;16(7). pii: E1145. doi: 10.3390/ijerph16071145.  It is available for free here