e-Cigarette and Cigarette Use Among Youth: Gateway or Common Liability?

Delnevo, Cristine D.

doi:10.1001/jamanetworkopen.2023.4890

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…an upcoming Cochrane Tobacco Addiction Group review of e-cigarettes and subsequent smoking in young people concludes that there is only “very low” certainty of evidence for direct associations between e-cigarette use and initiation and progression of smoking [ 66 ]; and another recent meta-analysis identified “[n]umerous methodological flaws in the body of [gateway] literature [which] limit the generalizability of findings to the question of an association between e-cigarette use and cigarette smoking initiation” [ 67 ]. Finally, population-level research similar to the present study has found, contrary to prediction from gateway effects, that smoking prevalence among adolescents underwent an accelerated decline as e-cigarette use increased [ 9 – 18 ] and has stayed at historic lows in the latest National Youth Tobacco Survey data [ 19 , 68 ]. Thus, trends among adults and adolescents at the population level appear to be consistent in this regard [ 44 ].…”

Section: Discussionsupporting

confidence: 40%

Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults

Foxon,

Selya,

Gitchell

et al. 2024

Harm Reduct J

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Background If US adults who smoke cigarettes are switching to e-cigarettes, the effect may be observable at the population level: smoking prevalence should decline as e-cigarette prevalence increases, especially in sub-populations with highest e-cigarette use. This study aimed to assess such effects in recent nationally-representative data. Methods We updated a prior analysis with the latest available National Health Interview Survey data through 2022. Data were cross-sectional estimates of the yearly prevalence of smoking and e-cigarette use, respectively, among US adults and among specific age, race/ethnicity, and sex subpopulations. Non-linear models were fitted to observed smoking prevalence in the pre-e-cigarette era, with a range of ‘cut-off’ years explored (i.e., between when e-cigarettes were first introduced to when they became widely available). These trends were projected forward to predict what smoking prevalence would have been if pre-e-cigarette era trends had continued uninterrupted. The difference between actual and predicted smoking prevalence (‘discrepancy’) was compared to e-cigarette use prevalence in each year in the e-cigarette era to investigate whether the observed decline in smoking was statistically associated with e-cigarette use. Results Observed smoking prevalence in the e-cigarette era was significantly lower than expected based on pre-e-cigarette era trends; these discrepancies in smoking prevalence grew as e-cigarette use prevalence increased, and were larger in subpopulations with higher e-cigarette use, especially younger adults aged 18–34. Results were robust to sensitivity tests varying the analysis design. Conclusions Population-level data continue to suggest that smoking prevalence has declined at an accelerated rate in the last decade in ways correlated with increased uptake of e-cigarette use.

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Section: Discussionsupporting

confidence: 40%

Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults

Foxon,

Selya,

Gitchell

et al. 2024

Harm Reduct J

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“…There is limited support for a gateway theory among youth in the US, which argues that e-cigarettes are uniquely responsible for experimentation with cigarettes or other tobacco products. Instead, patterns of youth experimentation with multiple tobacco products and multiple substances are consistent with the common liability theory, which suggests that the propensity to try tobacco products influences patterns of use [20]. It is notable that e-cigarettes, as the most prevalent product used by youth, are likely to be the first tobacco product tried; however, longitudinal studies support that trying any non-cigarette tobacco product increases the odds of trying cigarettes [21].…”

Section: Discussionmentioning

confidence: 69%

Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes

Delnevo,

Villanti

2023

IJERPH

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There is concern that youth e-cigarette use could lead youth to initiate cigarette smoking. This study identifies epochs of cigarette smoking among U.S. high school students in three commonly utilized national school-based surveys over three decades without a priori assumptions. We examined trends in ever and current cigarette smoking among high school youth from 1991 to 2022 in three datasets: Monitoring the Future (MTF), the National Youth Risk Behavior Survey (NYRBS) and the National Youth Tobacco Survey (NYTS) via Joinpoint regression. High stable rates of ever smoking were noted from 1991 to 1999 (NYRBS and MTF) and then significantly declined from 1999 to 2013; declines accelerated through to 2022. In the NYTS, ever cigarette smoking significantly declined from 1999 to 2018 and then declines accelerated to 2022. Current cigarette smoking reached its peak in 1997, and then significantly declined from 1997 to 2013 in the NYRBS and MTF and similarly in the NYTS from 1999 to 2018. Declines in current smoking then accelerated in all surveys through to 2022. These findings suggest dramatic successes in reducing youth smoking since the late 1990s, with more rapid declines in prevalence in the past decade.

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Section: Introductionmentioning

confidence: 99%

“…The Common Liability model is an important consideration when assessing causality between e-cigarette and cigarette smoking, particularly among tobacco non-users [ 10 , 11 ]. Specifically, the common liability model posits that risks associated with using different substances can be explained by identifying common predisposing factors that also influence use behaviors [ 10 , 11 ]. According to this model, where risk-taking propensities and psychosocial processes can be factors that link patterns of multiple addictions, common liability can provide a parsimonious explanation of substance use and addiction co-occurrence [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes

Kim,

Steffensen,

Miguel

et al. 2024

Harm Reduct J

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Introduction The rapid increase in e-cigarette use over the past decade has triggered an important public health question on the potential association between e-cigarette use and combustible cigarette smoking. Following AMSTAR 2 and PRISMA guidelines, this evidence synthesis sought to identify and characterize any associations between e-cigarette use among individuals not smoking cigarettes and initiation of cigarette smoking. Methods The protocol was registered on September 24, 2018 (PROSPERO 2018 CRD42018108540). Three databases were queried from January 01, 2007 to April 26, 2023. Search results were screened using the PICOS review method. Results Among 55 included studies (40 “good” and 15 “fair”; evidence grade: “high”) that adjusted for gender, age, and race/ethnicity between groups, generally, there was a significant association between non-regular e-cigarette use and initiation of cigarette smoking, further supported by the meta-analytic results (AOR 3.71; 95% CI 2.86–4.81). However, smoking initiation was most often measured as ever/current cigarette smoking. Two studies (quality: 2 “good”) evaluated progression to regular cigarette smoking among individuals with regular use of e-cigarettes, and generally found no significant associations. One study (“good”) evaluated smoking initiation among individuals with regular use of e-cigarettes, finding an increasing probability of ever smoking cigarettes with increased e-cigarette use. Twelve studies (10 “good” and two “fair”) examining progression to regular smoking among individuals with non-regular use of e-cigarettes reported inconsistent findings. Conclusions Numerous methodological flaws in the body of literature limit the generalizability of these results to all individuals who are not smoking cigarettes with few studies measuring established/regular use/smoking of e-cigarettes and cigarettes. Further, studies did not control adequately for specific confounding variables representing common liabilities between e-cigarette use and cigarette smoking, nor did they account for sufficient follow-up durations. Collectively, these flaws limit the generalizability of findings to the question of an association between e-cigarette use and cigarette smoking initiation.

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e-Cigarette and Cigarette Use Among Youth: Gateway or Common Liability?

Cited by 9 publications

References 8 publications

Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults

Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults

Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes

A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes

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