The impact of e-cigarette use on adolescent uptake and persistence of conventional smoking: Who is most vulnerable?

项目摘要 青少年使用电子烟（e-cig）的日益普及是公共卫生和 监管关注。从2011年到2020年，青少年使用电子烟的人数增加了10倍以上。 2014年（1.5%至17%）。虽然电子烟比可燃香烟释放的已知毒素水平更低， 两者都提供尼古丁，可能通过对尼古丁的依赖促进交叉产品的使用。研究 表明大多数使用电子烟的青少年也使用可燃香烟（即，双重用途）。 虽然有人担心电子烟可能会侵蚀数十年的青少年吸烟习惯， 通过促进可燃性香烟吸烟的吸收和持续来控制努力，现有数据不能 充分证明或减轻这些担忧。迫切需要前瞻性的纵向研究来解决四个问题 至关重要的问题第一，电子烟是否可以作为年轻人经常吸烟的催化剂， 没有吸烟，如果有，为什么？第二，电子烟是否有助于持续定期吸烟？ 可燃香烟吸烟，可能是通过允许青少年用电子烟代替可燃香烟 在无烟的环境下三，哪些青少年最有可能发展到经常使用电子烟，然后 双重用途？第四，是否有青少年亚组具有独特的纵向模式， 使用（例如，只使用电子烟的青少年，只吸烟的青少年， 这些使用模式的青少年有哪些特点？ 我们建议通过一个前瞻性的纵向队列研究来解决证据基础中的这些关键差距 2,000名青少年从中期（14岁）到后期（18岁），测量电子烟的使用， 吸烟，以及每6个月使用一次的个人和环境风险因素（共8波）。 结果包括进展到定期使用（可燃，电子烟，和双重），吸烟持续性， 和使用轨迹。建议的方法将使我们能够建立一个全面的模式， 青少年使用电子烟与吸烟之间的发展关系， 确定独特的使用模式，并确定驱动单用途和双用途的因素。更大 了解电子烟的使用及其与吸烟的关系将是至关重要的 为循证公共卫生工作和电子烟监管行动提供信息，以保护青少年免受 尼古丁依赖和吸烟。

PROJECT SUMMARY The growing popularity of electronic cigarette (e-cig) use among adolescents is a cause for public health and regulatory concern. Current use of e-cigs among adolescents has increased more than 10-fold from 2011 to 2014 (1.5% to 17%). Although an e-cig delivers lower levels of known toxins than a combustible cigarette, both deliver nicotine, potentially fostering cross-product use through dependence on nicotine. Research indicates that the majority of adolescents who use e-cigs also use combustible cigarettes (i.e., dual use). While concerns have been raised regarding the potential for e-cigs to erode decades of adolescent smoking control efforts by promoting the uptake and persistence of combustible cigarette smoking, existing data cannot fully justify or allay these concerns. Prospective, longitudinal studies are urgently needed to address four vital questions. One, do e-cigs act as a catalyst for regular combustible cigarette smoking for youth who may not have otherwise smoked and if so, why? Two, do e-cigs contribute to the persistence of regular combustible cigarette smoking, possibly by allowing adolescents to substitute e-cigs for combustible cigarettes in smoke-free situations? Three, which adolescents are most likely to progress to regular e-cig use and then to dual use? Four, are there subgroups of adolescents with unique longitudinal patterns of single use and dual use (e.g., adolescents who only use e-cigs, adolescents who only smoke cigarettes, duals users who vary in their pathway to dual use) and what are the characteristics of adolescents who have these patterns of use? We propose to address these critical gaps in the evidence base by following a prospective, longitudinal cohort of 2,000 adolescents from mid (age 14 years) to late adolescence (age 18 years), measuring e-cig use, cigarette smoking, and individual and environmental risk factors for use every 6 months (8 waves total). Outcomes include the odds of progression to regular use (combustible, e-cig, and dual), smoking persistence, and trajectories of use. The proposed approach will enable us to create a comprehensive model of the developmental relationship between e-cig use and combustible cigarette smoking among adolescents, to identify unique patterns of use, and to determine the factors that drive single and dual use. A greater understanding of e-cig use and its relationship to combustible cigarette smoking will be fundamental to inform evidenced-based public health efforts and e-cig regulatory actions to protect youth from nicotine dependence and from smoking.