Social influence of e-cigarette smoking prevalence on smoking behaviours among high-school teenagers: Microsimulation experiments.

Dingding Chao,Naoki Kondo,Hideki Hashimoto,Vincenzo De Luca

doi:10.1371/journal.pone.0221557

Abstract

The prevalence of electronic cigarette (e-cigarette) use has rapidly increased among young people, while conventional cigarette use has decreased in this age group. However, some evidence suggests that e-cigarette use is likely to induce conventional cigarette smoking. The present study explored the social influence of the prevalence of e-cigarette use in the peer network and in the general population as a potential mechanism by which e-cigarette use affects adolescents’ overall smoking behaviours. For this purpose, we developed an agent-based model in which young agents repeatedly choose to smoke conventional cigarettes and/or e-cigarettes, or to remain non-smokers. The choice is based on the agent’s evaluation of the utility derived from smoking and attitude towards smoking (‘openness’), which is influenced by smoking prevalence in the agent’s peer network and in the broader society. We also assumed a ‘crossover’ effect between the different types of smoking. The model was calibrated with United States National Youth Tobacco Survey data to reflect real-world numbers. We further simulated the prevalence of different types of smoking under counterfactual scenarios with different levels of openness and crossover effects. The models developed successfully reproduced actual prevalence trends in different types of smoking from 2011 to 2014. Openness to smoking is associated with a dramatic increase in e-cigarette smoking and especially in dual smoking, which cancels out the decline in sole conventional smoking. Larger crossover effects are associated with a higher prevalence of conventional smoking. The simulation results indicate that the social influence of the prevalence of e-cigarette use may influence young people to initiate or continue conventional cigarette smoking. Assessing the impact of e-cigarettes in the general population as a ‘healthier’ alternative to conventional smoking may require carefully monitoring trends in young people’s smoking behaviours.

Highlights

Electronic cigarettes (e-cigarettes) are a form of electronic delivery of tobacco-derived products containing nicotine that is rapidly obtaining popularity in the United States and other countries [1, 2]
The rapid rise in e-cigarette use has been paralleled by a decrease in conventional cigarette smoking, growing evidence suggests that the use of e-cigarettes may induce the initiation of conventional cigarette smoking among young people [6,7,8,9,10,11]
Peer social influence is parameterised by referring to the number of smokers in the agent’s close network, and societal influence is parameterised according to the prevalence of each smoking type in the United States

Summary

Introduction

Electronic cigarettes (e-cigarettes) are a form of electronic delivery of tobacco-derived products containing nicotine that is rapidly obtaining popularity in the United States and other countries [1, 2]. Compared with the prevalence of conventional cigarette smoking, which is distributed evenly across age groups, the prevalence of e-cigarette use is disproportionally high among young people. The Surgeon General’s Office reported that, whereas the sole use of conventional cigarettes declined among young people from 2011 to 2015 (before the Food and Drug Administration’s prohibition of e-cigarette sales to adolescents), the dual use of e-cigarettes and conventional cigarettes increased rapidly among this age group during the same period [1]. Other studies have shown that e-cigarette use may be associated with intention to smoke conventional cigarettes, especially among young people [12,13,14,15,16,17]. A possible mechanism for the association involves the social influence of the peer network and the general population on teenagers’ attitudes towards smoking [4, 12, 14, 16]

Methods

Results

Conclusion