Implications of E-Cigarette Use Among Adolescents

Study Questions:

Does the use of e-cigarettes increase risk for combustible tobacco use among adolescents?


This was a longitudinal, repeated assessment of a school-based cohort. Ninth graders (as of 2013) from 10 public schools in Los Angeles, CA, were eligible for participation. Surveys were administered in the fall (2013), again 6 months later in the spring (2014), and at 12 months (fall of 2014). Students who reported never using combustible tobacco products (including cigarettes, cigars, and hookah) were included in the analysis. Those with missing data at 6 or 12 months were excluded. In addition to questions about combustible tobacco products, students were asked about use of e-cigarettes. The primary outcome of interest was use of combustible tobacco products at 6 or 12 months, including number of products used.


A total of 2,530 students (mean age 14 years) were included in the analysis. Over the 6-month follow-up, use of combustible tobacco products was more frequent among those who reported use of e-cigarettes at any time point compared to never-users (30.7% vs. 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% confidence interval (CI), 16.4%-28.9%]). A similar pattern was observed at 12-month follow-up (25.2% vs. 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Use of e-cigarettes at baseline was significantly associated with use of combustible tobacco products after adjustment for sociodemographic, environmental, and intrapersonal risk factors for smoking (odds ratio [OR], 2.73 [95% CI, 2.00-3.73]). Baseline e-cigarette use was associated with combustible cigarette use during follow-up (OR, 2.65 [95% CI, 1.73-4.05]). Cigars and hookah were also associated with baseline e-cigarette use (OR, 4.85 [95% CI, 3.38-6.96], and OR, 3.25 [95% CI, 2.29-4.62], respectively). E-cigarette use was also associated with a greater number of combustible tobacco products used.


The authors concluded that among high school students in Los Angeles, use of e-cigarettes was associated with use of combustible tobacco product use during follow-up.


These data suggest that use of e-cigarettes should be avoided by adolescents. Further research to understand trends in use in other areas is recommended.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Smoking

Keywords: Adolescent, Electronic Cigarettes, Primary Prevention, Risk Factors, Smoking, Tobacco, Tobacco Products, Tobacco Use Disorder

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