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Cited by 179Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesImpact of Technology on Adolescents

Associations of Electronic Cigarette Nicotine Concentration With Subsequent Cigarette Smoking and Vaping Levels in Adolescents

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Goldenson, Nicholas I., Leventhal, Adam M., Stone, Matthew D., McConnell, Rob S., Barrington-Trimis, Jessica L.·2017·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2017.3209PMC PMC5779618
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Abstract

Importance: Research indicates that electronic cigarette (e-cigarette) use (vaping) among adolescents is associated with the initiation and progression of combustible cigarette smoking. The reasons for this association are unknown. Objective: To evaluate whether use of e-cigarettes with higher nicotine concentrations is associated with subsequent increases in the frequency and intensity of combustible cigarette smoking and vaping. Design, Setting, and Participants: In this prospective cohort study involving students from 10 high schools in the Los Angeles, California, metropolitan area, surveys were administered during 10th grade in the spring (baseline) and 11th grade in the fall (6-month follow-up) of 2015 to students who reported using e-cigarettes within the past 30 days and the nicotine concentration level they used at baseline. Exposures: Self-report of baseline e-cigarette nicotine concentration of none (0 mg/mL), low (1-5 mg/mL), medium (6-17 mg/mL), or high (≥18 mg/mL) typically used during the past 30 days. Main Outcomes and Measures: Frequency of combustible cigarette smoking and e-cigarette use within the past 30 days (0 days [none], 1-2 days [infrequent], or ≥3 days [frequent]) and daily intensity of smoking and vaping (number of cigarettes smoked per day, number of vaping episodes per day, and number of puffs per vaping episode) at the 6-month follow-up. Results: The analytic sample included 181 students (96 boys [53.0%] and 85 girls [47.0%]; mean [SD] age, 16.1 [0.4] years). Each successive increase in nicotine concentration (none to low, low to medium, and medium to high) vaped was associated with a 2.26 (95% CI, 1.28-3.98) increase in the odds of frequent (vs no) smoking and a 1.65 (95% CI, 1.09-2.51) increase in the odds of frequent (vs no) vaping at follow-up after adjustment for baseline frequency of smoking and vaping and other relevant covariates. Use of e-cigarettes with high (vs no) nicotine concentration was associated with a greater number of cigarettes smoked per day at follow-up (adjusted rate ratio [RR], 7.03; 95% CI, 6.11-7.95). An association with a significantly greater number of vaping episodes per day was found with use of low (adjusted RR, 3.32; 95% CI, 2.61-4.03), medium (adjusted RR, 3.32; 95% CI, 2.54-4.10), and high (adjusted RR, 2.44; 95% CI, 1.63-3.24) nicotine concentrations (vs no nicotine) at baseline. Similar results were found for the number of puffs per vaping episode for low (adjusted RR, 2.05; 95% CI, 1.41-2.70), medium (adjusted RR, 3.39; 95% CI, 2.66-4.11), and high (adjusted RR, 2.23; 95% CI, 1.42-3.03) nicotine concentrations. Conclusions and Relevance: The results of this study provide preliminary evidence that use of e-cigarettes with higher nicotine concentrations by youths may increase subsequent frequency and intensity of smoking and vaping.

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  • More adolescents are inclined to transition from vaping to conventional cigarettes, reversing a two-decade-long decline.

    “Moreover, more adolescents are inclined to transition from vaping to conventional cigarettes, reversing a two-decade-long decline [166–169].”

    From Adolescent nicotine exposure and persistent neurocircuitry changes: unveiling lifelong psychiatric risks (2025) · cites this paper as [169]

    The Introduction says adolescents who vape are more likely to subsequently initiate or progress to cigarette smoking, and the Conclusions report smoking progression over six months among adolescent vapers using higher-nicotine e-cigarettes. The paper does not establish that increasing numbers of adolescents are making that transition or that vaping has reversed a two-decade decline in cigarette smoking. (LLM, conf=0.88)

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Authors
Goldenson, N. I., Leventhal, A. M., Stone, M. D., McConnell, R. S., & Barrington-Trimis, J. L.
Affiliations
  • University of Southern California (US)
  • Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
Corresponding author
Leventhal, Adam M.
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2017-12-01
Volume
171
Issue
12
Pages
1192
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2017.3209
PMC
PMC5779618
OpenAlex
W2765098017
Cited by
179
References
41
Citations by year
2026: 8 · 2025: 8 · 2024: 14 · 2023: 13 · 2022: 19 · 2021: 28 · 2020: 49 · 2019: 23 · 2018: 16 · 2014: 1
FWCI
17.81
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Drug Abuse (R01DA033296)
  • National Cancer Institute (P50CA180905)
  • National Institute of Environmental Health Sciences (P30ES007048)
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, adolescent smoking, combustible cigarette smoking, vaping, smoking initiation, smoking progression, nicotine dependence, adolescent substance use, high school students, smoking intensity, dual use of tobacco products, tobacco control, school-based prevention, Los Angeles, California, United States
MeSH terms
Adolescent, Adolescent Behavior, Female, Humans, Longitudinal Studies, Male, Nicotine, Risk Factors, Smoking, Los Angeles, Self Report, Tobacco Products, Electronic Nicotine Delivery Systems

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