Applying recommended evidence standards to understand the impact of e‐cigarettes on youth smoking and reporting of weak scientific evidence

Green, Michael J.; Hilton, Shona

doi:10.1111/add.14054

Cited by 6 publications

(9 citation statements)

References 8 publications

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“…Youth was defined as ages 10-15 due to the structure of the survey data, but patterns could be distinct among young adults aged 16+ (who were grouped with adults here), though the age-range covered here is similar to that in other studies of UK youth [17,18]. Further, while we have adjusted for many relevant confounders (including recent smoking history) while preserving the effects of SEP on these confounders, the effect estimates presented here assume no unmeasured confounding [46]. We did not have information on prior vaping, which could have particularly biased analyses of smoking cessation, as respondents recorded here as ex-smokers who do not vape could have already used vaping as an intermediate step to help them quit nicotine completely [49].…”

Section: Discussionmentioning

confidence: 92%

“…relapsing to nicotine but not cigarette use), as well as by disadvantaged smokers switching to vaping. We have not yet been able to investigate longitudinal dynamics between e-cigarette and cigarette use [9,15,46]. This will be possible with future waves of the study and clarifying inequalities in transitions between particular smoking and vaping states will be an important issue for such longitudinal research.…”

Section: Discussionmentioning

confidence: 99%

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Socioeconomic patterning of vaping by smoking status among UK adults and youth

et al. 2020

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Background:Smoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health. Methods: Data were from 3291 youth (aged 10-15) and 35,367 adults (aged 16+) from wave 7 (2015-17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128). Results: Socioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03-1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09-1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91-1.07) and current smoking (OR: 1.00; 95% CI: 0.93-1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an exsmoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82-0.95) than those who did not (OR: 0.82; 95% CI: 0.80-0.84; p-value for difference = 0.081). Conclusions: Inequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Socioeconomic patterning of vaping by smoking status among UK adults and youth

et al. 2020

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“…Respondents were from the 7th Wave of Understanding Society, a panel survey based on annual interviews conducted within UK households [27]. In fieldwork spanning 2015-2017, 4534 youth aged 10-15 were eligible for self-completion questionnaires.…”

Section: Samplementioning

confidence: 99%

“…The notion that vaping may increase risk for smoking can be contrasted with the notion of common liabilities [19,20]: that underlying propensities for both behaviours account for their close association among youth [2,9,17,[22][23][24][25][26]. While many studies [2,[22][23][24][25] have adjusted for measured differences in background, unmeasured common liabilities remain possible explanations [19,27], even for more recent longitudinal studies showing vaping preceding smoking [17,26,[28][29][30][31][32] and where respondents had stated no intention of smoking [33]. It is important to recognise that common liabilities and vaping increasing risk for smoking (or indeed, smoking increasing risk for vaping [32]) are not mutually exclusive explanations for associations between vaping and smoking among youth.…”

Section: Introductionmentioning

confidence: 99%

Youth vaping and smoking and parental vaping: a cross-sectional survey

Green¹,

Gray²,

Sweeting³

2020

Preprint

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Background: Concerns remain about potential negative impacts of e-cigarettes including possibilities that: youth e-cigarette use (vaping) increases risk of youth smoking; and vaping by parents may have impacts on their children’s vaping and smoking behaviour. Methods: With cross-sectional data from 3291 youth aged 10-15 years from the Understanding Society Survey, we estimated effects of youth vaping on youth smoking (ever, current and initiation in the past year), and of parental vaping on youth smoking and vaping, and examined whether the latter differed by parental smoking status. Propensity weighting was used to adjust for measured confounders and estimate effects of vaping under alternative scenarios of no vaping vs universal adoption, and vs observed vaping levels. E-values were calculated to assess the strength of unmeasured confounding influences needed to negate our estimates. Results: Associations between youth vaping and youth smoking were attenuated considerably by adjustment for measured confounders. Estimated effects of youth vaping on youth smoking were stronger comparing no use to universal adoption (e.g. OR for smoking initiation: 32.5; 95% CI: 9.8-107.1) than to observed levels of youth vaping (OR: 4.4; 0.6-30.9). Relatively strong unmeasured confounding would be needed to explain these effects. Associations between parental vaping and youth vaping were explained by measured confounders. However, estimates for parental vaping on youth smoking indicated effects, especially for youth with ex-smoking parents (e.g. OR for smoking initiation: 11.3; 2.7-46.4) rather than youth with currently smoking parents (OR: 1.0; 0.2-6.4). Relatively weak unmeasured confounding could explain these parental vaping effects. Conclusions: While results for youth vaping and youth smoking associations indicated support for underlying propensities, estimated effects still required considerable unmeasured confounding to be explained fully. However, these estimates from cross-sectional data could also be explained by smoking leading to vaping. Stronger estimates for universal vaping adoption vs observed usage, indicated that if youth vaping does increase risk of youth smoking, this effect may be stronger in the general population of youth, than among those youth who typically vape. Associations of parental vaping with youth smoking and vaping were either explained by measured confounding or could be relatively easily explained by unmeasured confounding.

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“…Respondents were from the 7 th Wave of Understanding Society, a panel survey based on annual interviews conducted within UK households [17]. In eldwork spanning 2015-2017, 4534 youth aged 10-15 were eligible for inclusion because they lived in a household with a member of the (adult) study sample.…”

Section: Samplementioning

confidence: 99%

Youth vaping and smoking and parental vaping: a panel survey

Green

Gray

Sweeting

2020

Preprint

Self Cite

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Background: Concerns remain about potential negative impacts of e-cigarettes including possibilities that: youth e-cigarette use (vaping) increases risk of youth smoking; and vaping by parents may have impacts on their children’s vaping and smoking behaviour.Methods: With panel data from 3291 youth aged 10-15 years from the 7th wave of the UK Understanding Society Survey (2015-2017), we estimated effects of youth vaping on youth smoking (ever, current and past year initiation), and of parental vaping on youth smoking and vaping, and examined whether the latter differed by parental smoking status. Propensity weighting was used to adjust for measured confounders and estimate average effects of vaping for all youth, and among youth who vaped. E-values were calculated to assess the strength of unmeasured confounding influences needed to negate our estimates.Results: Associations between youth vaping and youth smoking were attenuated considerably by adjustment for measured confounders. Estimated average effects of youth vaping on youth smoking were stronger for all youth (e.g. OR for smoking initiation: 32.5; 95% CI: 9.8-107.1) than among youth who vaped (OR: 4.4; 0.6-30.9). Relatively strong unmeasured confounding would be needed to explain these effects. Associations between parental vaping and youth vaping were explained by measured confounders. Estimates indicated effects of parental vaping on youth smoking, especially for youth with ex-smoking parents (e.g. OR for smoking initiation: 11.3; 2.7-46.4) rather than youth with currently smoking parents (OR: 1.0; 0.2-6.4), but these could be explained by relatively weak unmeasured confounding.Conclusions: While measured confounding accounted for much of the associations between youth vaping and youth smoking, indicating support for underlying propensities, our estimates suggested residual effects that could only be explained away by considerable unmeasured confounding or by smoking leading to vaping. Estimated effects of youth vaping on youth smoking were stronger among the general youth population than among the small group of youth who actually vaped. Associations of parental vaping with youth smoking and vaping were either explained by measured confounding or could be relatively easily explained by unmeasured confounding.

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Applying recommended evidence standards to understand the impact of e‐cigarettes on youth smoking and reporting of weak scientific evidence

Abstract: COMMENTARIESScientist Office of the Scottish Government (SPHSU13; SPHSU15).

Cited by 6 publications

References 8 publications

Socioeconomic patterning of vaping by smoking status among UK adults and youth

Socioeconomic patterning of vaping by smoking status among UK adults and youth

Youth vaping and smoking and parental vaping: a cross-sectional survey

Youth vaping and smoking and parental vaping: a panel survey

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