The great decline in adolescent cigarette smoking since 2000: consequences for drug use among US adolescents.
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ABSTRACT: Objective
Adolescent cigarette smoking declined steadily and substantially from 2000 to 2018. This paper considers the potential consequences of this 'great decline' for the prevalence of other drug use among adolescents.Methods
Data are annual, cross-sectional, nationally representative Monitoring the Future surveys of more than 1.2 million US students in 12th, 10th and 8th grades from 2000 to 2018. Analyses include trends in the past 12 months' non-medical amphetamine, tranquillisers and opioid use overall, among ever and never cigarette smokers, and projected if adolescent cigarette smoking levels had remained at 2000 levels.Results
Within groups of ever and never cigarette smokers, the prevalence for each of the three substances has either changed little or overall increased in 2018 as compared with 2000. When the two groups were combined into one pool, the overall prevalence for each of the drugs declined by about half. The decline resulted from the growing group of never smokers, whose levels of non-medical drug use over the study period were at least four times lower than the levels of ever smokers.Conclusions
The results support the 'gateway' prediction that declines in cigarette smoking among adolescents pull downward their non-medical use of amphetamines, tranquillisers and opioids. Continuing to reduce adolescent smoking through policy and programmatic prevention efforts should have further positive spillover effects on adolescent drug use.
SUBMITTER: Miech R
PROVIDER: S-EPMC7363524 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:: media-1vid110.1542/5839992666001PEDS-VA_2018-0486Video Abstract BACKGROUND AND OBJECTIVES: Electronic cigarette (e-cigarette) use is associated with cigarette initiation among adolescents. However, it is unclear whether e-cigarette use is associated with more frequent cigarette use after initiation. Also, the extent to which cigarette or dual cigarette and e-cigarette users transition to exclusive e-cigarette use or to the nonuse of either product is not yet known. METHODS:Data were pooled from 3 prospective cohort studies in California and Connecticut (baseline: 2013-2014; follow-up: 2014-2016; N = 6258). Polytomous regression models were used to evaluate the association of baseline e-cigarette use (never or ever) with cigarette use frequency at follow-up (experimental: initiation but no past-30-day use; infrequent: 1-2 of the past 30 days; frequent: 3-5 or more of the past 30 days). Polytomous regression models were also used to evaluate transitions between baseline ever or past-30-day single or dual product use and past-30-day single or dual product use at follow-up. RESULTS:Among baseline never smokers, e-cigarette users had greater odds of subsequent experimental (odds ratio [OR] = 4.58; 95% confidence interval [CI]: 3.56-5.88), infrequent (OR = 4.27; 95% CI: 2.75-6.62) or frequent (OR = 3.51; 95% CI: 1.97-6.24) cigarette use; the 3 OR estimates were not significantly different. Baseline past-30-day exclusive cigarette use was associated with higher odds at follow-up of exclusive cigarette or dual product use than of exclusive e-cigarette use. CONCLUSIONS:Tobacco control policy to reduce adolescent use of both e-cigarettes and cigarettes is needed to prevent progression to more frequent tobacco use patterns and reduce combustible cigarette use (with or without concurrent e-cigarette use) to lessen the adverse public health impact of e-cigarettes.
| S-EPMC6312103 | biostudies-other
Project description:ImportanceMany studies have reported a positive association of youth electronic cigarette (e-cigarette) use with subsequent cigarette smoking initiation, but it remains unclear whether e-cigarette use is associated with continued cigarette smoking after initiation.ObjectiveTo assess the association of youth baseline e-cigarette use with their continued cigarette smoking 2 years after initiation.Design, setting, and participantsThe Population Assessment of Tobacco and Health (PATH) Study is a national longitudinal cohort study. This sample consisted of youth who participated in waves 3, 4, and 5 of the study (wave 3 was from October 2015 to October 2016, wave 4 was from December 2016 to January 2018, and wave 5 was from December 2018 to November 2019) and had never used cigarettes (cigarette-naive) by wave 3. The current analysis used multivariable logistic regressions in August 2022 to assess the association between e-cigarette use among cigarette-naive adolescents aged 12 to 17 years in 2015 and 2016 and subsequent continued cigarette smoking. PATH uses audio computer-assisted self-interviewing and computer-assisted personal interviewing to collect data.ExposuresEver and current (past 30-day) use of e-cigarettes in wave 3.Main outcomes and measuresContinued cigarette smoking in wave 5 after initiating smoking in wave 4.ResultsThe current sample included 8671 adolescents who were cigarette naive in wave 3 and also participated in waves 4 and 5; 4823 of the participants (55.4%) were aged 12 to 14 years, 4454 (51.1%) were male, and 3763 (51.0%) were non-Hispanic White. Overall, regardless of e-cigarette use, few adolescents (362 adolescents [4.1%]) initiated cigarette smoking at wave 4, and even fewer (218 participants [2.5%]) continued smoking at wave 5. Controlling for multiple covariates, the adjusted odds ratio of baseline ever e-cigarette use, compared with never e-cigarette use, was 1.81 (95% CI, 1.03 to 3.18) for continued smoking measured as past 30-day smoking at wave 5. However, the adjusted risk difference (aRD) was small and not significant. The aRD was 0.88 percentage point (95% CI, -0.13 to 1.89 percentage points) for continued smoking, with the absolute risk being 1.19% (95% CI, 0.79% to 1.59%) for never e-cigarette users and 2.07% (95% CI, 1.01% to 3.13%) for ever e-cigarette users. Similar results were found using an alternative measure of continued smoking (lifetime ≥100 cigarettes and current smoking at wave 5) and using baseline current e-cigarette use as the exposure measure.Conclusions and relevanceIn this cohort study, absolute and relative measures of risks yielded findings suggesting very different interpretations of the association. Although there were statistically significant odds ratios of continued smoking comparing baseline e-cigarette users with nonusers, the minor risk differences between them, along with the small absolute risks, suggest that few adolescents are likely to continue smoking after initiation regardless of baseline e-cigarette use.
| S-EPMC10043747 | biostudies-literature
Project description:IntroductionCigar, cigarillo, and little cigar (CCLC) use is prevalent among adolescents, particularly among those who smoke cigarettes.MethodsUsing data from a longitudinal study of smoking patterns among adolescents, we examined differences between CCLC users (ever and past 30 days) and nonusers (never and not in the past 30 days) among adolescents who smoked a cigarette in the last month (n = 486).ResultsIn our sample, 76.7% reported ever trying CCLC and 40.7% reported past month CCLC use. Bivariate analyses showed that CCLC users differed from nonusers in terms of demographics, other forms of tobacco use, other substance use, and mental health. Multivariate logistic regression analyses found that both ever and past 30-day CCLC use were strongly associated with being male and concurrent use of hookah. Ever CCLC use was also strongly associated with recent use of alcohol, and past 30-day CCLC use was strongly associated with antisocial behavior. After controlling for the number of days on which cigarettes were smoked in the past 30 days, past 30-day CCLC use was associated with most other forms of tobacco use, other substance use, and mental health, but not with number of cigarettes smoked in the past month and nicotine dependence.ConclusionsResults suggest that CCLC use is high among adolescent cigarette users and is associated with a variety of negative correlates. Importantly, many of these relationships are not accounted for by the adolescent's level of cigarette use. Further characterizing CCLC use will be important for developing more targeted and tailored interventions.
| S-EPMC3621583 | biostudies-literature
Project description:There is a need to obtain greater clarity regarding adolescents' e-cigarette use and the associations of use with a wider range of risk behaviors. This study examines the associations among past-month e-cigarette use only, traditional cigarette smoking only, dual use (i.e., concurrent e-cigarette use and cigarette smoking), school-related (i.e., truancy and poor academic performance) risk behaviors, and substance-related (i.e., alcohol use, binge drinking, marijuana use, illicit drug use, and nonmedical prescription drug use) risk behaviors.Data were collected via self-administered questionnaires from a nationally representative sample of 8,696 high school seniors.An estimated 9.9% of U.S. high school seniors reported past-month e-cigarette use only, 6.0% reported past-month cigarette smoking only, and 7.3% reported past-month dual use. School- and substance-related risk behaviors had strong associations with past-month e-cigarette use. Adolescents who only used e-cigarettes had significantly greater odds of all school- and substance-related risk behaviors relative to nonusers. Dual users had significantly greater odds of frequent/daily e-cigarette use as well as all school- and substance-related risk behaviors relative to those who only used e-cigarettes. Finally, adolescents who engaged in frequent/daily e-cigarette use had significantly greater odds of binge drinking, marijuana use, other illicit drug use and nonmedical prescription drug use, relative to experimental e-cigarette users.E-cigarette use is common among U.S. adolescents, and there are robust associations between e-cigarette use and school- and substance-related risk behaviors. There is evidence that e-cigarette use clusters with risk behaviors and appears to represent a problem behavior, especially dual use of e-cigarettes and traditional cigarettes.
| S-EPMC5522777 | biostudies-literature
Project description:PurposeThis study evaluated whether e-cigarette trial among Mexican adolescents increased the likelihood of trial and use of conventional cigarettes or marijuana use at follow-up.MethodA school-based longitudinal survey was conducted in 60 public middle schools from the three largest cities in Mexico. Students (12-13years old) were surveyed in 2015 and followed up 20 months later (n=6574). Generalized estimating equations models were used to evaluate the association between e-cigarette trial at baseline and conventional cigarettes smoking and marijuana use at follow-up.ResultAdolescents who had tried e-cigarettes (but not cigarettes) at baseline were more likely to have tried conventional cigarettes at followup compared to adolescents who had tried neither e-cigarettes nor cigarettes (43% vs. 24%, respectively; RR 1.41, 95% CI 1.18-1.70). We also found that adolescents who had tried both conventional cigarettes and e-cigarettes at baseline were more likely to have tried marijuana at follow-up compared to adolescents who had tried neither tobacco product (20% vs. 4%, respectively; RR 2.67, 95% CI 1.78-4.02). Trial of only e-cigarettes was not independently associated with marijuana use at followup.ConclusionsAdolescents who had tried e-cigarettes were more likely to have tried conventional cigarettes and marijuana 20 months later. Although e-cigarettes have been banned in Mexico, it is likely that additional policies and public health campaigns are needed to reduce adolescent use of e-cigarettes and its consequences.
| S-EPMC5771440 | biostudies-literature
Project description:Introduction:This study examines the associations between early onset of e-cigarette use and cigarette smoking and other substance use behaviors among US adolescents. Methods:Data were collected via self-administered questionnaires from a nationally representative sample of 2299 US high school seniors attending public and private high schools during the spring of their senior year in 2015 as part of the Monitoring the Future study. Results:A higher percentage of adolescents who began using e-cigarettes in ninth grade or earlier (early onset) were found to report current and lifetime cigarette smoking and other substance use relative to those individuals who never used e-cigarettes or those who began using e-cigarettes later in the 12th grade. Multivariate logistic regression analyses indicated that the adjusted odds of alcohol use, cigarette smoking, marijuana use, nonmedical prescription drug use, and other illicit drug use among early onset e-cigarette users were significantly greater than those for individuals never having used e-cigarettes (adjusted odds ratios [AORs] ranged 9.5-70.6, p < .001). While these associations were significant for both experimental and frequent e-cigarette users, the effects of early onset were stronger among frequent e-cigarette users. Similarly, the odds of these substance use behaviors (except alcohol) among early onset e-cigarette users were also significantly greater than the odds for later onset e-cigarette users (AORs ranged 2.8-4.1, p < .05). Conclusions:Early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. E-cigarette use is often preceded by alcohol use, cigarette smoking, and marijuana use, suggesting that more long-term prospective studies are warranted. Implications:To date, no studies have examined the probability of cigarette smoking and other substance use behaviors as a function of age at onset of e-cigarette use. In the present study, early onset of e-cigarette use was significantly associated with increased odds of cigarette smoking and other substance use behaviors. The findings reinforce the importance of addressing a wide range of substances including alcohol, traditional cigarettes, and marijuana when developing early primary prevention efforts to reduce e-cigarette use among youth.
| S-EPMC6037083 | biostudies-other
Project description:Alternative tobacco products are increasing in popularity. An important question is whether their use is associated with or even leads to conventional smoking, but large-scale (European) studies are scarce. In two cohorts of Dutch adolescents (Cohort I n = 6819, mean age = 13.8 SD = 1.1, 48.2% female; Cohort II n = 2758, mean age = 17.3 SD = 1.8, 61.3% female), we investigated use of electronic (e)-cigarettes with nicotine, e-cigarettes without nicotine and waterpipe. Generalized estimating equation modelling was conducted with ever conventional smoking as the dependent variable (0 = no, 1 = yes) and ever alternative tobacco use as the independent variable, correcting for clustering within schools, age, sex and education in both cohorts. In a subsample (n = 2100), the association between alternative tobacco use at baseline and conventional smoking 6 months later was tested, taking into account smoking propensity (based on personality, susceptibility to peer pressure and smoking intentions). Ever use prevalence was 13.7% for e-cigarettes with nicotine, 29.4% for e-cigarettes without nicotine and 22.1% for waterpipe in Cohort I and 12.3, 27.6 and 45.3% respectively in Cohort II. Ever smokers had tried alternative tobacco products more often than never smokers. Among never-smoking adolescents at baseline, alternative tobacco use predicted ever smoking 6 months later (e-cigarettes with nicotine OR 11.90 95% CI 3.36-42.11; e-cigarettes without nicotine OR 5.36 95% CI 2.73-10.52; waterpipe OR 5.36 95% CI 2.78-10.31). This association was strongest for adolescents with a low baseline risk of smoking. Experimenting with alternative tobacco products is common among Dutch youth. Alternative tobacco use predicts (future) smoking, especially among adolescents with a low smoking propensity.
| S-EPMC5889768 | biostudies-literature
Project description:OBJECTIVE:E-cigarette use has been linked to onset of cigarette smoking among adolescents, but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower versus higher on propensity to smoke. METHODS:School-based survey with a longitudinal sample of 1136 students (9th-11th graders, mean age 14.7?years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1?year later (T2). We assessed e-cigarette use, propensity to smoke based on 3 psychosocial factors known to predict smoking (rebelliousness, parental support and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower versus higher on T1 propensity to smoke. RESULTS:The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR=0.88, p=0.01) indicated a significantly larger effect for smoking onset among lower risk youth. CONCLUSIONS:The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower risk adolescents to smoking, which has public health implications.
| S-EPMC5537057 | biostudies-literature
Project description:Adolescents' relationships can play an influential role in adopting, maintaining, or changing health behaviors. Previous research has suggested that adolescent dating is a risk factor for both concurrent and prospective tobacco use. This study extends previous research by examining whether a partner's smoking status moderated the relationship between dating and adolescent smoking.Participants were 1,263 9th and 10th grade students who took part in a longitudinal study investigating the social and emotional contexts of adolescent smoking patterns. Adolescents were recruited into the longitudinal study based on prior smoking history. The presence of a romantic partner, the partner's smoking status, and the adolescents' smoking behavior were assessed at baseline and at 15 months.Our findings indicated that a change in dating status from not dating to having a partner significantly increased the odds of the adolescent smoking at 15 months but significantly only for those who dated a smoker. This effect was especially pronounced among boys. All boys who dated a smoker smoked themselves. Among adolescents who smoked at 15 months, there was also a strong protective effect among boys for dating a nonsmoker, compared with either those who did not have partners or those with smoking partners; boys with nonsmoking partners smoked significantly less than those with partners who smoked or those without partners.These results highlight the importance of considering the smoking status of the romantic partner in the smoking-dating relationship in adolescents.
| S-EPMC2746838 | biostudies-other
Project description:The study objectives were to examine smoking abstinence and reinstatement effects on subjective experience and cognitive performance among adolescent smokers.Adolescents (aged 14-17 years, 60 daily smokers and 32 nonsmokers) participated. Participants completed baseline assessments (Session 1) and returned to the laboratory 1-3 days later to repeat assessments (Session 2); half of the smokers were randomly assigned to 15-17 hr tobacco abstinence preceding Session 2.During Session 2, abstaining smokers reported significantly greater increases in withdrawal symptoms, smoking urges, and negative affect compared with smokers who did not abstain and compared with nonsmokers. Smoking reinstatement reversed abstinence effects, returning to baseline levels for smoking urges and negative affect. Abstaining smokers showed significantly enhanced cognitive performance on two of six tasks (two-letter search compared with nonabstaining smokers; serial reaction time compared with nonsmokers); smoking reinstatement resulted in significant decrements on these two tasks relative to nonabstaining smokers.Effects of smoking abstinence and reinstatement on self-report measures are consistent with earlier research with adolescent as well as adult smokers and may help to elucidate the motivational underpinnings of smoking maintenance among adolescent smokers. Effects found on cognitive performance were contrary to hypotheses; further research is needed to understand better the role of cognitive performance effects in smoking maintenance among adolescents.
| S-EPMC2902909 | biostudies-other