E-cigarette use and willingness to smoke: a sample of adolescent non-smokers.
OBJECTIVE
There is little evidence on the consequences of using electronic cigarettes (e-cigarette) in adolescence. With a multiethnic sample of non-smokers, we assessed the relation between e-cigarette use and social-cognitive factors that predict smoking of combustible cigarettes.


METHODS
School-based cross-sectional survey of 2309 high school students (mean age 14.7 years). Participants reported on e-cigarette use and cigarette use; on smoking-related cognitions (smoking expectancies, prototypes of smokers) and peer smoker affiliations; and on willingness to smoke cigarettes. Regression analyses conducted for non-cigarette smokers tested the association between e-cigarette use and willingness to smoke cigarettes, controlling for demographics, parenting, academic and social competence, and personality variables. Structural equation modelling (SEM) analysis tested whether the relation between e-cigarette use and willingness to smoke was mediated through any of the three smoking-related variables.


RESULTS
Non-smokers who had used e-cigarettes (18% of the total sample) showed more willingness to smoke cigarettes compared with those who had never used any tobacco product; the adjusted OR was 2.35 (95% CI 1.73 to 3.19). SEM showed that the relation between e-cigarette use and willingness to smoke was partly mediated through more positive expectancies about smoking, but there was also a direct path from e-cigarette use to willingness.


CONCLUSIONS
Among adolescent non-smokers, e-cigarette use is associated with willingness to smoke, a predictor of future cigarette smoking. The results suggest that use of e-cigarettes by adolescents is not without attitudinal risk for cigarette smoking. These findings have implications for formulation of policy about access to e-cigarettes by adolescents.
Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii USA.
Thomas A
TA
Wills
Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA.
James D
JD
Sargent
Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii USA.
Rebecca
R
Knight
Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, Hawaii USA.
Ian
I
Pagano
Department of Psychology, University of Connecticut, Storrs, Connecticut, USA.
Frederick X
FX
Gibbons
D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D016009:Chi-Square Distribution; D003071:Cognition; D003430:Cross-Sectional Studies; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D000067074:Peer Influence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology*; D012919:Social Behavior; D011795:Surveys and Questionnaires; D000072137:Vaping / Q000009:adverse effects
Addiction; Electronic nicotine delivery devices; Public policy