Sequence of cigarette and e-cigarette initiations and daily smoking in adolescents (HBSC 2018)

Abstract

Abstract Background Electronic cigarette may help adults quit smoking. For adolescents, the concern is whether e-cigarette initiation is a gateway to subsequent smoking. Our objectives were to describe the sequence of conventional cigarette and e-cigarette initiations among adolescents who had already used both products, and to analyse the current smoking behaviour according to the first experienced product. Methods Analyses were based on a two-stage random sample of 9,937 12-20-year-old adolescents included in the French-speaking Belgian 2018 Health Behaviour in School-aged Children cross-sectional survey. Cigarette and e-cigarette initiations and its sequence, current daily smoking and other characteristics were collected through a self-administered questionnaire. Associations, adjusted for demographic data, were estimated using logistic regression and weighted. Sampling design was considered in analyses. Results In 2018, 66.0% of adolescents reported never having tried a cigarette and e-cigarette, 8.1% having experimented cigarettes only, 9.2% e-cigarette only and 16.6% having experimented both. Among adolescents who tried both products, eight out of ten smoked cigarettes before trying the e-cigarette (78.2%). In the whole sample, 6.8% of adolescents were smoking every day. Daily smoking was observed in 19.8% of adolescents who initiated e-cigarette and cigarettes and in 6.4% of those who initiated cigarettes only. Adolescents who first smoked cigarettes were more likely to further smoke daily (aOR: 2.48 [1.69-3.64]) than those who first used e-cigarette. The risk of daily smoking was not different between adolescents who first used e-cigarette compared with those who tried cigarettes only (aOR: 1.23 [0.76-2.00]). Conclusions In French-speaking Belgium, conventional cigarette was the first step in the initiation and continuation of tobacco smoking. These findings help understand smoking patterns among adolescents and will support the development of smoking prevention strategies. Key messages Our findings suggest that health promotion interventions should remain focused on conventional cigarette. Based on a cross-sectional study, they should however be confirmed by prospective studies.