The Daffodil Centre, The University of Sydney, A joint venture with Cancer Council NSW, Woolloomooloo, Australia.
The Daffodil Centre, The University of Sydney, A joint venture with Cancer Council NSW, Woolloomooloo, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Australia.
Aust N Z J Public Health. 2024 Oct;48(5):100173. doi: 10.1016/j.anzjph.2024.100173. Epub 2024 Sep 10.
The objective of this study was to estimate the association between vaping and subsequent initiation of smoking among Australian adolescents and explore the impact of design and analytical methods in previous studies.
We conducted a retrospective cohort analysis of cross-sectional data from 5114 Australian adolescents aged 14-17 recalling information on smoking and vaping initiation from age 12 to 17. The outcome was smoking initiation, analysed with negative-binomial regression to estimate incidence rate ratios (IRRs) for vape status (ever-vaped vs never-vaped) as a time-varying exposure. We also re-analysed using the methods of previous studies not accounting for the time-varying nature of e-cigarette exposure.
Participants (n=5114) were retrospectively followed for 20478 person-years. After adjusting for socio-demographic variables and proxy measures of common liabilities for vaping and smoking, the rate of smoking initiation for those who ever-vaped was nearly 5 times that of those who never-vaped (IRR=4.9; 95% confidence interval: [3.9, 6.0], p<0.001), with IRRs considerably higher at younger ages. Not accounting for the time-varying nature of e-cigarette exposure in re-analysis attenuated the estimated IRR by 44%.
Controlled analyses indicate that vaping markedly increases the risk of subsequent smoking initiation among Australian adolescents from age 12 to 17, with those aged 12, 13, and 14 bearing an alarmingly disproportionate burden of the elevated risk. Additionally, the relative risk of future smoking due to vaping may have been underestimated in other studies due to methodological differences.
Our findings highlight the need for public health interventions and strict e-cigarette access laws.
本研究旨在估计澳大利亚青少年吸电子烟与随后开始吸烟之间的关联，并探讨先前研究中设计和分析方法的影响。
我们对 5114 名年龄在 14-17 岁的澳大利亚青少年的横断面数据进行了回顾性队列分析，这些青少年在 12 至 17 岁时回忆了吸烟和吸电子烟的起始信息。吸烟起始是研究的结局，使用负二项回归来估计吸电子烟状态（曾吸电子烟与从未吸电子烟）作为时变暴露的发病率比值（IRR）。我们还使用未考虑电子烟暴露时变性质的先前研究的方法进行了重新分析。
参与者（n=5114）在回顾性随访中经历了 20478 人年。在校正社会人口统计学变量和吸电子烟与吸烟的常见共同危险因素的替代指标后，曾吸电子烟者的吸烟起始率几乎是从未吸电子烟者的 5 倍（IRR=4.9；95%置信区间：[3.9, 6.0]，p<0.001），且在较年轻时IRR 更高。在重新分析中不考虑电子烟暴露的时变性质，估计的 IRR 降低了 44%。
对照分析表明，吸电子烟显著增加了澳大利亚青少年从 12 岁到 17 岁时随后开始吸烟的风险，12 岁、13 岁和 14 岁的青少年吸烟风险异常升高。此外，由于方法学差异，其他研究可能低估了由于吸电子烟而导致未来吸烟的相对风险。
我们的研究结果强调了需要采取公共卫生干预措施和严格的电子烟获取法律。
