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Relationships Between E-cigarette Use and Subsequent Cigarette Initiation Among Adolescents in the PATH Study: an Entropy Balancing Propensity Score Analysis


This study aimed to examine the relationship between electronic cigarette use and subsequent combustible cigarette use, controlling for confounding by using a propensity score method approach. Data from the first three annual waves of the Population Assessment of Tobacco and Health study were analyzed (n = 6309). Participants were tobacco-naïve at Wave 1; used e-cigarettes exclusively (n = 414), used combustible cigarettes exclusively (n = 46), or not used any tobacco products (n = 5849) at Wave 2. We conducted entropy balancing propensity score analysis to examine the association between exclusive e-cigarette or cigarette initiation and subsequent cigarette use at Wave 3, adjusting for non-response bias, sampling bias, and confounding. Among tobacco-naïve youth, exclusive e-cigarette use was associated with greater risk for subsequent combustible cigarette smoking initiation (OR = 3.42, 95% CI = (1.99, 5.93)) and past 30-day combustible cigarette use (OR = 2.88, 95% CI = (1.22, 6.86)) in the following year. However, the latter risk was comparatively lower than the risk if youth started with a combustible cigarette (OR = 25.79, 95% CI = (9.68, 68.72)). Results of sensitivity analyses indicated that estimated effects were robust to unmeasured confounding. Use of e-cigarettes in tobacco-naïve youth is associated with increased risk of subsequent past 30-day combustible cigarette use but the risk is an order of magnitude higher if they start with a combustible cigarette.

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This work was supported by a grant from the New York University (NYU) Research Challenge Fund Program. Research reported in this publication was also supported by the National Cancer Institute of the National Institutes of Health (NIH) and FDA Center for Tobacco Products (CTP) under Award Number U54CA229974. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

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Correspondence to Shu Xu.

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This study is a secondary data analysis of the publicly available data from the Population Assessment of Tobacco and Health Study (PATH). All data have been de-identified (by Inter-University Consortium for Political and Social Research before releasing to researchers) and the current research involved no human participants and/or animals.

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This study is a secondary data analysis of publicly available data. No informed consent form was concerned.

Conflict of Interest

DC, BL, YX, and JH report no financial or other relationship relevant to the subject of this article. SX receives the research grants from NYU Research Challenge Fund and NIH/NCI supplement award through Grant U54CA229974. RN receives funding from the Food and Drug Administration Center for Tobacco Products via contractual mechanisms with Westat and the National Institutes of Health. The work presented here is independent of this funding, and does not represent the views or opinions of any government institutes or agencies.

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Xu, S., Coffman, D.L., Liu, B. et al. Relationships Between E-cigarette Use and Subsequent Cigarette Initiation Among Adolescents in the PATH Study: an Entropy Balancing Propensity Score Analysis. Prev Sci 23, 608–617 (2022).

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  • E-cigarette use
  • Combustible cigarette use initiation
  • Youth
  • Entropy balancing
  • Sensitivity analysis