Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents | Tobacco and e-Cigarettes | JAMA Pediatrics | JAMA Network
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Original Investigation
December 2017

Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents

Author Affiliations
  • 1Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
  • 2Department of Psychology, University of Southern California, Los Angeles
JAMA Pediatr. 2017;171(12):1192-1199. doi:10.1001/jamapediatrics.2017.3209
Key Points

Question  Is the use of electronic cigarettes with higher nicotine concentrations prospectively associated with greater frequency and intensity of combustible cigarette smoking and vaping in adolescents?

Findings  In this cohort study of 181 adolescent electronic cigarette users, use of electronic cigarettes with higher nicotine concentrations at baseline was associated with greater levels of combustible cigarette and electronic cigarette use in the past 30 days at the 6-month follow-up and greater intensity of daily use after controlling for baseline use.

Meaning  Use of electronic cigarettes with higher nicotine concentrations may contribute to the progression to smoking and vaping at higher levels of frequency and intensity among youths.

Abstract

Importance  Research indicates that electronic cigarette (e-cigarette) use (vaping) among adolescents is associated with the initiation and progression of combustible cigarette smoking. The reasons for this association are unknown.

Objective  To evaluate whether use of e-cigarettes with higher nicotine concentrations is associated with subsequent increases in the frequency and intensity of combustible cigarette smoking and vaping.

Design, Setting, and Participants  In this prospective cohort study involving students from 10 high schools in the Los Angeles, California, metropolitan area, surveys were administered during 10th grade in the spring (baseline) and 11th grade in the fall (6-month follow-up) of 2015 to students who reported using e-cigarettes within the past 30 days and the nicotine concentration level they used at baseline.

Exposures  Self-report of baseline e-cigarette nicotine concentration of none (0 mg/mL), low (1-5 mg/mL), medium (6-17 mg/mL), or high (≥18 mg/mL) typically used during the past 30 days.

Main Outcomes and Measures  Frequency of combustible cigarette smoking and e-cigarette use within the past 30 days (0 days [none], 1-2 days [infrequent], or ≥3 days [frequent]) and daily intensity of smoking and vaping (number of cigarettes smoked per day, number of vaping episodes per day, and number of puffs per vaping episode) at the 6-month follow-up.

Results  The analytic sample included 181 students (96 boys [53.0%] and 85 girls [47.0%]; mean [SD] age, 16.1 [0.4] years). Each successive increase in nicotine concentration (none to low, low to medium, and medium to high) vaped was associated with a 2.26 (95% CI, 1.28-3.98) increase in the odds of frequent (vs no) smoking and a 1.65 (95% CI, 1.09-2.51) increase in the odds of frequent (vs no) vaping at follow-up after adjustment for baseline frequency of smoking and vaping and other relevant covariates. Use of e-cigarettes with high (vs no) nicotine concentration was associated with a greater number of cigarettes smoked per day at follow-up (adjusted rate ratio [RR], 7.03; 95% CI, 6.11-7.95). An association with a significantly greater number of vaping episodes per day was found with use of low (adjusted RR, 3.32; 95% CI, 2.61-4.03), medium (adjusted RR, 3.32; 95% CI, 2.54-4.10), and high (adjusted RR, 2.44; 95% CI, 1.63-3.24) nicotine concentrations (vs no nicotine) at baseline. Similar results were found for the number of puffs per vaping episode for low (adjusted RR, 2.05; 95% CI, 1.41-2.70), medium (adjusted RR, 3.39; 95% CI, 2.66-4.11), and high (adjusted RR, 2.23; 95% CI, 1.42-3.03) nicotine concentrations.

Conclusions and Relevance  The results of this study provide preliminary evidence that use of e-cigarettes with higher nicotine concentrations by youths may increase subsequent frequency and intensity of smoking and vaping.

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