The association between vaping and subsequent initiation of cigarette smoking in young Australians from age 12 to 17 years: a retrospective cohort analysis using cross-sectional recall data from 5114 adolescents

2024/09/10 by Sam Egger, Michael David, Christina Watts +7 · 1 voice · 4 citations
Medicine · Psychology · #Bullying, Victimization, and Aggression #Smoking Behavior and Cessation #Substance Abuse Treatment and Outcomes

paper · doi:10.1016/j.anzjph.2024.100173

openalex publication_date 2024/09/10 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/23

Abstract

OBJECTIVE: The objective of this study was to estimate the association between vaping and subsequent initiation of smoking among Australian adolescents and explore the impact of design and analytical methods in previous studies. METHODS: We conducted a retrospective cohort analysis of cross-sectional data from 5114 Australian adolescents aged 14-17 recalling information on smoking and vaping initiation from age 12 to 17. The outcome was smoking initiation, analysed with negative-binomial regression to estimate incidence rate ratios (IRRs) for vape status (ever-vaped vs never-vaped) as a time-varying exposure. We also re-analysed using the methods of previous studies not accounting for the time-varying nature of e-cigarette exposure. RESULTS: Participants (n=5114) were retrospectively followed for 20478 person-years. After adjusting for socio-demographic variables and proxy measures of common liabilities for vaping and smoking, the rate of smoking initiation for those who ever-vaped was nearly 5 times that of those who never-vaped (IRR=4.9; 95% confidence interval: [3.9, 6.0], p<0.001), with IRRs considerably higher at younger ages. Not accounting for the time-varying nature of e-cigarette exposure in re-analysis attenuated the estimated IRR by 44%. CONCLUSIONS: Controlled analyses indicate that vaping markedly increases the risk of subsequent smoking initiation among Australian adolescents from age 12 to 17, with those aged 12, 13, and 14 bearing an alarmingly disproportionate burden of the elevated risk. Additionally, the relative risk of future smoking due to vaping may have been underestimated in other studies due to methodological differences. IMPLICATIONS FOR PUBLIC HEALTH: Our findings highlight the need for public health interventions and strict e-cigarette access laws.

Cited by

• Vaping health perceptions and never vaping among Australian adolescents: a strength-based analysis of cross-sectional survey data
• The OurFutures Vaping eHealth intervention to prevent e-cigarette use among adolescent students in Australia: a cluster randomised controlled trial
• Footprints in time: individual, social, and environmental factors and never-use of e-cigarettes among Indigenous adolescents
• ‘We’ve seen it escalate – it’s a huge problem’: A mixed methods study of teachers’ perceptions of vaping in secondary schools

Discussions

• Our 3rd most downloaded ANZJPH article published last year looked at vaping and teenagers - finding those who had vaped were five times more likely to then try smoking. Read it open-access here: doi.o [bsky, 3 points, 0 comments]

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