Use of E-cigarettes and Other Tobacco Products and Progression to Daily Cigarette Smoking

In this cohort study, we examine the age at first experimentation and daily use of multiple tobacco products and then investigate predictors of progression to daily cigarette smoking. OBJECTIVES: To identify predictors of becoming a daily cigarette smoker over the course of 4 years. METHODS: We identified 12- to 24-year-olds at wave 1 of the US Population Assessment of Tobacco and Health Study and determined ever use, age at first use, and daily use through wave 4 for 12 tobacco products. RESULTS: Sixty-two percent of 12- to 24-year-olds (95% confidence interval [CI]: 60.1% to 63.2%) tried tobacco, and 30.2% (95% CI: 28.7% to 31.6%) tried >= 5 tobacco products by wave 4. At wave 4, 12% were daily tobacco users, of whom 70% were daily cigarette smokers (95% CI: 67.4% to 73.0%); daily cigarette smoking was 20.8% in 25- to 28-year-olds (95% CI: 18.9% to 22.9%), whereas daily electronic cigarette (e-cigarette) vaping was 3.3% (95% CI: 2.4% to 4.4%). Compared with single product triers, the risk of progressing to daily cigarette smoking was 15 percentage points higher (adjusted risk difference [aRD] 15%; 95% CI: 12% to 18%) among those who tried >= 5 products. In particular, e-cigarette use increased the risk of later daily cigarette smoking by threefold (3% vs 10%; aRD 7%; 95% CI: 6% to 9%). Daily smoking was 6 percentage points lower (aRD -6%; 95% CI: -8% to -4%) for those who experimented after age 18 years. CONCLUSIONS: Trying e-cigarettes and multiple other tobacco products before age 18 years is strongly associated with later daily cigarette smoking. The recent large increase in e-cigarette use will likely reverse the decline in cigarette smoking among US young adults.

Automated summary

Young people who try e-cigarettes and multiple other tobacco products, and start before the age of 18, are strongly associated with the risk of later daily cigarette smoking. The recent increase in e-cigarette use may reverse the decline in smoking among young adults in the US.