Background: Several studies indicate an association between e-cigarette use and subsequent smoking among youth. However, most previous studies lack measures of the nicotine content of e-liquid and have not usually measured regular smoking.
Methods: We tested the association between e-cigarette use, with and without nicotine, and subsequent daily use of conventional cigarettes and nicotine e-cigarettes among study population of 3474 students. A survey was conducted in lower secondary schools of the Helsinki metropolitan area, Finland, with 15 - 16-year-olds in 2014 (baseline) and in upper secondary schools in 2016 when the cohort was 17 - 18-year-olds (follow-up). Firth logistic regression and generalized linear mixed models (GLMM) were used.
Results: Of students, 25% had experimented with nicotine e-cigarettes at baseline and 40% at follow-up. Among baseline never-smokers, experimentation with or use of nicotine e-cigarettes predicted the uptake of daily smoking at follow-up (AOR 2.92; 95% CI 1.09-7.85), but baseline experimentation with non-nicotine e-cigarettes did not when compared with the non-e-cigarette experimenters. Nicotine e-cigarette experimentation at baseline predicted daily nicotine e-cigarette use at follow-up (AOR 2.96; 95% CI 1.22-7.22). Non-nicotine e-cigarette experimentation at baseline did not predict statistically significantly daily nicotine e-cigarette use at follow-up (AOR 3.13; 95% CI 0.98-10.02). The small number of cases may have diminished the statistical significance.
Conclusions: The findings suggest that experimentation with nicotine e-cigarettes serves as a gateway to subsequent use of conventional cigarettes as well as nicotine e-cigarettes. Our results support the actions to limit youths' access to e-cigarettes in order to prevent nicotine addiction.
Keywords: Adolescents; Electronic cigarette; Longitudinal; Nicotine; School survey; Smoking.
Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.