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

项目总结 电子烟(e-cig)在青少年中的使用日益流行，这是一项公共健康和 监管方面的担忧。目前在青少年中使用电子烟的人数比2011年增加了10倍以上 2014年(1.5%至17%)。尽管电子烟的已知毒素水平低于可燃香烟， 两者都提供尼古丁，通过依赖尼古丁潜在地促进了跨产品的使用。研究 指出，大多数使用电子烟的青少年也使用易燃香烟(即两用)。 虽然人们对电子烟可能侵蚀青少年数十年的吸烟表示担忧 通过促进可燃香烟吸烟的吸收和持久性来控制努力，现有数据不能 充分证明或消除这些担忧是合理的。迫切需要进行前瞻性的纵向研究，以解决四个问题 关键问题。第一，电子烟是否会成为年轻人吸烟的催化剂，这些年轻人可能会 没有以其他方式吸烟，如果有，为什么？第二，电子烟是否有助于规则的持续 吸烟可燃香烟，可能是通过允许青少年用电子烟取代可燃香烟 在无烟的情况下？三、哪些青少年最有可能发展为经常使用电子烟，然后 两用？是否存在具有单一使用和双重使用的独特纵向模式的青少年亚群 使用(例如，只使用电子烟的青少年、只吸烟的青少年、不同年龄的青少年 他们获得双重用途的途径)以及具有这些使用模式的青少年的特征是什么？ 我们建议通过跟踪前瞻性的纵向队列来解决证据基础中的这些关键差距 对2,000名从青春期中期(14岁)到青春期晚期(18岁)的青少年进行调查，衡量电子烟的使用情况， 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)。 结果包括进展到常规使用(可燃、电子烟和双重使用)的几率，持续吸烟， 和使用轨迹。建议的方法将使我们能够创建一个全面的模型 青少年使用电子烟与吸食易燃香烟的发展关系 确定独特的使用模式，并确定推动单一用途和双重用途的因素。一个更伟大的 了解电子烟的使用及其与易燃香烟吸烟的关系将是基本的 向以证据为基础的公共卫生努力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.