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Original Investigation
February 2018

Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015

Author Affiliations
  • 1Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco
  • 2Center for Tobacco Control Research and Education, Department of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
  • 3Center for Tobacco Control Research and Education, Department of Preventive and Restorative Dentistry, University of California, San Francisco
JAMA Pediatr. 2018;172(2):181-187. doi:10.1001/jamapediatrics.2017.4173
Key Points

Question  Does noncigarette tobacco use among never-smoking youth determine subsequent cigarette smoking initiation?

Findings  In this cohort study of the Population Assessment of Tobacco and Health, ever and past 30-day use of electronic cigarettes, hookah (tobacco waterpipe), noncigarette combustible tobacco, or smokeless tobacco was associated with cigarette initiation within 1 year.

Meaning  Youths who use any tobacco product may be at greater risk of initiating cigarette smoking.

Abstract

Importance  Approximately 90% of adult smokers first tried a cigarette by 18 years of age, and even infrequent smoking in adolescence is associated with established adult smoking. Noncigarette tobacco use is increasing and could stimulate subsequent conventional cigarette smoking in youths.

Objective  To estimate the longitudinal association between noncigarette tobacco use and subsequent cigarette smoking initiation among US youth.

Design, Setting, and Participants  In this prospective cohort study of the Population Assessment of Tobacco and Health (PATH) waves 1 (September 12, 2013, to December 14, 2014) and 2 (October 23, 2014, to October 30, 2015), a nationally representative sample of youths who never smoked a conventional cigarette at baseline and completed wave 2 follow-up (N = 10 384) was studied. PATH retention at follow-up was 87.9%.

Exposures  Ever use and past 30-day use of electronic cigarettes (e-cigarettes), hookah, noncigarette combustible tobacco, or smokeless tobacco at baseline.

Main Outcomes and Measures  Ever use and past 30-day use of cigarettes at follow-up.

Results  The present analysis was based on the 10 384 PATH youth respondents who reported never having smoked a cigarette in wave 1 and whose cigarette ever or past 30-day use was reported in wave 2 (mean [SD] age, 14.3 [1.7] years; age range, 12-17 years; 5087 [49.1%] female; 4829 [52.5%] white). At 1-year follow-up, 469 (4.6%) of all baseline never-smoking youths had tried a cigarette and 219 (2.1%) had smoked a cigarette within the past 30 days. Cigarette ever use at follow-up was higher among youths who had ever used e-cigarettes (78 [19.1%]), hookah (60 [18.3%]), noncigarette combustible tobacco (45 [19.2%]), or smokeless tobacco (29 [18.8%]) at baseline. After adjusting for sociodemographic, environmental, and behavioral smoking risk factors and for baseline ever use of other tobacco products, the odds of past 30-day cigarette use at follow-up were approximately twice as high among baseline ever users of e-cigarettes (odds ratio [OR], 1.87; 95% CI, 1.15-3.05), hookah (OR, 1.92; 95% CI, 1.17-3.17), noncigarette combustible tobacco (OR, 1.78; 95% CI, 1.00-3.19), and smokeless tobacco (OR, 2.07; 95% CI, 1.10-3.87). Youths who had tried more than 1 type of tobacco product at baseline had 3.81 (95% CI, 2.22-6.54) greater adjusted odds of past 30-day cigarette smoking at follow-up than did baseline never tobacco users.

Conclusions and Relevance  Any use of e-cigarettes, hookah, noncigarette combustible tobacco, or smokeless tobacco was independently associated with cigarette smoking 1 year later. Use of more than 1 product increased the odds of progressing to cigarette use.

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