The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors
The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors
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DOI：
10.1093/ntr/ntz157
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发表时间：
2020-07-01
影响因子：
4.7
通讯作者：
Selya, Arielle S.
中科院分区：
文献类型：
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作者：
Kim, Sooyong;Selya, Arielle S.
简介：电子烟在年轻人中的日益普及引起了人们对传统吸烟可能产生因果影响的担忧。然而，由于香烟和电子烟的使用之间存在严重混淆，过去的研究仍然没有定论。本研究使用倾向评分方法来稳健地调整估计电子烟使用与传统吸烟之间的关系的共同风险。方法：从 2015-2016 年监测未来浪潮中提取 8 年级和 10 年级学生的横断面数据（n = 12 421）。使用逻辑回归分析检查 (1) 寿命和 (2) 当前电子烟使用对 (A) 寿命和 (B) 当前传统香烟吸烟的影响基于 14 个相关风险因素的逆倾向权重。结果：根据 14 个风险因素考虑使用电子烟的倾向后，终生和当前使用电子烟均显着增加了曾经吸过传统香烟的风险（分别为 OR = 2.49，95% CI = 1.77 至 3.51；OR = 2.32，95% CI = 1.66 至 3.25）。然而，终生（OR = 2.17，95% CI = 0.62 至 7.63）和当前电子烟使用（OR = 0.95，95% CI = 0.55 至 1.63）并没有显着增加当前吸烟传统香烟的风险。结论：电子烟使用似乎与当前持续吸烟无关。相反，电子烟使用与当前传统吸烟之间的明显关系完全可以用共同的风险因素来解释，因此无法支持电子烟对青少年同时吸烟有因果关系的说法。倾向评分调整后，电子烟的使用与终生吸烟仍存在关联；然而，需要未来的研究来确定这是否是因果关系或仅仅反映了无法衡量的混杂因素。
Introduction: The growing popularity of electronic cigarettes (e-cigarettes) among youth raises concerns about possible causal effects on conventional cigarette smoking. However, past research remains inconclusive due to heavy confounding between cigarette and e-cigarette use. This study uses propensity score methods to robustly adjust for shared risk in estimating the relationship between e-cigarette use and conventional smoking.Methods: Cross-sectional data from 8th and 10th graders were drawn from the 2015-2016 waves of Monitoring the Future (n = 12 421).The effects of (1) lifetime and (2) current e-cigarette use on (A) lifetime and (B) current conventional cigarette smoking were examined using logistic regression analyses with inverse propensity weighting based on 14 associated risk factors.Results: After accounting for the propensity for using e-cigarettes based on 14 risk factors, both lifetime and current e-cigarette use significantly increased the risk of ever smoking a conventional cigarette (OR = 2.49, 95% CI = 1.77 to 3.51; OR = 2.32, 95% CI = 1.66 to 3.25, respectively). However, lifetime (OR = 2.17, 95% CI = 0.62 to 7.63) and current e-cigarette use (OR = 0.95, 95% CI = 0.55 to 1.63) did not significantly increase the risk of current conventional cigarette smoking.Conclusions: E-cigarette use does not appear to be associated with current, continued smoking. Instead, the apparent relationship between e-cigarette use and current conventional smoking is fully explained by shared risk factors, thus failing to support claims that e-cigarettes have a causal effect on concurrent conventional smoking among youth. E-cigarette use has a remaining association with lifetime cigarette smoking after propensity score adjustment; however, future research is needed to determine whether this is a causal relationship or merely reflects unmeasured confounding.