E-cigarette and waterpipe use in two adolescent cohorts: Cross-sectional and longitudinal associations with conventional cigarette smoking

J. L. Treur, A.D. Rozema, J.J.P. Mathijssen, J.A.M. van Oers, J. M. Vink

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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.
Original languageEnglish
Pages (from-to)323-334
JournalEuropean Journal of Epidemiology
Issue number3
Publication statusPublished - 2018


  • Adolescents
  • E-cigarettes
  • Longitudinal
  • Smoking
  • Smoking propensity
  • Waterpipe


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