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Smoking Intention and Progression from E-Cigarette Use to Cigarette

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Smoking Intention and Progression from E-Cigarette Use to Cigarette Smoking Intention and Progression From E-Cigarette Use to Cigarette Smoking Olusegun Owotomo, MD, PhD, MPH,a Haley Stritzel, MA,b,c Sean Esteban McCabe, PhD,d,e,f,g,h,i Carol J. Boyd, PhD,d,e,f,j Julie Maslowsky, PhDc,k,l OBJECTIVES: To investigate whether the prospective association between electronic cigarette abstract (e-cigarette) use and cigarette smoking is dependent on smoking intention status. METHODS: Waves 2 and 3 data of the Population Assessment of Tobacco and Health (PATH) Study, a US nationally representative prospective cohort study of tobacco use. Data were collected in 2014–2015 (wave 2) and 2015–2016 (wave 3) and analyzed in 2019. RESULTS: At wave 2, 12.8% of adolescent never-smokers of conventional cigarettes had intention to smoke and 8.5% had ever used an e-cigarette. At wave 3, 3.2% had ever smoked a cigarette. Both smoking intention and ever using e-cigarettes at wave 2 were positively associated with cigarette smoking at wave 3 (adjusted odds ratio [aOR] = 3.03; 95% confidence interval [CI] = 1.97–4.68, P , .001; aOR = 4.62, 95% CI = 2.87–7.42, P , .001, respectively). The interaction between smoking intention and ever using e-cigarettes was significant (aOR = 0.34, 95% CI = 0.18–0.64, P , .01). Among adolescents who had expressed intention to smoke conventional cigarettes at wave 2, the odds of cigarette smoking at wave 3 did not significantly differ for e-cigarette users and never e-cigarette users (aOR = 1.57; 95% CI 0.94–2.63; P = .08). Among adolescents who had no intention to smoke at wave 2, e-cigarette users, compared with never e-cigarette users, had .4 times the odds of cigarette smoking (aOR = 4.62; 95% CI 2.87–7.42; P , .0001). CONCLUSIONS: E-cigarette use is associated with increased odds of cigarette smoking among adolescents who had no previous smoking intention. E-cigarette use may create intention to smoke and/or nicotine use disorder that lead to onset of cigarette smoking. WHAT’S KNOWN ON THIS SUBJECT: ’ aChildren’s National Hospital, Washington, District of Columbia; bDepartment of Sociology and cPopulation Adolescents Research Center, College of Liberal Arts and kDepartment of Kinesiology & Health Education, College of Education electronic cigarette (e-cigarette) use and intention to and lDepartment of Population Health, Dell Medical School, The University of Texas at Austin, Austin, Texas; and smoke cigarettes are strong predictors of future cigarette dCenter for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing and eDepartment of Health smoking. However, it is unknown whether the association f Behavior and Biological Sciences, School of Public Health and Institutes for Research on Women and Gender, of e-cigarette use with future cigarette smoking differs on gSocial Research, and hHealthcare Policy and Innovation and iRogel Cancer Center and jAddiction Center, the basis of adolescents’ intentions to smoke cigarettes. Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan WHAT THIS STUDY ADDS: Dr Owotomo conceived of the study, wrote the primary draft of the manuscript, performed In prospective longitudinal data statistical analysis, and reviewed and revised the manuscript; Dr Maslowsky conceived of the study of 8661 adolescents, e-cigarette use was associated with and wrote the primary draft of the manuscript; Ms Stritzel performed statistical analysis and higher risk of cigarette smoking among adolescents who reviewed and revised the manuscript; Drs McCabe and Boyd assisted with conceptualizing the study had no previous smoking intention but not among those and reviewed and revised the manuscript; and all authors approved the final manuscript as who had previously expressed smoking intention. submitted and agree to be accountable for all aspects of the work. To cite: DOI: https://doi.org/10.1542/peds.2020-002881 Owotomo O, Stritzel H, McCabe SE, et al. Smoking Intention and Progression From E-Cigarette Use to Accepted for publication Sep 16, 2020 Cigarette Smoking. Pediatrics. 2020;146(6):e2020002881 Downloaded from www.aappublications.org/news by guest on September 27, 2021 PEDIATRICS Volume 146, number 6, December 2020:e2020002881 ARTICLE Cigarette smoking remains a leading attitudes, subjective norms, and smoking is essential to guide preventable cause of morbidity and perceived behavioral control (PBC) adolescent smoking prevention mortality in the United States. predict behavioral intention, which in research and intervention efforts. – Lifelong cigarette smoking is fueled turn predicts behavior.19 21 Although In the current study, we employ by nicotine dependence (hereafter both e-cigarette use and smoking a theory-guided approach to referred to as nicotine use disorder intention predict cigarette smoking, it investigate whether the prospective according to Diagnostic and Statistical remains unclear how they interact to association between e-cigarette use Manual of Mental Disorders, Fifth influence cigarette smoking among and conventional cigarette smoking is Edition criteria), which typically adolescents. For example, does having dependent on baseline smoking begins during adolescence.1,2 previous smoking intention increase intention status. Specifically, we use Although adolescent cigarette the risk of progressing from TPB to examine whether the smoking has declined over the past e-cigarette use to cigarette smoking? likelihood of progressing from several decades, electronic cigarette According to TPB, intention is more e-cigarette use to cigarette smoking (e-cigarette) use presents a new risk likely to lead to behavior in the differs on the basis of smoking for nicotine use disorder.1 Adolescent presence of factors that facilitate the – intention in a national sample of e-cigarette users are at heightened behavior’s performance,19 21,24 and adolescent never-smokers of risk of developing symptoms of e-cigarette use facilitates cigarette conventional cigarettes. nicotine use disorder and progressing smoking.7,9 Accordingly, adolescent – to conventional cigarette smoking.3 9 e-cigarette users who have previous However, which e-cigarette users intention to smoke cigarettes may be METHODS progress to cigarette smoking, and at a higher risk of progressing to Study Participants why, remains unclear. Some cigarette smoking than those without prevailing hypotheses include the smoking intention. However, Deidentified data on adolescents aged potential addictiveness of nicotine- emerging evidence questions whether 12 to 17 years were obtained from containing e-cigarettes, similar smoking intention is a necessary public-use files of the Population commercial and social sources for antecedent of cigarette smoking Assessment of Tobacco and Health e-cigarettes and conventional among adolescent e-cigarette (PATH) Study, a nationally cigarettes, and characteristic smoking users.3,4,25 representative household cohort techniques that mimic and possibly study of tobacco use among the prime e-cigarette users for In a regional study of adolescents in civilian, noninstitutionalized US conventional cigarette smoking.10 Southern California, e-cigarette use population.26,27 Wave 1 data were Empirical evidence suggests 2 major predicted future smoking among collected in 2013–2014, wave 2 in potential pathways from e-cigarette adolescents with no previous 2014–2015, and wave 3 in 3 use to cigarette smoking: an addiction intention to smoke at baseline. This 2015–2016. Waves 2 and 3 data were pathway and a smoking intention finding suggests that e-cigarettes are used in the current study because of pathway.11,12 not simply a transitional product the higher prevalence of e-cigarette used by adolescents with intention to use in wave 2 versus wave 1, The addiction pathway model smoke on their journey to cigarette reflecting the increased popularity of suggests that e-cigarettes are capable smoking, but that e-cigarette use can e-cigarette use in wave 2 years. of delivering high concentrations of predispose nonintending tobacco- Inclusion criteria for the current – nicotine to the blood,13 15 which may naive adolescents to cigarette study were that participants were lead to nicotine use disorder.16 smoking.3 In other studies, e-cigarette ages 12 to 17 at waves 2 and 3, Nicotine use disorder, in turn, use predicted cigarette smoking reported at both waves 1 and 2 that potentially fuels continued e-cigarette among adolescents who were they had never smoked conventional use and future cigarette smoking.11 In considered low risk for cigarette cigarettes, and provided valid data on the current study, we test the smoking on the basis of several cigarette smoking at wave 3 (n = smoking intention pathway, which factors including smoking 6779). Youth who were ,12 years at posits that e-cigarette use may lead to intention.4,25 These findings challenge wave 1 (“shadow youth”) but aged up the development of smoking the importance of smoking intention to $12 years in wave 2 were also intention,12 namely, lack of firm as a predictor of cigarette smoking included (n = 1882) for a total final commitment not to smoke among adolescent e-cigarette users. sample of 8661 youth. Youth aged cigarettes,17,18 which according to the In the current e-cigarette use $18 were not included because they theory of planned behavior epidemic, identifying whether have characteristics (eg, legal access (TPB),19–21 predicts cigarette smoking intention continues to be to cigarettes) that differ from the smoking.22,23 TPB posits that a reliable predictor of cigarette target adolescent population. The Downloaded from www.aappublications.org/news by guest on September 27, 2021 2 OWOTOMO et al current study was determined to be Exposure to antitobacco cigarettes (injunctive norm) was non–human subjects research by the advertisements was measured by measured via the item, “If your sponsoring university’s institutional creating a composite variable from 6 parents or guardians found you using review board. items asking whether participants tobacco, how do you think they would had seen or heard specific react? Would they . ?” Responses Measures antismoking advertisements (eg, were 1 = “be very upset,” 2=“not be “ ’ ” “ ” All variables were measured at wave Cigarettes are bullies.
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