Electronic cigarette use: Is it a gateway to cigarette use, or a smoking cessation tool?

Objectives: Whether electronic cigarette (e-cigarette) use is a gateway to cigarette use or a smoking cessation aid is currently a subject of contentious debate. We assessed whether e-cigarette use is generating or increasing the intent to use cigarettes in the future among never-smoked youth and experimenters or the intent to quit cigarette smoking among current youth smokers.

Methods: We analyzed the 2012 National Youth Tobacco Survey dataset. Respondents were split into three groups based on smoking status: never-smoked youth, experimenters, and current smokers. The propensity score matching on the likelihood of being an e-cigarette user was used to minimize possible selection bias. For each matching, imbalance test was conducted to confirm the statistical equivalence between groups. The ordinal logistic regression analyses were performed for matched samples.

Results: Youth who ever used e-cigarettes but never smoked cigarettes (adjusted odds ratio [AOR] = 4.22; 95% CI = 2.25, 7.95) and those who ever used e-cigarettes and experimented cigarette smoking before (AOR= 1.82; 95% CI = 1.38, 2.41) were more likely to report intentions to smoke cigarettes in the future than their respective counterparts who never used e-cigarettes. There was no significant association between e-cigarette use and intentions to quit smoking among current youth smokers.

Conclusions: E-cigarette use appears to act as a gateway to cigarette use. The result does not support the notion that e-cigarettes are useful for quitting. Restricting e-cigarette use is important to prevent nonsmoking youth from developing a habit of smoking cigarettes.