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Original Investigation |

Electronic Cigarettes and Conventional Cigarette Use Among US Adolescents:  A Cross-sectional Study

Lauren M. Dutra, ScD1; Stanton A. Glantz, PhD1
[+] Author Affiliations
1Center for Tobacco Research and Education, University of California, San Francisco
JAMA Pediatr. 2014;168(7):610-617. doi:10.1001/jamapediatrics.2013.5488.
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Importance  Electronic cigarette (e-cigarette) use is increasing rapidly among adolescents, and e-cigarettes are currently unregulated.

Objective  To examine e-cigarette use and conventional cigarette smoking.

Design, Setting, and Participants  Cross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n = 17 353) and 2012 (n = 22 529) who completed the 2011 and 2012 National Youth Tobacco Survey.

Exposures  Ever and current e-cigarette use.

Main Outcomes and Measures  Experimentation with, ever, and current smoking, and smoking abstinence.

Results  Among cigarette experimenters (≥1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (≥100 cigarettes; odds ratio [OR] = 6.31; 95% CI, 5.39-7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67-6.27). Current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63-9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01-10.32). In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03-2.28). Among experimenters with conventional cigarettes, ever use of e-cigarettes was associated with lower 30-day (OR = 0.24; 95% CI, 0.21-0.28), 6-month (OR = 0.24; 95% CI, 0.21-0.28), and 1-year (OR = 0.25; 95% CI, 0.21-0.30) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR = 0.11; 95% CI, 0.08-0.15), 6-month (OR = 0.11; 95% CI, 0.08-0.15), and 1-year (OR = 0.12; 95% CI, 0.07-0.18) abstinence. Among ever smokers of cigarettes (≥100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR = 0.61; 95% CI, 0.42-0.89), 6-month (OR = 0.53; 95% CI, 0.33-0.83), and 1-year (OR = 0.32; 95% CI, 0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR = 0.35; 95% CI, 0.18-0.69), 6-month (OR = 0.30; 95% CI, 0.13-0.68), and 1-year (OR = 0.34; 95% CI, 0.13-0.87) abstinence.

Conclusions and Relevance  Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among US adolescents.

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Figure.
Electronic Cigarette Use and Conventional Cigarette Smoking in 2011 and 2012

Current e-cigarette use in 2011 (A) and 2012 (B) was associated (P = .003 in 2011; P = .001 in 2012) with heavier smoking among conventional smokers (≥100 cigarettes in lifetime, having smoked in past 30 days). Participants were a representative sample of US middle and high school students who responded to the National Youth Tobacco Survey. Current e-cigarette users had used e-cigarettes in the past 30 days. Former e-cigarette users had tried e-cigarettes but had not used e-cigarettes in the past 30 days. Never e-cigarette users had never tried an e-cigarette. The numbers of conventional cigarettes smoked per day are on the days cigarettes were smoked during the past 30 days.

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