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Initiation of Electronic Cigarette Use by Age Among Youth in the U.S.

      Introduction

      The rapid increase in electronic cigarette (e-cigarette) smoking among U.S. youth requires data regarding the age pattern of initiation risk for effective tobacco use prevention.

      Methods

      Data from the 2014 National Youth Tobacco Survey (N=20,680, aged 11–19 years, 50.6% male) were analyzed using survival analysis in 2016 to quantify the likelihood of e-cigarette use initiation by age, overall and by gender and racial/ethnic groups.

      Results

      The estimated mean age of e-cigarette initiation was 17.50 (95% CI=17.47, 17.52) years. The estimated hazards of e-cigarette use initiation were 0 up to age 6 years, increased slowly from age 7 to 11 years, and continued with an accelerated increase up to age 17 years before it slowed down. There were significant gender (male > female) and racial/ethnicity (from high to low: multiracial, white, Hispanic, African, and Asian) differences in the age pattern.

      Conclusions

      E-cigarette smoking is initiated as young as age 7 years. Different from conventional cigarette smoking with peak initiation risk at age 14–15 years, the likelihood of initiating e-cigarette smoking continues to increase up to age 18 years. The unique age pattern and significant gender and racial/ethnic differences provide useful data to support further research to strengthen tobacco use prevention in the U.S.
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      Linked Article

      • E-cigarettes and the Youngest, Not a Problem in Europe: No Data Yet
        American Journal of Preventive MedicineVol. 54Issue 4
        • Preview
          Chen et al.1 provided frightening facts: “e-cigarette smoking is initiated as young as age 7 years while peak initiation of conventional cigarette is 14–15 years.” The term gateway appeared soon in titles of articles about e-cigarettes because nicotine, smoked or vaped, is a most potent addictive product, even more when associated with flavor.2 Nevertheless, no one expected initiation could have been so early. As the early age of smoking initiation is a major risk factor for smoking-related morbidities and all-cause mortality,3 Chen et al.’s finding needs robust and rapid responses.
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