Sokol Natasha A, Feldman Justin M
Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA.
Department of Social and Behavioral Sciences, FXB Center for Health and Human Rights, Harvard University, Boston, MA, USA.
Nicotine Tob Res. 2021 Oct 7;23(11):1958-1961. doi: 10.1093/ntr/ntab102.
Studies have indicated that youth who use e-cigarettes are more likely to progress to cigarette smoking; however, the likelihood that these youth would have used tobacco products in the pre-vaping era is unclear.
This study sought to determine whether youth who used e-cigarettes in 2014-2018 would have likely been smokers in the period preceding e-cigarette availability. Analyzing Monitoring the Future 12th grade data (United States, 2009-2018), we forecasted the prevalence of current smoking with logistic regression-derived propensity scores. Models predicted smoking for all subsequent years, incorporating sociodemographic, family, alcohol, and school-related variables, and a linear time trend. We compared forecasted to observed smoking prevalence annually, and prevalence of current e-cigarette use among nonsmokers across smoking propensity tertiles.
Until 2014, observed smoking prevalence mirrored forecasted prevalence. Afterward, forecasted rates consistently overestimated prevalence. Among nonsmoking youth, e-cigarette use was lowest among those with lowest predicted probability of cigarette smoking (3.8%; 95% confidence interval [CI]: 3.3, 4.4) and highest among those with highest probability (23.5%; 95% CI: 22.2, 24.9).
Youth e-cigarette use has increased rapidly, with high prevalence among nonsmoking youth. However, the decline in current smoking among 12th graders has accelerated since e-cigarettes have become available. E-cigarette use is largely concentrated among youth who share characteristics with smokers of the pre-vaping era, suggesting e-cigarettes may have replaced cigarette smoking.
Among nonsmoking youth, vaping is largely concentrated among those who would have likely smoked prior to the introduction of e-cigarettes, and the introduction of e-cigarettes has coincided with an acceleration in the decline in youth smoking rates. E-cigarettes may be an important tool for population-level harm reduction, even considering their impact on youth.
研究表明，使用电子烟的青少年更有可能发展为吸食卷烟；然而，这些青少年在电子烟出现之前使用烟草制品的可能性尚不清楚。
本研究旨在确定在2014 - 2018年使用电子烟的青少年在电子烟出现之前是否可能成为吸烟者。通过分析“未来监测”12年级数据（美国，2009 - 2018年），我们使用逻辑回归得出的倾向得分预测当前吸烟率。模型预测了随后所有年份的吸烟情况，纳入了社会人口统计学、家庭、酒精和学校相关变量以及线性时间趋势。我们每年将预测的吸烟率与观察到的吸烟率进行比较，并比较了非吸烟者中当前电子烟使用情况在吸烟倾向三分位数中的分布。
直到2014年，观察到的吸烟率与预测率相符。此后，预测率一直高估了实际发生率。在不吸烟的青少年中，预测吸烟可能性最低的人群中电子烟使用率最低（3.8%；95%置信区间[CI]：3.3，4.4），而可能性最高的人群中使用率最高（23.5%；95% CI：22.2，24.9）。
青少年电子烟使用迅速增加，在不吸烟的青少年中患病率很高。然而，自电子烟出现以来，12年级学生当前吸烟率的下降加速。电子烟使用主要集中在与电子烟出现之前的吸烟者具有相同特征的青少年中，这表明电子烟可能已经取代了卷烟吸食。
在不吸烟的青少年中，吸电子烟主要集中在那些在电子烟引入之前可能吸烟的人群中，并且电子烟的引入与青少年吸烟率下降加速同时发生。即使考虑到电子烟对青少年的影响，它也可能是降低人群危害的重要工具。
