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

Abstract

BackgroundAlthough 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. MethodsWe 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. ResultsBaseline 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. ConclusionsBaseline 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.