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Exploring the gateway hypothesis of e-cigarettes and tobacco: A prospective replication study among adolescents in the Netherlands and Flanders
Martinelli,Thomas F. Candel,Math J J M de Vries,Hein Talhout,Reinskje Knapen,Vera van Schayck,Constant P Nagelhout,Gera E
Martinelli,Thomas F.
Candel,Math J J M
de Vries,Hein
Talhout,Reinskje
Knapen,Vera
van Schayck,Constant P
Nagelhout,Gera E
Abstract
Background: Studies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking. This study replicates a cornerstone study revealing a positive association between both adolescent e-cigarette use and subsequent tobacco use; and tobacco and subsequent e-cigarette use in the Netherlands and Flanders. Design: The longitudinal design included baseline (n=2839) and 6-month (n=1276) and 12-month (n=1025) follow-up surveys among a school-based cohort (mean age: 13.62). Ten high schools were recruited as a convenience sample. The analyses involved (1) associations of baseline e-cigarette use and subsequent tobacco smoking among never smokers; (2) associations of e-cigarette use frequency at baseline and tobacco smoking frequency at follow-up; and (3) the association of baseline tobacco smoking and subsequent e-cigarette use among non-users of e-cigarettes. Findings: Consistent with prior findings, baseline e-cigarette use was associated with higher odds of tobacco smoking at 6-month (OR=1.89; 95% CI 1.05 to 3.37) and 12-month (OR=5.63; 95% CI 3.04 to 10.42) follow-ups. More frequent use of e-cigarettes at baseline was associated with more frequent smoking at follow-ups. Baseline tobacco smoking was associated with subsequent e-cigarette use (OR=3.10; 95% CI 1.58 to 6.06 at both follow-ups). Conclusion: Our study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.
Description
This study was funded by NWO (401.16.012).
Date
2023
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Volume Title
Publisher
Research Projects
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Keywords
ASSOCIATION, CONVENTIONAL CIGARETTE, DRUG-USE, DUAL-USE, ELECTRONIC CIGARETTES, NICOTINE, PATTERNS, RISK-FACTORS, SMOKELESS TOBACCO, SMOKING, electronic nicotine delivery devices, harm reduction, public policy
Citation
Martinelli, T F, Candel, M J J M, de Vries, H, Talhout, R, Knapen, V, van Schayck, C P & Nagelhout, G E 2023, 'Exploring the gateway hypothesis of e-cigarettes and tobacco : A prospective replication study among adolescents in the Netherlands and Flanders', Tobacco Control, vol. 32, no. 2, pp. 170-178. https://doi.org/10.1136/tobaccocontrol-2021-056528
License
info:eu-repo/semantics/openAccess