E-cigarettes and National Adolescent Cigarette Use: 2004-2014

Abstract

Background: E-cigarette use is rapidly increasing among adolescents in the United States, with some suggesting that e-cigarettes are the cause of declining youth cigarette smoking. We hypothesized that the decline in youth smoking changed after e-cigarettes arrived on the US market in 2007.

Methods: Data were collected by using cross-sectional, nationally representative school-based samples of sixth- through 12th-graders from 2004-2014 National Youth Tobacco Surveys (samples ranged from 16 614 in 2013 to 25 324 in 2004). Analyses were conducted by using interrupted time series of ever (≥1 puff) and current (last 30 days) cigarette smoking. Logistic regression was used to identify psychosocial risk factors associated with cigarette smoking in the 2004-2009 samples; this model was then applied to estimate the probability of cigarette smoking among cigarette smokers and e-cigarette users in the 2011-2014 samples.

Results: Youth cigarette smoking decreased linearly between 2004 and 2014 (P = .009 for ever smoking and P = .05 for current smoking), with no significant change in this trend after 2009 (P = .57 and .23). Based on the psychosocial model of smoking, including demographic characteristics, willingness to wear clothing with a tobacco logo, living with a smoker, likelihood of smoking in the next year, likelihood of smoking cigarettes from a friend, and use of tobacco products other than cigarettes or e-cigarettes, the model categorized <25% of current e-cigarette-only users (between 11.0% in 2012 and 23.1% in 2013) as current smokers.

Conclusions: The introduction of e-cigarettes was not associated with a change in the linear decline in cigarette smoking among youth. E-cigarette-only users would be unlikely to have initiated tobacco product use with cigarettes.

FIGURE 1

The advent of e-cigarettes did not affect declining trends in ever (≥1 puff lifetime; top panel) or current (use in past 30 days; bottom panel) cigarette use in the NYTS, including dual use with e-cigarettes (dark-gray, cross-hatched shading). E-cigarette–only users (light-gray shading) are in addition to youth who are smoking cigarettes and are at low risk of having initiated tobacco products with cigarettes. (E-cigarette use, defined by using the same criteria as cigarettes, was assessed starting in 2011.)