Objective
E-cigarette use has been linked to onset of cigarette smoking among adolescents but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower vs. higher on propensity to smoke.
Methods
School-based survey with a longitudinal sample of 1,136 students (9th – 11th graders, mean age 14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on three psychosocial factors known to predict smoking (rebelliousness, parental support, and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower vs. higher on T1 propensity to smoke.
Results
The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR = 0.88, p = .01) indicated a significantly larger effect for smoking onset among lower-risk youth.
Conclusions
The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower-risk adolescents to smoking, which has public health implications.