High School Seniors Who Used E-Cigarettes May Have Otherwise Been Cigarette Smokers: Evidence From Monitoring the Future (United States, 2009–2018)

Abstract

Abstract Introduction Studies have indicated that youth who use e-cigarettes are more likely to progress to cigarette smoking; however, the likelihood that these youth would have used tobacco products in the pre-vaping era is unclear. Aims and Methods This study sought to determine whether youth who used e-cigarettes in 2014–2018 would have likely been smokers in the period preceding e-cigarette availability. Analyzing Monitoring the Future 12th grade data (United States, 2009–2018), we forecasted the prevalence of current smoking with logistic regression-derived propensity scores. Models predicted smoking for all subsequent years, incorporating sociodemographic, family, alcohol, and school-related variables, and a linear time trend. We compared forecasted to observed smoking prevalence annually, and prevalence of current e-cigarette use among nonsmokers across smoking propensity tertiles. Results Until 2014, observed smoking prevalence mirrored forecasted prevalence. Afterward, forecasted rates consistently overestimated prevalence. Among nonsmoking youth, e-cigarette use was lowest among those with lowest predicted probability of cigarette smoking (3.8%; 95% confidence interval [CI]: 3.3, 4.4) and highest among those with highest probability (23.5%; 95% CI: 22.2, 24.9). Conclusions Youth e-cigarette use has increased rapidly, with high prevalence among nonsmoking youth. However, the decline in current smoking among 12th graders has accelerated since e-cigarettes have become available. E-cigarette use is largely concentrated among youth who share characteristics with smokers of the pre-vaping era, suggesting e-cigarettes may have replaced cigarette smoking. Implications Among nonsmoking youth, vaping is largely concentrated among those who would have likely smoked prior to the introduction of e-cigarettes, and the introduction of e-cigarettes has coincided with an acceleration in the decline in youth smoking rates. E-cigarettes may be an important tool for population-level harm reduction, even considering their impact on youth.