Floe Foxon1,2, Arielle S Selya2,3. 1. School of Physics and Astronomy, University of Nottingham, Nottingham, UK. 2. Behavioral Sciences Group, Sanford Research, Sioux Falls, SD, USA. 3. Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
Abstract
BACKGROUND AND AIMS: Recent nicotine use trends raise concerns that electronic cigarettes (ECs) may act as a gateway to cigarettes among adolescents. The aims of this study were to examine prevalence trends of exclusive EC use, exclusive cigarette use and dual use to determine the corresponding ages of initiation and to investigate hypothetical trends in total nicotine use and cigarette use in the absence of ECs among US adolescents. DESIGN: Observational study using data from the National Youth Tobacco Survey (NYTS) to statistically model trends in the prevalences of each user group and their initiation ages. Projections from counterfactual models based on data from 1999 to 2009 (before EC introduction) were compared with actual trends based on data from 1999 to 2018. Rigorous error analyses were applied, including Theil proportions. SETTING: USA. PARTICIPANTS AND MEASUREMENTS: Adolescents aged 12-17 years who were established exclusive cigarette users (≥ 100 cigarettes smoked and ≤ 100 days vaped), established exclusive EC users (< 100 cigarettes smoked and > 100 days vaped) and established dual users (≥ 100 cigarettes smoked and > 100 days vaped), based on cumulative life-time exposure (n ≈ 12 500-31 000 per wave). FINDINGS: Exclusive cigarette use prevalence declined from 1999 to 2018, while exclusive EC use and dual use prevalences increased since their introduction in 2009. The age of cigarette initiation began a slight increase after 2014, whereas the age for EC use remained approximately constant and was higher than that of cigarettes. The counterfactual comparison results were consistent with ECs not increasing the number of US adolescent nicotine users, and in fact diverting adolescents from cigarettes. CONCLUSIONS: Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk.
BACKGROUND AND AIMS: Recent nicotine use trends raise concerns that electronic cigarettes (ECs) may act as a gateway to cigarettes among adolescents. The aims of this study were to examine prevalence trends of exclusive EC use, exclusive cigarette use and dual use to determine the corresponding ages of initiation and to investigate hypothetical trends in total nicotine use and cigarette use in the absence of ECs among US adolescents. DESIGN: Observational study using data from the National Youth Tobacco Survey (NYTS) to statistically model trends in the prevalences of each user group and their initiation ages. Projections from counterfactual models based on data from 1999 to 2009 (before EC introduction) were compared with actual trends based on data from 1999 to 2018. Rigorous error analyses were applied, including Theil proportions. SETTING: USA. PARTICIPANTS AND MEASUREMENTS: Adolescents aged 12-17 years who were established exclusive cigarette users (≥ 100 cigarettes smoked and ≤ 100 days vaped), established exclusive EC users (< 100 cigarettes smoked and > 100 days vaped) and established dual users (≥ 100 cigarettes smoked and > 100 days vaped), based on cumulative life-time exposure (n ≈ 12 500-31 000 per wave). FINDINGS: Exclusive cigarette use prevalence declined from 1999 to 2018, while exclusive EC use and dual use prevalences increased since their introduction in 2009. The age of cigarette initiation began a slight increase after 2014, whereas the age for EC use remained approximately constant and was higher than that of cigarettes. The counterfactual comparison results were consistent with ECs not increasing the number of US adolescent nicotine users, and in fact diverting adolescents from cigarettes. CONCLUSIONS: Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk.
Authors: Samir Soneji; Jessica L Barrington-Trimis; Thomas A Wills; Adam M Leventhal; Jennifer B Unger; Laura A Gibson; JaeWon Yang; Brian A Primack; Judy A Andrews; Richard A Miech; Tory R Spindle; Danielle M Dick; Thomas Eissenberg; Robert C Hornik; Rui Dang; James D Sargent Journal: JAMA Pediatr Date: 2017-08-01 Impact factor: 16.193
Authors: David J Nutt; Lawrence D Phillips; David Balfour; H Valerie Curran; Martin Dockrell; Jonathan Foulds; Karl Fagerstrom; Kgosi Letlape; Anders Milton; Riccardo Polosa; John Ramsey; David Sweanor Journal: Eur Addict Res Date: 2014-04-03 Impact factor: 3.015
Authors: David T Levy; Kenneth E Warner; K Michael Cummings; David Hammond; Charlene Kuo; Geoffrey T Fong; James F Thrasher; Maciej Lukasz Goniewicz; Ron Borland Journal: Tob Control Date: 2018-11-20 Impact factor: 7.552
Authors: Hugo Torregrossa; Bertrand Dautzenberg; Pierre Birkui; Nicole Rieu; Marie-Dominique Dautzenberg; Maria Melchior; Murielle Mary-Krause Journal: BMC Public Health Date: 2022-07-15 Impact factor: 4.135
Authors: Stephen R Shamblen; Melissa H Abadi; Kirsten T Thompson; Sharon Lipperman-Kreda; Joel W Grube; Bonnie O Richard Journal: Psychol Addict Behav Date: 2022-01-13
Authors: David T Levy; Luz María Sánchez-Romero; Nargiz Travis; Zhe Yuan; Yameng Li; Sarah Skolnick; Jihyoun Jeon; Jamie Tam; Rafael Meza Journal: Int J Environ Res Public Health Date: 2021-05-03 Impact factor: 4.614