Morgenstern M, Nies A, Goecke M, Hanewinkel R. E-Cigarettes and the Use of Conventional Cigarettes.
DEUTSCHES ARZTEBLATT INTERNATIONAL 2019;
115:243-248. [PMID:
29716689 DOI:
10.3238/arztebl.2018.0243]
[Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/02/2017] [Accepted: 01/23/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND
In 2015, 12.1% of 12- to 17-year-olds in Germany had reportedly already tried e-cigarette smoking at least once. We carried out a study of the "gateway" hypothesis, according to which the use of e-cigarettes can motivate adolescents to start smoking conventional cigarettes.
METHODS
During the 2015/2016 school year, 2186 tenth-graders in the German states of Lower Saxony and Schleswig-Holstein who had never smoked conventional cigarettes before took part in a survey over a 6-month period (mean age 15.5 years, standard deviation 0.65; 53.6% female).
RESULTS
14.3% of the survey population (313 adolescents) said at the start of the survey period that they had already tried e-cigarettes at least once. By the end of the survey period, 12.3% (268) of those who had never smoked before had begun to experiment with conventional cigarettes. The risk of beginning such experimentation was 2.2 times higher among e-cigarette users. This association remained (relative risk = 2.18 [1.65; 2.83]) after statistical control for age, sex, state, immigrant background, type of school, socioeconomic status, various personality traits (sensation-seeking, impulsivity, anxiety, hopelessness, extraversion, agreeableness, conscientiousness, neuroticism, openness), and the use of alcohol, cannabis, and other illicit drugs. Further analysis revealed that the association between the use of e-cigarettes and the onset of conventional cigarette smoking was stronger among adolescents with low sensation-seeking scores and without any experience of alcohol intoxication.
CONCLUSION
Among adolescents who have never smoked, experimentation with conventional cigarettes is more common in those who have used e-cigarettes. This effect seems to be stronger among adolescents who, in general, have a lower risk of starting to smoke. The 6-month observation period of this study is too short to allow any inference regarding a connection between e-cigarette use and the development of tobacco dependence.
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