Intentions to Smoke Cigarettes Among Never-Smoking U.S. Middle and High School Electronic Cigarette Users, National Youth Tobacco Survey, 2011-2013

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Office on Smoking and Health - Centers for Disease Control and Prevention 
Office of Science - Center for Tobacco Products - Food and Drug Administration
Department of Epidemiology and Biostatistics - School of Public Health - Georgia State University

  • Rebecca E. Bunnell, ScD, MEd
  • Israel T. Agaku, DMD, MPH
  • Rene Arrazola, MPH
  • Benjamin J. Apelberg, PhD, MHS
  • Ralph S. Caraballo, PhD
  • Catherine G. Corey, MSPH
  • Blair Coleman, MPH
  • Shanta R. Dube, PhD, MPH
  • Brian A. King, PhD, MPH

Published: Aug. 20, 2014 in Nicotine and Tobacco Research

Report Intro/Brief:
Electronic cigarette (e-cigarette) use is increasing rapidly and their impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among U.S. youth who had never smoked conventional cigarettes.

We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6-12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke, while all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and non-combustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses assessing associations with smoking intentions among never-cigarette-smoking youth.

Between 2011-2013, the number of never-smoking youth who used e-cigarettes increased three-fold, from 79,000 to over 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds of having smoking intentions than never users (Adjusted Odds Ratio: 1.70, 95% Confidence Interval: 1.24-2.32). Those who ever used other combustibles, ever used non-combustibles, or reported pro-tobacco advertisement exposure also had increased odds of smoking intentions.

In 2013, over a quarter million never-smoking youth had used e-cigarettes. E-cigarette use was associated with increased intentions to smoke cigarettes. Enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes."