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

  • Brian A. Primack
    Correspondence
    Requests for reprints should be addressed to Brian A. Primack, MD, PhD, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213.
    Affiliations
    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
    Search for articles by this author
  • Ariel Shensa
    Affiliations
    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
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  • Jaime E. Sidani
    Affiliations
    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
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  • Beth L. Hoffman
    Affiliations
    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
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  • Samir Soneji
    Affiliations
    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
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  • James D. Sargent
    Affiliations
    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
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  • Robert M. Hoffman
    Affiliations
    VA Pittsburgh Healthcare System, Pittsburgh, Pa
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  • Michael J. Fine
    Affiliations
    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
    Search for articles by this author
Published:December 10, 2017DOI:https://doi.org/10.1016/j.amjmed.2017.11.005

      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

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