Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. Objective: To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. Data Sources: PubMed, EMBASE, Cochrane Library, Web of Science, the 2016 Society for Research on Nicotine and Tobacco 22nd Annual Meeting abstracts, the 2016 Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions abstracts, and the 2016 National Institutes of Health Tobacco Regulatory Science Program Conference were searched between February 7 and February 17, 2017. The search included indexed terms and text words to capture concepts associated with e-cigarettes and traditional cigarettes in articles published from database inception to the date of the search. Study Selection: Longitudinal studies reporting odds ratios for cigarette smoking initiation associated with ever use of e-cigarettes or past 30-day cigarette smoking associated with past 30-day e-cigarette use. Searches yielded 6959 unique studies, of which 9 met inclusion criteria (comprising 17 389 adolescents and young adults). Data Extraction and Synthesis: Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale and the Risk of Bias in Non-randomized Studies of Interventions tool, respectively. Data and estimates were pooled using random-effects meta-analysis. Main Outcomes and Measures: Among baseline never cigarette smokers, cigarette smoking initiation between baseline and follow-up. Among baseline non-past 30-day cigarette smokers who were past 30-day e-cigarette users, past 30-day cigarette smoking at follow-up. Results: Among 17 389 adolescents and young adults, the ages ranged between 14 and 30 years at baseline, and 56.0% were female. The pooled probabilities of cigarette smoking initiation were 30.4% for baseline ever e-cigarette users and 7.9% for baseline never e-cigarette users. The pooled probabilities of past 30-day cigarette smoking at follow-up were 21.5% for baseline past 30-day e-cigarette users and 4.6% for baseline non-past 30-day e-cigarette users. Adjusting for known demographic, psychosocial, and behavioral risk factors for cigarette smoking, the pooled odds ratio for subsequent cigarette smoking initiation was 3.62 (95% CI, 2.42-5.41) for ever vs never e-cigarette users, and the pooled odds ratio for past 30-day cigarette smoking at follow-up was 4.28 (95% CI, 2.52-7.27) for past 30-day e-cigarette vs non-past 30-day e-cigarette users at baseline. A moderate level of heterogeneity was observed among studies (I2 = 60.1%). Conclusions and Relevance: e-Cigarette use was associated with greater risk for subsequent cigarette smoking initiation and past 30-day cigarette smoking. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking.
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Teen e-cigarette use is associated with higher risk of later starting and continuing cigarette smoking.
“teen e-cigarette use is associated with greater risk for subsequent initiation and continuation of cigarette smoking”
From Unique, long-term effects of nicotine on adolescent brain. (2020) · cites this paper as Soneji et al, 2017
The Abstract Results and Conclusions report an association between e-cigarette use and later cigarette-smoking initiation and past-30-day cigarette smoking. But the Methods (Statistical Analysis) specify that the later-smoking analysis involved people who were not current cigarette smokers at baseline; it does not establish that e-cigarette use was associated with continuing to smoke cigarettes among existing smokers. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIt is possible that e-cigarettes may result in greater cigarette initiation in adolescence than would otherwise be expected.
“it is possible that e-cigarettes may result in greater cigarette initiation in adolescence than would otherwise be expected”
From Trends in the age of cigarette smoking initiation among young adults in the US from 2002 to 2018 (2020) · cites this paper as [27]
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“Additionally, we found that older age, being Non-Hispanic White, and using other tobacco products were significantly associated with subsequent cigarette smoking in our study, consistent with findings reported in previous studies [8,10,29,32].”
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- Authors
- Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A., Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornik, R. C., Dang, R., & Sargent, J. D.
- Affiliations
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Department of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles
- University of Hawaii Cancer Center (US)
- University of Southern California (US)
- University of Pennsylvania (US)
- currently a medical student at Warren Alpert Medical School of Brown University, Providence, Rhode Island
- University of Pittsburgh (US)
- Oregon Research Institute (US)
- University of Michigan (US)
- Virginia Commonwealth University (US)
- Corresponding author
- Soneji, Samir
- ORCID
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2017-08-01
- Volume
- 171
- Issue
- 8
- Pages
- 788
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5656237
- OpenAlex
- W2698106459
- Cited by
- 1,170
- References
- 42
- Citations by year
- 2026: 55 · 2025: 89 · 2024: 110 · 2023: 125 · 2022: 132 · 2021: 150 · 2020: 193 · 2019: 170 · 2018: 122 · 2017: 24
- FWCI
- 17.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (P50CA179546, R01CA153154, P50CA180905, P30CA023108)
- National Institute on Minority Health and Health Disparities (U54MD007584)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Keywords
- electronic cigarettes, cigarette smoking initiation, adolescents, young adults, vaping
- MeSH terms
- Adolescent, Adolescent Behavior, Female, Humans, Male, Risk Factors, Smoking, Tobacco Use Disorder, Smoking Cessation, Disease Progression, Young Adult, Electronic Nicotine Delivery Systems
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