Abstract
Research has demonstrated associations between e-cigarette use and tobacco use among youth. However, few studies have examined whether reciprocal relationships exist between e-cigarette and tobacco use. The objective of this study was to examine whether bi-directional associations exist between e-cigarette and tobacco use in a large longitudinal sample of Canadian youth. A longitudinal sample of secondary students (n = 6729) attending 87 schools in Ontario and Alberta, Canada, who completed the COMPASS student questionnaire across three waves (from 2014–2015 to 2016–2017) was identified. Using cross-lagged models, we explored bi-directional associations between current tobacco and e-cigarette use, adjusting for relevant covariates. Our findings showed that current e-cigarette use predicted subsequent tobacco use between Wave 1 (W1) and Wave 2 (W2) of the study (W1–2: OR = 1.54, 95% CI = 1.37–1.74). Similarly, current tobacco use predicted e-cigarette use during earlier waves of the study (W1–2: OR = 1.43, 95% CI = 1.30–1.58). However, these relationships dissipated in later waves, when tobacco use no longer predicted e-cigarette use (W2–3: OR = 1.07, 95% CI = 0.99–1.16). This study extends prior work that focused mainly on the association between e-cigarette and subsequent tobacco use. Specifically, our findings portray a more complex relationship, where e-cigarette use may influence and be influenced by tobacco use.
Highlights
Adolescent use of electronic cigarettes (e-cigarettes) has been on the rise in recent years both globally and within Canada [1,2,3]
A recent meta-analysis that examined nine longitudinal studies comprised of adolescents and young adults demonstrated that ever-users of e-cigarettes were 3.63 times more likely to smoke cigarettes at follow-up, in comparison to never-users of e-cigarettes [15]
Controlling for relevant covariates, we identified significant auto-regressive effects for both current tobacco use and e-cigarette use at each wave; for example, current tobacco use at Wave 1 (W1) predicted current tobacco use at Wave 2 (W2) (OR = 1.91; 95% CI = 1.68–2.18)
Summary
Adolescent use of electronic cigarettes (e-cigarettes) has been on the rise in recent years both globally and within Canada [1,2,3]. The prevalence of past 30-day e-cigarette use among Canadian youth aged 15–19 years rose from 2.6 to 6.3 % between 2013 and 2015 [4] The emergence of these novel devices has sparked concerns within the public health community that e-cigarette use among adolescents may re-normalize smoking behaviors [5,6]. A recent meta-analysis that examined nine longitudinal studies comprised of adolescents and young adults demonstrated that ever-users of e-cigarettes were 3.63 times more likely to smoke cigarettes at follow-up, in comparison to never-users of e-cigarettes [15]. These findings remained significant even after adjusting for numerous known risk factors for smoking, such as sensation-seeking tendencies [15]
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