association of Electronic Cigarette Use by US adolescents With Subsequent Persistent Cigarette Smoking.

Introduction:
This text provides an analysis of the association between electronic cigarette (e-cigarette) use among cigarette-naive adolescents and their continued cigarette smoking two years after initiation. The study uses data from the Population assessment of Tobacco and health (PaTh) Study, a nationally representative longitudinal cohort study. The authors examine the association between e-cigarette use and continued cigarette smoking using multivariable logistic regression, controlling for multiple covariates.

Key Points:

* The study included 8671 adolescents who were cigarette-naive in wave 3 and participated in waves 4 and 5 of the PaTh Study.
* The authors assessed e-cigarette use in wave 3 using two different measures: ever use and current (past 30-day) use.
* The outcome measure was continued cigarette smoking in wave 5 after initiating smoking in wave 4.
* The authors constructed five different measures of continued cigarette smoking, representing progressively more substantial commitment to smoking.
* The study controlled for multiple independent risk factors, including sociodemographics, environmental factors, other substance use, cigarettes susceptibility, and mental health measures.
* The results showed that the adjusted odds ratio of baseline ever e-cigarette use, compared with never e-cigarette use, was 1.81 (95% CI, 1.03 to 3.18) for continued smoking measured as past 30-day smoking at wave 5.
* however, the adjusted risk difference (aRD) was small and not significant. The aRD was 0.88 percentage point (95% CI, −0.13 to 1.89 percentage points) for continued smoking, with the absolute risk being 1.19% (95% CI, 0.79% to 1.59%) for never e-cigarette users and 2.07% (95% CI, 1.01% to 3.13%) for ever e-cigarette users.

Main Message:
although the study found a statistically significant odds ratio of continued smoking comparing baseline e-cigarette users with non-users, the small magnitude of absolute risks and the minor risk differences in continued smoking between baseline e-cigarette users and non-users indicate that few adolescents are likely to continue smoking after initiation regardless of baseline e-cigarette use. Therefore, while e-cigarette use may be a risk factor for continued smoking, the overall public health impact appears to be minimal. Regulators should consider this evidence when evaluating the potential risks and benefits of e-cigarette use.

Sun R, Méndez D, Warner KE. association of Electronic Cigarette Use by US adolescents With Subsequent Persistent Cigarette Smoking. JaMa network open. 2023;6(3):1. doi:10.1001/jamanetworkopen.2023.4885