High school students who use electronic cigarettes are more likely to initiate use of traditional cigarettes than their peers who do not engage in any type of smoking, according to JAMA.
“E-cigarette use is prospectively associated with increased risk of combustible tobacco use initiation during early adolescence,” Adam M. Leventhal, PhD, of the department of preventive medicine at the University of Southern California, Keck School of Medicine, and colleagues wrote. “These results raise the possibility that the association between e-cigarette and combustible tobacco use initiation may be bidirectional in early adolescence.”
The researchers compiled a cohort of 2,530 students from 10 California public high schools. Students were assessed at an initial meeting during their first semester of 9th grade, at month 6 and at month 12. Smoking behaviors, including use of e-cigarettes, traditional cigarettes, cigars, hookahs and blunts, were recorded within the past 6 months of each meeting.
Study results showed that at month 6, the prevalence rate for the use of traditional cigarettes within the last 6 months was higher for e-cigarette users (30.7%) compared with students who never used e-cigarettes (8.1%; difference in rates, 22.7%; 95% CI, 16.4%-28.9%). Results were similar at the month 12 follow up, with a 25.2% prevalence rate for electronic cigarette users vs. a rate of 9.3% for nonusers (15.9%; 95% CI, 10%-21.8%).
Electronic cigarette use also was associated with cigar (OR = 4.85; 95% CI, 3.38-6.96) and hookah use (OR = 3.25; 95% CI, 2.29-4.62).
The researchers posit that e-cigarette use could be caused by common risk factors such as beliefs that the devices are not harmful and addictive, marketing that targets teens, flavors that target teenagers and lack of clear regulations against the sale of e-cigarettes to teens.
“Early adolescence is also a period of uneven brain development in which the neural circuits that underlie motivation to seek out novel experiences develop more rapidly than circuits involving impulse control and effective decision making,” Leventhal and colleagues wrote. “Consequently, the expression of a propensity to initiate combustible tobacco use may be heightened during this age period.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures.