Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study
Open Access
- 17 March 2020
- journal article
- research article
- Published by BMJ in Tobacco Control
- Vol. 30 (2), 212-220
- https://doi.org/10.1136/tobaccocontrol-2019-055283
Abstract
Introduction This study assessed whether initiating e-cigarette use increases the uptake of cigarette smoking in US adolescents compared with behavioural and synthetic controls. Methods Data come from 78 265 adolescents in the National Youth Tobacco Survey (2014–2017) of whom 38 630 provided information about the first tobacco product they had used in 2014/15. Ever, past 30 day and established (30 day use and 100+ lifetime cigarettes) cigarette smoking was compared in adolescents who first used an e-cigarette (exposure group), a non-cigarette combustible (CT) or other non-combustible tobacco (NT) product (behavioural controls), and propensity score matched adolescents without initial e-cigarette use (synthetic controls). Results Relative to behavioural controls, adolescents who tried e-cigarettes first were less likely to have ever smoked cigarettes (26% vs CT (42.4%; OR 0.48, 95% CI 0.40 to 0.57), or NT initiators (52.7%; OR 0.32, 95% CI 0.26 to 0.39)), to be past 30 day (6% vs CT (11.9%; OR 0.48, 95% CI 0.36 to 0.62), or NT initiators (20.0%; OR 0.26, 95% CI 0.19 to 0.35)) or be established cigarette smokers (0.7% vs CT (3.9%; OR 0.17, 95% CI 0.10 to 0.30), or NT initiators (8.4%; OR 0.08, 95% CI 0.04 to 0.13)). E-cigarette initiators were also less likely than synthetic controls (without initial e-cigarette use) to have ever smoked cigarettes (OR 0.76, 95% CI 0.62 to 0.93), be past 30 day (OR 0.71, 95% CI 0.55 to 0.91) or be established cigarette smokers (OR 0.26, 95% CI 0.13 to 0.51). Conclusion Less than 1% of US adolescents who use e-cigarettes first were established cigarette smokers. They were less likely to be smokers than adolescents who tried other combustible or non-combustible tobacco products first and propensity score matched adolescents without initial e-cigarette use.Keywords
Funding Information
- Cancer Research UK (C1417/A22962)
- United Kingdom Clinical Research Collaboration (MR/K023195/1)
This publication has 30 references indexed in Scilit:
- Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young AdultsJAMA Pediatrics, 2015
- Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early AdolescenceJama-Journal Of The American Medical Association, 2015
- Using Bayes to get the most out of non-significant resultsFrontiers in Psychology, 2014
- Assessing the association between the use of NRT for smoking reduction and attempts to quit smoking using propensity score matchingDrug and Alcohol Dependence, 2012
- Performance of Disease Risk Scores, Propensity Scores, and Traditional Multivariable Outcome Regression in the Presence of Multiple ConfoundersAmerican Journal of Epidemiology, 2011
- An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational StudiesMultivariate Behavioral Research, 2011
- The Impact of Residual and Unmeasured Confounding in Epidemiologic Studies: A Simulation StudyAmerican Journal of Epidemiology, 2007
- Comparison of Logistic Regression versus Propensity Score When the Number of Events Is Low and There Are Multiple ConfoundersAmerican Journal of Epidemiology, 2003
- Performance of tests of significance based on stratification by a multivariate confounder score or by a propensity scoreJournal of Clinical Epidemiology, 1989
- The central role of the propensity score in observational studies for causal effectsBiometrika, 1983