E-cigarette use and willingness to smoke: a sample of adolescent non-smokers

Abstract

Objective: There is little evidence on the consequences of using electronic cigarettes (e-cigarette) in adolescence. With a multiethnic sample of non-smokers, we assessed the relation between e-cigarette use and social-cognitive factors that predict smoking of combustible cigarettes.

Methods: School-based cross-sectional survey of 2309 high school students (mean age 14.7 years). Participants reported on e-cigarette use and cigarette use; on smoking-related cognitions (smoking expectancies, prototypes of smokers) and peer smoker affiliations; and on willingness to smoke cigarettes. Regression analyses conducted for non-cigarette smokers tested the association between e-cigarette use and willingness to smoke cigarettes, controlling for demographics, parenting, academic and social competence, and personality variables. Structural equation modelling (SEM) analysis tested whether the relation between e-cigarette use and willingness to smoke was mediated through any of the three smoking-related variables.

Results: Non-smokers who had used e-cigarettes (18% of the total sample) showed more willingness to smoke cigarettes compared with those who had never used any tobacco product; the adjusted OR was 2.35 (95% CI 1.73 to 3.19). SEM showed that the relation between e-cigarette use and willingness to smoke was partly mediated through more positive expectancies about smoking, but there was also a direct path from e-cigarette use to willingness.

Conclusions: Among adolescent non-smokers, e-cigarette use is associated with willingness to smoke, a predictor of future cigarette smoking. The results suggest that use of e-cigarettes by adolescents is not without attitudinal risk for cigarette smoking. These findings have implications for formulation of policy about access to e-cigarettes by adolescents.

Keywords: Addiction; Electronic nicotine delivery devices; Public policy.

Figure 1

Structural model for relation between e-cigarette use and willingness to smoke cigarettes. Straight single-headed arrows are regression (path) effects, curved double-headed arrows indicate covariances. Values are standardized coefficients. ** indicates coefficient significant at p < .01; *** p < .001; **** p < .0001. Values in circles at top of figure are squared multiple correlation ns, the variance accounted for in a given construct by all constructs to the left of it in the model. Residual correlations among endogenous variables are in box in figure. For correlations among exogenous variables, included in the model but excluded from the figure, see Table 3. Parental support was included in the model but had no significant unique effects. Demographics (gender, ethnicity, family structure, and parental education) were included in the model but are excluded from the figure for graphical simplicity.