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Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults

Primack, BA and Shensa, A and Sidani, JE and Hoffman, Beth L. and Soneji, S and Sargent, JD and Hoffman, RM and Fine, MJ (2018) Initiation of Traditional Cigarette Smoking after Electronic Cigarette Use Among Tobacco-Naïve US Young Adults. The American Journal of Medicine, 131 (4). 443.e1-443.e9. ISSN 00029343

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Background. While electronic cigarettes (e-cigarettes) may help some smokers quit, some young adult never-smokers are now using e-cigarettes recreationally, potentially increasing their risk for initiation of smoking. We aimed to determine the association between baseline e-cigarette use and subsequent initiation of cigarette smoking among initially never-smoking young adults.

Methods. We conducted a prospective cohort study with assessments at baseline (March 2013) and follow-up (October 2014). We used sampling frames representing 97% of the U.S. population to recruit a nationally-representative sample of never-smoking young adults ages 18-30. The independent variable was baseline ever use of e-cigarettes. The main outcome measure was initiation of traditional cigarette smoking between baseline and 18-month follow-up.

Results. Baseline surveys were completed by 1506 never-smoking young adults, of whom 915 (60.8%) completed follow-up. There were no demographic differences between responders and non-responders. After applying survey weights—which accounted for both non-response and over or under coverage—2.5% of the represented population of never-smokers (801,010 of 32,040,393) used e-cigarettes at baseline. Cigarette smoking was initiated by 47.7% of e-cigarette users and 10.2% of non-users (P=.001). In fully-adjusted multivariable models, e-cigarette use at baseline was independently associated with initiation of smoking at 18 months (adjusted odds ratio=6.8, 95% confidence interval=1.7–28.3). Results remained similar in magnitude and statistically significant in all sensitivity analyses.

Conclusions: Baseline e-cigarette use was independently associated with initiation of traditional cigarette smoking at 18 months. This finding supports policy and educational interventions designed to decrease use of e-cigarettes among non-smokers.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Primack, BAbprimack@pitt.eduBPRIMACK
Shensa, Aariel.shensa@pitt.eduARS146
Sidani, JEjes107@pitt.eduJES107
Hoffman, Beth L.blh72@pitt.eduBLH72
Soneji, S
Sargent, JD
Hoffman, RM
Fine, MJmjf1@pitt.eduMJF1
Centers: Other Centers, Institutes, Offices, or Units > Center for Research on Media, Technology, and Health
Date: April 2018
Date Type: Publication
Journal or Publication Title: The American Journal of Medicine
Volume: 131
Number: 4
Page Range: 443.e1-443.e9
DOI or Unique Handle: 10.1016/j.amjmed.2017.11.005
Schools and Programs: School of Medicine > Family Medicine
Refereed: Yes
ISSN: 00029343
Official URL:
Funders: National Cancer Institute
Article Type: Research Article
PubMed ID: 29242110
Date Deposited: 01 Nov 2018 13:28
Last Modified: 01 May 2019 05:15


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