E-Cigarettes and Future Cigarette Use.
There has been little research examining whether e-cigarette use increases the risk of cigarette initiation among adolescents in the transition to adulthood when the sale of cigarettes becomes legal.



The Children's Health Study is a prospectively followed cohort in Southern California. Data on e-cigarette use were collected in 11th and 12th grade (mean age = 17.4); follow-up data on tobacco product use were collected an average of 16 months later from never-smoking e-cigarette users at initial evaluation (n = 146) and from a sample of never-smoking, never e-cigarette users (n = 152) frequency matched to e-cigarette users on gender, ethnicity, and grade.



Cigarette initiation during follow-up was reported by 40.4% of e-cigarette users (n = 59) and 10.5% of never users (n = 16). E-cigarette users had 6.17 times (95% confidence interval: 3.30-11.6) the odds of initiating cigarettes as never e-cigarette users. Results were robust to adjustment for potential confounders and in analyses restricted to never users of any combustible tobacco product. Associations were stronger in adolescents with no intention of smoking at initial evaluation. E-cigarette users were also more likely to initiate use of any combustible product (odds ratio = 4.98; 95% confidence interval: 2.37-10.4), including hookah, cigars, or pipes.



E-cigarette use in never-smoking youth may increase risk of subsequent initiation of cigarettes and other combustible products during the transition to adulthood when the purchase of tobacco products becomes legal. Stronger associations in participants with no intention of smoking suggests that e-cigarette use was not simply a marker for individuals who would have gone on to smoke regardless of e-cigarette use.
Department of Preventive Medicine, University of Southern California, Los Angeles, California jtrimis@usc.edu.
Jessica L
JL
Barrington-Trimis
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Robert
R
Urman
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Kiros
K
Berhane
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Jennifer B
JB
Unger
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Tess Boley
TB
Cruz
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Mary Ann
MA
Pentz
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Jonathan M
JM
Samet
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Adam M
AM
Leventhal
Department of Preventive Medicine, University of Southern California, Los Angeles, California.
Rob
R
McConnell
D000293:Adolescent; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D057566:Self Report; D012907:Smoking / Q000453:epidemiology*; D062789:Tobacco Products / Q000706:statistics & numerical data*; D055815:Young Adult