High school seniors who used e-cigarettes may have otherwise been cigarette smokers: Evidence from Monitoring the Future (United States, 2009-2018)

Studies have indicated that youth who use e-cigarettes are more likely to progress to cigarette smoking; however, the likelihood that these youth would have used tobacco products in the pre-vaping era is unclear.

This study sought to determine whether youth who used e-cigarettes in 2014-2018 would have likely been smokers in the period preceding e-cigarette availability.

Methods: Analyzing Monitoring the Future 12 th grade data (USA, 2009-2018), we forecasted the prevalence of current smoking with logistic regression-derived propensity scores. Models predicted smoking for all subsequent years, incorporating sociodemographic, family, alcohol, and school-related variables, and a linear time trend. We compared forecasted to observed smoking prevalence annually, and prevalence of current e-cigarette use among non-smokers across smoking propensity tertiles.

Results: Until 2014, observed smoking prevalence mirrored forecasted prevalence. Afterward, forecasted rates consistently overestimated prevalence. Among non-smoking youth, e-cigarette use was lowest among those with lowest predicted probability of cigarette smoking (3.8%; 95% CI: 3.3, 4.4) and highest among those with highest probability (23.5%; 95% CI: 22.2, 24.9).

Discussion: Youth e-cigarette use has increased rapidly, with high prevalence among non-smoking youth. However, the decline in current smoking among 12 th graders has accelerated since e-cigarettes have become available. E-cigarette use is largely concentrated among youth who share characteristics with smokers of the pre-vaping era, suggesting e-cigarettes may have replaced cigarette smoking.

Implications: Vaping is largely concentrated among non-smoking youth who would likely have smoked prior to the introduction of e-cigarettes, and the introduction of e-cigarettes has coincided with an acceleration in the decline in youth smoking rates. E-cigarettes may be an important tool for population-level harm reduction, even considering their impact on youth.