Risk factors for e-cigarette, conventional cigarette, and dual use in German adolescents: A cohort study
Introduction
Electronic cigarettes (e-cigarettes) are battery-powered nicotine delivery systems, which are marketed in many varieties (Hajek et al., 2014). Awareness and use of e-cigarettes have increased rapidly during the past few years (Pepper and Brewer, 2014). E-cigarettes expose users to high levels of particulates, which may increase cardiovascular risk. Since no tobacco is burnt, e-cigarettes reduce the exposure to cancer-related agents. Therefore, it has been suggested that e-cigarettes are less harmful compared to conventional cigarettes. In addition, discussion of e-cigarettes has focused on their potential as a smoking cessation aid for adult smokers (Bullen et al., 2013).
Little is known about e-cigarette use in young people. The prevalence of e-cigarette use in adolescents was recently summarized (Dutra and Glantz, 2014b). Ten cross-sectional studies with adolescent populations have been conducted in the United States, Poland, Korea, and France. The major finding is that e-cigarette use is increasing rapidly among youth in these countries. In Poland for example two cross-sectional studies among 15- to 19-year olds found an absolute increase of ever e-cigarette use of about 45% points from 2010–11 to 2013–14 (Goniewicz et al., 2014, Goniewicz and Zielinska-Danch, 2012). A large scale cross-sectional study with US adolescents found that the use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, and higher odds of established smoking (Dutra and Glantz, 2014a). A recently published cross-sectional paper on e-cigarette use among a large sample of Korean adolescents found that e-cigarette use was strongly associated with current and heavier cigarette smoking (Lee et al., 2014).
The aim of our study is to contribute to the literature by investigating risk factors associated with e-cigarette and dual use in a sample of German adolescents and compare these risk factors with risk factors that are associated with conventional cigarette use.
Section snippets
Design and sample
We used data from a randomized-controlled school-based smoking prevention study described in detail elsewhere (Hansen et al., 2011, Isensee et al., 2014). A two-arm (intervention vs. control) prospective cluster randomized controlled trial with five waves was conducted in four federal states in Germany (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein). A total of 45 public secondary schools with 3444 students from 172 classes were recruited in September/October 2010 (baseline). In
Attrition analysis
More boys and more persons with migration background dropped out of the study. Persons lost to follow-up were significantly older at baseline, had lower family affluence scores, attended less often a Gymnasium, scored higher on sensation-seeking, and had more often friends/siblings/parents who smoked conventional cigarettes.
Use of conventional and e-cigarettes
A total of 2135 students (80.4%) never smoked a conventional nor an e-cigarette (Table 1). One hundred twenty six students (4.7%) had tried e-cigarettes, of whom 76.2% (n =
Discussion
Almost 5% of a sample of 2693 German seventh graders had used e-cigarettes in 2012. E-cigarette use and dual use were associated with higher sensation seeking scores, and higher odds of having friends and parents who smoke conventional cigarettes. Lifetime prevalence of conventional cigarette use was 18.4%. Conventional cigarette use was associated with male gender, being older, higher sensation seeking scores, higher odds of friends/siblings/parents who smoke conventional cigarettes, and less
Funding
This work was supported by German Cancer Aid (Grant Number: 108374). German Cancer Aid had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Participating investigators
Karin Maruska, Julia Hansen and Marianne Bayrhuber contributed to the completion of the project by organizing the data assessments.
Conflict of interest statement
The authors declare that there are no conflicts of interests.
Ethics approval
Ethics approval was provided by the Ethics Committee of the Medical Faculty of the University of Kiel (Ref.: D 419/10). Additional approvals (e.g., from ministries of education and parents) were sought as required.
Trial registration
Current controlled trials ISRCTN99442407.
Acknowledgments
Malin Bachmann, Tina Basner, Jana Blumkowski, Dorothea Breckwoldt, Roxana Buzila, Svenja Cleve, Malte Dincher, Eva-Maria Eggers, Nadia El Bouhayati, Almut Engelhardt, Sigrid Feierabend, Sarah Göhlert, Lars Grabbe, Judith Hanewinkel, Oksana Herdt, Semiha Idrizovic, Sabiha Izaamriouane, Martin Karsten, Andre Lischick, Stefanie Otte, Serdar Peker, Ines Pohlmann, Wiebke Pustal, Gesa Sander, Christoph Schlüter, Björn Seiler, Beate Steiber, Alexander Wierzock and Nicole Wilmes assessed the data. The
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