What it is that triggers a teen to smoke? There is significant concern with the changing epidemiology that e-cigarettes are driving increased use. Owotomo et al (10.1542/peds.2020-002881) share with us data derived from two “waves” of the longitudinal prospective cohort study of tobacco use called the Population Assessment of Tobacco and Health (PATH) Study, with data collection in 2014-15 (n=8661) and again in 2015-16 (n=8242). In the first wave of collected data, more than 8,600 teens who had never smoked were surveyed as to whether they had any intention of wanting to smoke conventional cigarettes and whether or not they had ever used an e-cigarette. A year later, these same teens were asked if they were smoking combustible cigarettes. Teens who responded to either question (intention to smoke or currently using e-cigarettes) were found to be more likely using conventional cigarettes one year later than those who did not respond positively to these questions.
What makes this study even more interesting is what happens when you look at both questions separately. For example, for those who indicated in the first wave they intend to smoke cigarettes but had not yet, the odds of smoking cigarettes was higher than those who had no intention of smoking, but was unaffected as to whether or not e-cigarettes were also being used. On the other hand, among teens who had no intention of smoking cigarettes but were using e-cigarettes, the odds of smoking tobacco cigarettes were four times higher than teens who had not yet tried e-cigarettes but intended to smoke.
The initiation of combustible tobacco cigarette smoking is strongly associated with the use of e-cigarettes. This study also suggests the potential benefit of prevention and education strategies to discourage teens from using vaping products. There is much more information to smoke out in this study so link to it and then share what you learn with your adolescent patients and perhaps with the schools in your community who might further target their efforts to teach adolescents the dangers of vaping and e-cigarettes.