Aleyan Sarah, Cole Adam, Qian Wei, Leatherdale Scott T
School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
BMJ Open. 2018 May 26;8(5):e021080. doi: 10.1136/bmjopen-2017-021080.
Given that many adolescent e-cigarette users are never-smokers, the possibility that e-cigarettes may act as a gateway to future cigarette smoking has been discussed in various studies. Longitudinal data are needed to explore the pathway between e-cigarette and cigarette use, particularly among different risk groups including susceptible and non-susceptible never-smokers. The objective of this study was to examine whether baseline use of e-cigarettes among a sample of never-smoking youth predicted cigarette smoking initiation over a 2-year period.
Longitudinal cohort study.
89 high schools across Ontario and Alberta, Canada.
A sample of grade 9-11 never-smoking students at baseline (n=9501) who participated in the COMPASS study over 2 years.
Participants completed in-class questionnaires that assessed smoking susceptibility and smoking initiation.
Among the baseline sample of non-susceptible never-smokers, 45.2% of current e-cigarette users reported trying a cigarette after 2 years compared with 13.5% of non-current e-cigarette users. Among the baseline sample of susceptible never-smokers, 62.4% of current e-cigarette users reported trying a cigarette after 2 years compared with 36.1% of non-current e-cigarette users. Overall, current e-cigarette users were more likely to try a cigarette 2 years later. This association was stronger among the sample of non-susceptible never-smokers (AOR=5.28, 95% CI 2.81 to 9.94; p<0.0001) compared with susceptible never-smokers (AOR=2.78, 95% CI 1.84 to 4.20; p<0.0001).
Findings from this large, longitudinal study support public health concerns that e-cigarette use may contribute to the development of a new population of cigarette smokers. They also support the notion that e-cigarettes are expanding the tobacco market by attracting low-risk youth who would otherwise be unlikely to initiate using cigarettes. Careful consideration will be needed in developing an appropriate regulatory framework that prevents e-cigarette use among youth.
鉴于许多青少年电子烟使用者从不吸烟，电子烟可能成为未来吸烟的一个途径这一可能性已在各项研究中被讨论。需要纵向数据来探究电子烟使用与香烟使用之间的路径，尤其是在包括易感和不易感的从不吸烟者在内的不同风险群体中。本研究的目的是检验在一群从不吸烟的青少年样本中，基线时使用电子烟是否能预测其在两年内开始吸烟。
纵向队列研究。
加拿大安大略省和艾伯塔省的89所高中。
基线时9至11年级从不吸烟的学生样本（n = 9501），他们在两年内参与了COMPASS研究。
参与者完成了课堂问卷，问卷评估了吸烟易感性和开始吸烟情况。
在基线时不易感的从不吸烟者样本中，45.2% 的当前电子烟使用者报告在两年后尝试过吸烟，而在非当前电子烟使用者中这一比例为13.5%。在基线时易感的从不吸烟者样本中，62.4% 的当前电子烟使用者报告在两年后尝试过吸烟，而在非当前电子烟使用者中这一比例为36.1%。总体而言，当前电子烟使用者在两年后更有可能尝试吸烟。与易感的从不吸烟者相比，这种关联在不易感的从不吸烟者样本中更强（比值比 = 5.28，95% 置信区间2.81至9.94；p < 0.0001），易感的从不吸烟者的比值比为2.78（95% 置信区间1.84至4.20；p < 0.0001）。
这项大型纵向研究的结果支持了公共卫生方面的担忧，即电子烟使用可能导致新的吸烟人群的出现。它们还支持了这样一种观点，即电子烟正在通过吸引原本不太可能开始使用香烟的低风险青少年来扩大烟草市场。在制定防止青少年使用电子烟的适当监管框架时需要仔细考虑。
