Initiation sequence of e‐cigarette and cigarette smoking among US adolescents: a national study.

Introduction:
This article, published in the american Journal on addictions, examines the initiation sequence of e-cigarette use and cigarette smoking among US secondary school students. The study also investigates the role of early initiation of e-cigarette use and assesses substance use behaviors as a function of the initiation patterns of e-cigarette use and cigarette smoking.

Key Points:

* The study uses data from the Monitoring the Future (MTF) study, a nationally representative survey of 8th, 10th, and 12th grade students in the US.
* The study identifies five initiation patterns of e-cigarette use and cigarette smoking: e-cigarette use before cigarette smoking, cigarette smoking before e-cigarette use, e-cigarette use and cigarette smoking in the same grade, e-cigarette use only, and cigarette smoking only.
* The study finds that the prevalence of substance use behaviors is highest among those who report a history of both e-cigarette use and cigarette smoking, regardless of initiation pattern.
* The study also finds that dual users have significantly greater risk of other substance use behaviors relative to those who only use e-cigarettes or smoke cigarettes.
* The study investigates the role of early initiation of e-cigarette use and finds that early initiation of e-cigarette use is associated with increased odds of substance use behaviors for all three age groups.
* The study also examines the initiation of e-cigarette use and all other substance use behaviors and finds that the most prevalent initiation sequence of e-cigarette use involves initiating other substances before e-cigarettes, especially among older adolescents.

Main Message:
The study highlights the importance of considering the initiation sequence of e-cigarette use and cigarette smoking when assessing substance use behaviors among US secondary school students. The study also emphasizes the need to address early initiation of e-cigarette use in substance use prevention efforts, as it is associated with increased odds of substance use behaviors for all age groups. Overall, the study suggests that youth substance use prevention programs and prospective studies must take into account polysubstance use when addressing the relationships between e-cigarette use and cigarette smoking.

McCabe SE, Veliz P, McCabe VV, Boyd CJ. Initiation sequence of e‐cigarette and cigarette smoking among US adolescents: a national study. The american Journal on addictions. 2019;28(4):285-294. doi:10.1111/ajad.12886