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Martinelli T, Candel MJJM, de Vries H, Talhout R, Knapen V, van Schayck CP, Nagelhout GE. Exploring the gateway hypothesis of e-cigarettes and tobacco: a prospective replication study among adolescents in the Netherlands and Flanders. Tob Control 2023; 32:170-178. [PMID: 34226262 PMCID: PMC9985733 DOI: 10.1136/tobaccocontrol-2021-056528] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/10/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Studies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking. This study replicates a cornerstone study revealing a positive association between both adolescent e-cigarette use and subsequent tobacco use; and tobacco and subsequent e-cigarette use in the Netherlands and Flanders. DESIGN The longitudinal design included baseline (n=2839) and 6-month (n=1276) and 12-month (n=1025) follow-up surveys among a school-based cohort (mean age: 13.62). Ten high schools were recruited as a convenience sample. The analyses involved (1) associations of baseline e-cigarette use and subsequent tobacco smoking among never smokers; (2) associations of e-cigarette use frequency at baseline and tobacco smoking frequency at follow-up; and (3) the association of baseline tobacco smoking and subsequent e-cigarette use among non-users of e-cigarettes. FINDINGS Consistent with prior findings, baseline e-cigarette use was associated with higher odds of tobacco smoking at 6-month (OR=1.89; 95% CI 1.05 to 3.37) and 12-month (OR=5.63; 95% CI 3.04 to 10.42) follow-ups. More frequent use of e-cigarettes at baseline was associated with more frequent smoking at follow-ups. Baseline tobacco smoking was associated with subsequent e-cigarette use (OR=3.10; 95% CI 1.58 to 6.06 at both follow-ups). CONCLUSION Our study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.
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Affiliation(s)
- Thomas Martinelli
- IVO, The Hague, The Netherlands
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Math J J M Candel
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Hein de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - Reinskje Talhout
- Laboratory for Health Protection Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Vera Knapen
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | | | - Gera E Nagelhout
- IVO, The Hague, The Netherlands
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
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2
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Relationships between ENDS-Related Familial Factors and Oral Health among Adolescents in the United States. Healthcare (Basel) 2022; 10:healthcare10020402. [PMID: 35207015 PMCID: PMC8871736 DOI: 10.3390/healthcare10020402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/06/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
The influence of familial and social environments plays a significant role in Electronic Nicotine Delivery System (ENDS) use and may contribute to poor oral health among adolescents. This study utilized the Population Assessment of Tobacco and Health (PATH) database and included youths aged 12 to 17 years who reported no history of dental health issues at baseline. Adjusted odds ratios (AOR) were used to examine the association between END-related familial factors and oral health among adolescents in the United States, with statistical significance set at p < 0.05. The sample consisted of 3892 adolescents (weighted N = 22,689,793). Parents’ extremely negative reaction towards ENDS when they found their children using ENDS (AOR = 0.309) was connected to a lower risk of oral health issues. The findings suggest that clinicians and policymakers need to consider the roles of these factors when developing strategies to improve oral health outcomes.
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Hedman L, Backman H, Stridsman C, Lundbäck M, Andersson M, Rönmark E. Predictors of electronic cigarette use among Swedish teenagers: a population-based cohort study. BMJ Open 2020; 10:e040683. [PMID: 33376167 PMCID: PMC7778771 DOI: 10.1136/bmjopen-2020-040683] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES The aim was to identify predictors of electronic cigarette (e-cigarette) use among teenagers. DESIGN AND SETTING A prospective population-based cohort study of schoolchildren in northern Sweden. PARTICIPANTS In 2006, a cohort study about asthma and allergic diseases among schoolchildren started within the Obstructive Lung Disease in Northern Sweden studies. The study sample (n=2185) was recruited at age 7-8 years, and participated in questionnaire surveys at age 14-15 and 19 years. The questionnaire included questions about respiratory symptoms, living conditions, upper secondary education, physical activity, diet, health-related quality of life, parental smoking and parental occupation. Questions about tobacco use were included at age 14-15 and 19 years. PRIMARY OUTCOME E-cigarette use at age 19 years. RESULTS At age 19 years, 21.4% had ever tried e-cigarettes and 4.2% were current users. Among those who were daily tobacco smokers at age 14-15 years, 60.9% had tried e-cigarettes at age 19 years compared with 19.1% of never-smokers and 34.0% of occasional smokers (p<0.001). Among those who had tried e-cigarettes, 28.1% were never smokers both at age 14-15 and 19 years, and 14.4% were never smokers among the current e-cigarette users. In unadjusted analyses, e-cigarette use was associated with daily smoking, use of snus and having a smoking father at age 14-15 years, as well as with attending vocational education, physical inactivity and unhealthy diet. In adjusted analyses, current e-cigarette use was associated with daily tobacco smoking at age 14-15 years (OR 6.27; 95% CI 3.12 to 12.58), attending a vocational art programme (OR 2.22; 95% CI 1.04 to 4.77) and inversely associated with eating a healthy diet (OR 0.74; 95% CI 0.59 to 0.92). CONCLUSIONS E-cigarette use was associated with personal and parental tobacco use, as well as with physical inactivity, unhealthy diet and attending vocational upper secondary education. Importantly, almost one-third of those who had tried e-cigarettes at age 19 years had never been tobacco smokers.
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Affiliation(s)
- Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
- Department of Health Science, Division of Nursing, Luleå University of Technology, Luleå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University Faculty of Medicine, Umeå, Sweden
| | - Magnus Lundbäck
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN Unit, Umeå University Faculty of Medicine, Umeå, Sweden
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4
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Goldenson NI, Khoddam R, Stone MD, Leventhal AM. Associations of ADHD Symptoms With Smoking and Alternative Tobacco Product Use Initiation During Adolescence. J Pediatr Psychol 2019; 43:613-624. [PMID: 29304219 DOI: 10.1093/jpepsy/jsx153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 01/01/2023] Open
Abstract
Objective Recently, use of alternative tobacco products, such as electronic cigarettes (e-cigarettes) and hookah (water-pipe tobacco), has increased among adolescents. It is unknown whether attention-deficit hyperactivity disorder (ADHD) symptoms are associated with initiation of alternative tobacco product use. Methods Ninth grade high school students who never used any tobacco product at baseline (N = 1,921) participated in a longitudinal survey from 2014 to 2015. Overall symptomatology and inattention (IN) and hyperactivity-impulsivity (HI) ADHD subtypes were assessed at baseline. Past 6-month e-cigarette, hookah, and combustible cigarette use (yes/no) were reported at three semi-annual follow-ups. Repeated measures logistic regression models assessed the association of baseline ADHD symptoms with likelihood of tobacco product initiation across follow-ups. Results For ADHD main effect estimates, unadjusted odds of reporting e-cigarette, hookah, and combustible cigarette use pooled across follow-up time points were 45%, 33%, and 37% greater, respectively, with each increase in one SD-unit of baseline ADHD symptoms in baseline never-users of tobacco products. ADHD was not associated with hookah or combustible cigarette use after adjusting for other risk factors. After adjustment, e-cigarette use initiation remained associated with overall ADHD (odds ratio, OR [95%confidence interval, 95% CI] = 1.22 [1.04, 1.42]) and HI (OR [95% CI] = 1.26 [1.09, 1.47]) symptoms, but not IN symptoms (OR [95% CI] = 1.13 [0.97, 1.32]). ADHD × Time interactions were not significant, suggesting ADHD increased odds of e-cigarette use initiation but did not alter the shape of use trajectory across follow-up among initiators. Conclusions Understanding the psychosocial mechanisms underlying the pathway from ADHD to e-cigarette use may advance tobacco product use etiologic theory and prevention practice in the current era in which e-cigarette use is popular among youth.
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Affiliation(s)
- Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Rubin Khoddam
- Department of Psychology, University of Southern California
| | - Matthew D Stone
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine.,Department of Psychology, University of Southern California
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5
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Cho J, Goldenson NI, Stone MD, McConnell R, Barrington-Trimis JL, Chou CP, Sussman SY, Riggs NR, Leventhal AM. Characterizing Polytobacco Use Trajectories and Their Associations With Substance Use and Mental Health Across Mid-Adolescence. Nicotine Tob Res 2019; 20:S31-S38. [PMID: 30125023 PMCID: PMC6093375 DOI: 10.1093/ntr/ntx270] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/07/2017] [Indexed: 12/30/2022]
Abstract
Background Polytobacco product use is suspected to be common, dynamic across time, and increase risk for adverse behavioral outcomes. We statistically modeled characteristic types of polytobacco use trajectories during mid-adolescence and tested their prospective association with substance use and mental health problems. Methods Adolescents (N = 3393) in Los Angeles, CA, were surveyed semiannually from 9th to 11th grade. Past 6-month combustible cigarette, e-cigarette, or hookah use (yes/no) over four assessments were analyzed using parallel growth mixture modeling to identify a parsimonious set of polytobacco use trajectories. A tobacco product use trajectory group was used to predict substance use and mental health at the fifth assessment. Results Three profiles were identified: (1) tobacco nonusers (N = 2291, 67.5%) with the lowest use prevalence (<3%) of all products across all timepoints; (2) polyproduct users (N = 920, 27.1%) with moderate use prevalence of each product (8–35%) that escalated for combustible cigarettes but decreased for e-cigarettes and hookah across time; and (3) chronic polyproduct users (N = 182, 5.4%) with high prevalence of each product use (38–86%) that escalated for combustible cigarettes and e-cigarettes. Nonusers, polyproduct users, and chronic polyproduct users reported successively higher alcohol, marijuana, and illicit drug use and ADHD at the final follow-up, respectively. Both tobacco using groups (vs. nonusers) reported greater odds of depression and anxiety at the final follow-up but did not differ from each other. Conclusions Adolescent polytobacco use may involve a common moderate risk trajectory and a less common high-risk chronic trajectory. Both trajectories predict substance use and mental health symptomology. Implications Variation in use and co-use of combustible cigarette, e-cigarette, and hookah use in mid-adolescence can be parsimoniously characterized by a small set common trajectory profiles in which polyproduct use are predominant patterns of tobacco product use, which predict adverse behavioral outcomes. Prevention and policy addressing polytobacco use (relative to single product use) may be optimal tobacco control strategies for youth, which may in turn prevent other forms of substance use and mental health problems.
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Affiliation(s)
- Junhan Cho
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Nicholas I Goldenson
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Matthew D Stone
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, San Diego, CA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jessica L Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.,School of Social Work, University of Southern California, Los Angeles, CA
| | - Steven Y Sussman
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.,School of Social Work, University of Southern California, Los Angeles, CA.,Department of Psychology, University of Southern California, Los Angeles, CA
| | - Nathaniel R Riggs
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO
| | - Adam M Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA.,Department of Psychology, University of Southern California, Los Angeles, CA
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6
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Jongenelis MI, Brennan E, Slevin T, Kameron C, Jardine E, Rudaizky D, Pettigrew S. Factors associated with intentions to use e-cigarettes among Australian young adult non-smokers. Drug Alcohol Rev 2019; 38:579-587. [PMID: 31317596 DOI: 10.1111/dar.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS A growing body of evidence suggests e-cigarette use increases the risk of conventional cigarette use. Assessing the factors associated with intentions to use e-cigarettes can inform programs designed to minimise uptake, potentially assisting in preventing a new population of smokers. This study developed and tested a model assessing the importance of various factors that may be associated with intentions to use e-cigarettes among young adults who have never used e-cigarettes or tobacco cigarettes. DESIGN AND METHODS A web-panel provider recruited 429 Australian 18- to 25-year-olds who had never used e-cigarettes or smoked tobacco cigarettes (56% female, mean age = 21.17 years). Various individual and social factors were assessed as potential direct and indirect predictors of e-cigarette use intentions. RESULTS The developed model provided an excellent fit to the data and accounted for 49% of the variance in use intentions. Males had greater intentions to use e-cigarettes compared to females (β = -0.13). Having a greater number of friends who smoke tobacco cigarettes (β = 0.11) and curiosity about e-cigarette use (β = 0.58) were also directly associated with greater use intentions. Positive expectancies about e-cigarettes (β = 0.14), having family members who use e-cigarettes (β = 0.11), and having friends who smoke tobacco cigarettes (β = 0.07) were indirectly associated with intentions via curiosity. DISCUSSION AND CONCLUSIONS Curiosity about e-cigarette use was strongly associated with use intentions. Aspects of the social environment were also important. Further research is needed to identify effective means of challenging positive e-cigarette expectancies given these were found to be strongly associated with intentions via curiosity.
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Affiliation(s)
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Australia
| | - Terry Slevin
- School of Psychology, Curtin University, Perth, Australia.,Public Health Association of Australia, Canberra, Australia
| | - Caitlin Kameron
- School of Psychology, Curtin University, Perth, Australia.,Cancer Council WA, Perth, Australia
| | | | - Daniel Rudaizky
- School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia
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Bals R, Boyd J, Esposito S, Foronjy R, Hiemstra PS, Jiménez-Ruiz CA, Katsaounou P, Lindberg A, Metz C, Schober W, Spira A, Blasi F. Electronic cigarettes: a task force report from the European Respiratory Society. Eur Respir J 2019; 53:13993003.01151-2018. [PMID: 30464018 DOI: 10.1183/13993003.01151-2018] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/09/2018] [Indexed: 01/10/2023]
Abstract
There is a marked increase in the development and use of electronic nicotine delivery systems or electronic cigarettes (ECIGs). This statement covers electronic cigarettes (ECIGs), defined as "electrical devices that generate an aerosol from a liquid" and thus excludes devices that contain tobacco. Database searches identified published articles that were used to summarise the current knowledge on the epidemiology of ECIG use; their ingredients and accompanied health effects; second-hand exposure; use of ECIGs for smoking cessation; behavioural aspects of ECIGs and social impact; in vitro and animal studies; and user perspectives.ECIG aerosol contains potentially toxic chemicals. As compared to conventional cigarettes, these are fewer and generally in lower concentrations. Second-hand exposures to ECIG chemicals may represent a potential risk, especially to vulnerable populations. There is not enough scientific evidence to support ECIGs as an aid to smoking cessation due to a lack of controlled trials, including those that compare ECIGs with licenced stop-smoking treatments. So far, there are conflicting data that use of ECIGs results in a renormalisation of smoking behaviour or for the gateway hypothesis. Experiments in cell cultures and animal studies show that ECIGs can have multiple negative effects. The long-term effects of ECIG use are unknown, and there is therefore no evidence that ECIGs are safer than tobacco in the long term. Based on current knowledge, negative health effects cannot be ruled out.
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Affiliation(s)
- Robert Bals
- Dept of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | | | - Susanna Esposito
- Pediatric Clinic, Dept of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Robert Foronjy
- Pulmonary and Critical Care Medicine, SUNY Downstate Medical Center, New York, NY, USA
| | - Pieter S Hiemstra
- Dept of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Paraskevi Katsaounou
- 1st ICU Evangelismos Hospital, National Kapodistrian University of Athens, Athens, Greece
| | - Anne Lindberg
- Dept of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden
| | - Carlos Metz
- Dept of Internal Medicine V - Pulmonology, Allergology and Critical Care Medicine, Saarland University, Homburg, Germany
| | - Wolfgang Schober
- Bavarian Health and Food Safety Authority, Dept of Chemical Safety and Toxicology, Munich, Germany
| | - Avrum Spira
- Boston University School of Medicine, Boston, MA, USA
| | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, Università degli Studi di Milano, Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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Auf R, Trepka MJ, Selim M, Ben Taleb Z, De La Rosa M, Bastida E, Cano MÁ. E-cigarette use is associated with other tobacco use among US adolescents. Int J Public Health 2019; 64:125-134. [PMID: 30413840 PMCID: PMC6585986 DOI: 10.1007/s00038-018-1166-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To examine whether tobacco initiation via e-cigarettes increases the likelihood of subsequent tobacco use among a large representative sample of US adolescents. METHODS This study is a retrospective longitudinal analysis from a representative sample of US middle and high school students (n = 39,718) who completed the 2014 and 2015 National Youth Tobacco Survey. The adjusted odds ratios of lifetime and current use of tobacco use were estimated by logistic regression analysis while controlling for important socio-ecological factors associated with tobacco use. RESULTS E-cigarette initiators were more likely to report current use of cigarettes (AOR 2.7; 1.9-4.0, p < 0.001), cigars (AOR 1.7; 1.2-2.4, p < 0.01), or smokeless tobacco (AOR 3.1; 2.2-5.4, p < 0.001), and lifetime use of the same products as well. Also, lifetime and current use of e-cigarettes significantly increased the likelihood of cigarettes, cigars, and smokeless tobacco use. CONCLUSIONS Initiation of tobacco via e-cigarette, lifetime, and current use of e-cigarettes are associated with higher odds of lifetime and current use of cigarettes, cigars, and smokeless tobacco. Collectively this suggests e-cigarettes may lead to an increased use of tobacco among adolescents.
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Affiliation(s)
- Rehab Auf
- Department of Health, Human Performance, and Leisure (HHPL), College of Arts and Science (COAS), Howard University, Washington, DC, 20059, USA.
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA.
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, 33199, USA
| | - Mazen Selim
- Jackson South Community Hospital, Miami, FL, 33176, USA
| | - Ziyad Ben Taleb
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, 33199, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Elena Bastida
- Department of Health Promotion, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, 33199, USA
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL, 33199, USA
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Auf R, Trepka MJ, Selim M, Ben Taleb Z, De La Rosa M, Cano MÁ. E-cigarette marketing exposure and combustible tobacco use among adolescents in the United States. Addict Behav 2018; 78:74-79. [PMID: 29127787 DOI: 10.1016/j.addbeh.2017.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/27/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022]
Abstract
E-cigarette advertising has been shown to be associated with use of e-cigarettes, but its association with tobacco use has not been studied. Therefore, we examined the association between e-cigarettes advertisement and tobacco use. Data from nationally representative 22,007 middle and high school students (grades 6-12) were used to conduct the analysis. Logistic regression models estimated the adjusted odds ratios (AOR) of ever and current use of cigarette, hookah, cigar, and polytobacco use. Odds ratios were weighted and adjusted for study design, non-response rates, school level, gender, race/ethnicity, e-cigarette use, and smoking at home. E-cigarette marketing exposure was significantly associated with ever use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.5), hookah (AOR: 1.4, 95% CI: 1.2-1.7), cigars (AOR: 1.5, 95% CI: 1.4-1.6), and polytobacco (AOR: 1.7, 95% CI: 1.5-1.8). Likewise, E-cigarette marketing exposure was significantly associated with current use of cigarettes (AOR: 1.3, 95% CI: 1.1-1.6), hookah (AOR: 1.3, 95% CI: 1.03-1.7), cigars (AOR: 1.3, 95% CI: 1.1-1.6), and polytobacco use (AOR: 1.8, 95% CI: 1.5-2.1). The results suggest that e-cigarette advertisement is associated with use of cigarettes, hookah, cigars, and polytobacco products. These results add to the evidence about the risks of e-cigarette marketing and highlight the need for stricter regulation of e-cigarette advertisements.
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Affiliation(s)
- Rehab Auf
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA.
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; Center for Research on U.S. Latino HIV/AIDS and Drug Abuse [CRUSADA], Florida International University, Miami, FL 33199, USA
| | - Moaz Selim
- Jackson South Community Hospital, Miami, FL 33176, USA
| | - Ziyad Ben Taleb
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA
| | - Mario De La Rosa
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse [CRUSADA], Florida International University, Miami, FL 33199, USA; School of Social Work, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA
| | - Miguel Ángel Cano
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL 33199, USA; Center for Research on U.S. Latino HIV/AIDS and Drug Abuse [CRUSADA], Florida International University, Miami, FL 33199, USA
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10
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Wang JW, Cao SS, Hu RY. Smoking by family members and friends and electronic-cigarette use in adolescence: A systematic review and meta-analysis. Tob Induc Dis 2018; 16:05. [PMID: 31516405 PMCID: PMC6659504 DOI: 10.18332/tid/84864] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/15/2018] [Accepted: 01/28/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Evidence suggests that smoking by family members and friends is a strong predictor of smoking uptake in adolescents, yet the influence on electronic cigarette (e-cigarette) use has not been systematically reviewed and quantified. METHODS Relevant studies were identified by searches of the PubMed and ScienceDirect databases up to December 2016. The summary odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS A total of 21 studies were included in this meta-analysis. A positive association was observed between adolescent e-cigarette use and smoking by family members (OR=1.47, 95% CI=1.30-1.66) and friends (OR=2.72, 95% CI=1.87-3.95), even after adjusting for the individual smoking status. Stratified by family members, the association with smoking in siblings (OR=1.87, 95% CI=1.35-2.60) was more prominent than that in parents (OR=1.41, 95% CI=1.191-.68) and other family members (OR=1.39, 95% CI=1.12-1.72). CONCLUSIONS The present meta-analysis suggests that smoking by family members and friends is significantly associated with increased probability of e-cigarette use in adolescents.
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Affiliation(s)
- Jian-Wei Wang
- Yidu Central Hospital of Weifang, Qingzhou, Shandong, China
| | | | - Ru-Ying Hu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Kong G, Kuguru KE, Krishnan-Sarin S. Gender Differences in U.S. Adolescent E-Cigarette Use. CURRENT ADDICTION REPORTS 2017; 4:422-430. [PMID: 29545987 DOI: 10.1007/s40429-017-0176-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Purpose of Review This study aims to review the recent (2012-2017) available gender difference data on e-cigarette use among adolescents. Recent Findings E-cigarettes are the most commonly used tobacco product among adolescents, and recent study findings showed that e-cigarette use can lead to cigarette smoking. However, gender differences in e-cigarette use among adolescents are relatively unknown. Summary We used the search terms "adolescents" and "e-cigarettes" on PubMed and identified 652 articles. Of these, 16 articles (2.5%) examined gender differences in adolescent e-cigarette use. Boys appear to have greater use of e-cigarettes, but girls may be at increased risk if e-cigarettes are targeted to them, as it has been for cigarettes. Data on gender differences are limited, and future research should continue to examine gender differences in e-cigarette use. Trends in use rates could evolve with new regulations and innovations in e-cigarette marketing and product features.
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, 34 Park Street, Room S-211, New Haven, CT 06519, USA
| | - Karissa E Kuguru
- Yale School of Medicine, 34 Park Street, Room S-211, New Haven, CT 06519, USA
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kinnunen JM, Ollila H, Lindfors PL, Rimpelä AH. Changes in Electronic Cigarette Use from 2013 to 2015 and Reasons for Use among Finnish Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111114. [PMID: 27834885 PMCID: PMC5129324 DOI: 10.3390/ijerph13111114] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 01/01/2023]
Abstract
Electronic cigarettes are quite a new potential source of nicotine addiction among youth. More research is needed, particularly on e-liquid use and socioeconomic factors as potential determinants. We studied changes from 2013 to 2015 in adolescent e-cigarette awareness and ever-use, types of e-liquids, and determinants in Finland. In 2015, we studied weekly use and reasons for ever-use. Data were from two national surveys of 12–18-year-old Finns (2013, n = 3535, response rate 38%; 2015, n = 6698, 41%). Descriptive statistics and logistic regression analysis were used. Awareness and ever-use of e-cigarettes increased significantly from 2013 to 2015 in all age and gender groups. Ever-use increased from 17.4% to 25%, with half having tried nicotine e-liquids. In 2015, weekly use was rare (1.5%). Daily cigarette smoking was the strongest determinant (OR 51.75; 95% CI 38.18–70.14) for e-cigarette ever-use, as for e-cigarette weekly use, but smoking experimentation and ever-use of snus (Swedish type moist snuff) and waterpipes alongside parental smoking and poor academic achievement also increased the odds for ever-use. The most common reason behind e-cigarette ever-use was the desire to try something new. To conclude, adolescent e-cigarette ever-use is increasing, and also among never-smokers. Tobacco-related factors are stronger determinants for e-cigarette use than socioeconomic factors.
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Affiliation(s)
- Jaana M Kinnunen
- School of Health Sciences, University of Tampere, 33014 Tampere, Finland.
| | - Hanna Ollila
- Department of Health, National Institute for Health and Welfare, 00271 Helsinki, Finland.
| | - Pirjo L Lindfors
- School of Health Sciences, University of Tampere, 33014 Tampere, Finland.
- PERLA-Tampere Centre for Childhood, Youth and Family Research, University of Tampere, 33014 Tampere, Finland.
| | - Arja H Rimpelä
- School of Health Sciences, University of Tampere, 33014 Tampere, Finland.
- PERLA-Tampere Centre for Childhood, Youth and Family Research, University of Tampere, 33014 Tampere, Finland.
- Department of Adolescent Psychiatry, Pitkäniemi Hospital, Tampere University Hospital, 33380 Nokia, Finland.
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Khoury M, Manlhiot C, Fan CPS, Gibson D, Stearne K, Chahal N, Dobbin S, McCrindle BW. Reported electronic cigarette use among adolescents in the Niagara region of Ontario. CMAJ 2016; 188:794-800. [PMID: 27431303 PMCID: PMC4978575 DOI: 10.1503/cmaj.151169] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 03/11/2016] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Use of electronic cigarettes (e-cigarettes) among adolescents has not been fully described, in particular their motivations for using them and factors associated with use. We sought to evaluate the frequency, motivations and associated factors for e-cigarette use among adolescents in Ontario. METHODS We conducted a cross-sectional study in the Niagara region of Ontario, Canada, involving universal screening of students enrolled in grade 9 in co-operation with the Heart Niagara Inc. Healthy Heart Schools' Program (for the 2013-2014 school year). We used a questionnaire to assess cigarette, e-cigarette and other tobacco use, and self-rated health and stress. We assessed household income using 2011 Canadian census data by matching postal codes to census code. RESULTS Of 3312 respondents, 2367 answered at least 1 question in the smoking section of the questionnaire (1274 of the 2367 respondents [53.8%] were male, with a mean [SD] age of 14.6 [0.5] yr) and 2292 answered the question about use of e-cigarettes. Most respondents to the questions about use of e-cigarettes (n = 1599, 69.8%) had heard of e-cigarettes, and 380 (23.8%) of these respondents had learned about them from a store sign or display. Use of e-cigarettes was reported by 238 (10.4%) students. Most of the respondents who reported using e-cigarettes (171, 71.9%) tried them because it was "cool/fun/new," whereas 14 (5.8%) reported using them for smoking reduction or cessation. Male sex, recent cigarette or other tobacco use, family members who smoke and friends who smoke were strongly associated with reported e-cigarette use. Reported use of e-cigarettes was associated with self-identified fair/poor health rating (odds ratio [OR] 1.9 (95% confidence interval [CI] 1.2-3.0), p < 0.001), high stress level (OR 1.7 (95% CI 1.1-2.7), p < 0.001) and lower mean (33.4 [8.4] × $1000 v. 36.1 [10.7] × $1000, p = 0.001) and median [interquartile range] (26.2 [5.6] × $1000 v. 28.1 [5.7] × $1000) household incomes. INTERPRETATION Use of e-cigarettes is common among adolescents in the Niagara region and is associated with sociodemographic features. Engaging in seemingly exciting new behaviours appears to be a key motivating factor rather than smoking cessation.
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Affiliation(s)
- Michael Khoury
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Cedric Manlhiot
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Chun-Po Steve Fan
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Don Gibson
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Karen Stearne
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Nita Chahal
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Stafford Dobbin
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont
| | - Brian W McCrindle
- Department of Pediatrics (Khoury, Manlhiot, Fan, Chahal, McCrindle), Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ont.; Heart Niagara Inc. (Gibson, Stearne, Dobbin), Niagara Falls, Ont.
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Echevarria C, Sinha IP. Heterogeneity in the measurement and reporting of outcomes in studies of electronic cigarette use in adolescents: a systematic analysis of observational studies. Tob Control 2016; 26:247-253. [PMID: 27129981 DOI: 10.1136/tobaccocontrol-2015-052881] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 04/07/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine consistency between cross-sectional studies of conventional and electronic cigarette use among adolescents in terms of the measurement, analysis and reporting of parameters. DESIGN A systematic analysis of cross-sectional studies of conventional and electronic cigarette use in adolescents, to identify measured and reported parameters. DATA SOURCES Studies examining use of electronic and conventional cigarette use in adolescents were identified by searching the SCOPUS database in August 2015. STUDY SELECTION The selection criteria for studies were: cross-sectional studies, in English, on e-cigarette use in adolescents. Two reviewers independently selected relevant studies from the search. 60 abstracts were identified, from which 31 papers were eligible for review (23 unique studies). DATA EXTRACTION Measured and reported parameters were identified and tabulated. These included the prevalence of cigarette and/ or electronic cigarette use, and the definitions of terms. Data were extracted independently by two reviewers. DATA SYNTHESIS With regards basic parameters of 'ever' or 'current' use of electronic or conventional cigarettes, there were 31 unique measured parameters across 23 studies. Of 16/23 studies in which authors collected information on dual current use, prevalence was reported in 11/16, with six different definitions of 'dual use'. CONCLUSIONS There are substantial differences in measurement and reporting of parameters across observational studies of electronic and conventional cigarette use in adolescents. These studies are at risk of reporting bias, and results are difficult to interpret. A core outcome set that should be measured and reported in all observational studies is required, using structured consensus techniques.
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Affiliation(s)
- Carlos Echevarria
- Respiratory Department, North Tyneside General Hospital, North Shields, UK
| | - Ian P Sinha
- Respiratory Department, Alder Hey Children's Hospital, Liverpool, UK
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Zhang X, Pu J. E-cigarette use among US adolescents: secondhand smoke at home matters. Int J Public Health 2016; 61:209-13. [PMID: 26781545 DOI: 10.1007/s00038-015-0784-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 12/28/2015] [Accepted: 12/29/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To examine the association of family smoking status and exposure to secondhand smoke (SHS) at home with the use of electronic cigarettes among US adolescents, in particular the medication effect of SHS on the association between family smoking status and electronic cigarette use. METHODS Data from the 2013 National Youth Tobacco Survey were used and logistic regressions were conducted to model electronic cigarettes use. The mediation effect of SHS was tested using the Sobel-Goodman mediation test. RESULTS Overall, 8.1 % of the US adolescents reported ever use of e-cigarettes. Among both the overall population and never-cigarette smokers, adolescents living in smoker households were significantly more likely to report ever use of e-cigarettes (p < 0.05). However, the associations were attenuated after including SHS exposure at home during the past 7 days. SHS exposure at home was positively associated with ever use of e-cigarettes, adjusting for family smoking status (p < 0.05). CONCLUSIONS The association between smoking habits of the family and e-cigarette use was mediated through SHS exposure. The promotion of smoke-free home rules may help prevent the uptake of e-cigarettes among teenagers.
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Affiliation(s)
- Xiao Zhang
- UW Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.
| | - Jia Pu
- Mathematica Policy Research, Oakland, CA, USA
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Leventhal AM, Strong DR, Kirkpatrick MG, Unger JB, Sussman S, Riggs NR, Stone MD, Khoddam R, Samet JM, Audrain-McGovern J. Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence. JAMA 2015; 314:700-7. [PMID: 26284721 PMCID: PMC4771179 DOI: 10.1001/jama.2015.8950] [Citation(s) in RCA: 679] [Impact Index Per Article: 75.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Exposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco. OBJECTIVE To evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah). DESIGN, SETTING, AND PARTICIPANTS Longitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections. EXPOSURE Student self-report of whether he or she ever used e-cigarettes (yes or no) at baseline. MAIN OUTCOMES AND MEASURES Six- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3). RESULTS Past 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods. CONCLUSIONS AND RELEVANCE Among high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.
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Affiliation(s)
- Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
- Corresponding author: Adam M. Leventhal, Ph.D., University of Southern California, Keck School of Medicine, 2250 Alcazar St. CSC 271, Los Angeles, CA 90033, USA; , Phone: 323-442-8222, Fax: 323-442-2359
| | - David R. Strong
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, CA
| | - Matthew G. Kirkpatrick
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Jennifer B. Unger
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
- School of Social Work, University of Southern California, Los Angeles, CA
| | - Nathaniel R. Riggs
- Department of Human Development & Family Studies, Colorado State University, Fort Collins, CO
| | - Matthew D. Stone
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Rubin Khoddam
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
- Department of Psychology, University of Southern California, Los Angeles, CA
| | - Jonathan M. Samet
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA
| | - Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Alawsi F, Nour R, Prabhu S. Are e-cigarettes a gateway to smoking or a pathway to quitting? Br Dent J 2015; 219:111-5. [DOI: 10.1038/sj.bdj.2015.591] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 01/04/2023]
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Biyani S, Derkay CS. E-cigarettes: Considerations for the otolaryngologist. Int J Pediatr Otorhinolaryngol 2015; 79:1180-3. [PMID: 25998217 DOI: 10.1016/j.ijporl.2015.04.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/18/2015] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To review the literature regarding electronic cigarettes and discuss potential implications and need for advocacy for the pediatric otolaryngologist. BACKGROUND Electronic cigarettes (e-cigarettes) are battery-operated devices that deliver nicotine-containing vapors via inhalation. Research on the health related consequences of e-cigarettes is ongoing and safety has yet to be established. E-cigarettes are not presently under the regulation of any national governing body with wide accessibility to minors. Use of these products has substantially increased since arrival to the market, particularly within the adolescent population. These products are marketed via various platforms including television, Internet and social media. Hundreds of flavors are offered and e-cigarettes are packaged in various colors. Not only are the ill health effects and addictive quality of nicotine concerning, these products have the potential to serve as a gateway for minors to tobacco use. APPLICATIONS The relationship between tobacco use, secondhand smoke exposure and otolaryngology specific diseases has well been defined. As use of electronic cigarettes increases, pediatric otolaryngologists should be aware of the ongoing literature regarding these products and to be prepared to counsel families accordingly. CONCLUSIONS The use of e-cigarettes among teenagers, potential implications of secondhand vapor exposure from parents and friends, and concerns this may encourage adolescents to utilize conventional tobacco products needs to be considered.
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Affiliation(s)
- Sneh Biyani
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - Craig S Derkay
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA, USA; Children's Hospital of the King's Daughters, Norfolk, VA, USA
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