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Originally published by 2 Minute Medicine® (view original article). Reused on AccessMedicine with permission.

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1. In this study of self-reported habits of teenagers, use of e-cigarettes with greater nicotine concentration was associated with incremental increase in odds of cigarette smoking and vaping.

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Evidence Rating Level: 2 (Good)

Study Rundown:

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The introduction of e-cigarettes has been met with concerns that the use of such products may increase the subsequent use of cigarettes and other forms of traditional smoking. There is a particular concern as e-cigarettes may be advertised more towards younger users. The current study sought to better explore factors that may affect the progression of e-cigarette use to heavier use and cigarette smoking amongst teens. The study evaluated the nicotine concentration reported by teens who were e-cigarette users at baseline, and evaluated the risk of heavier vaping or smoking after six months. There was an incremental increase in the odds of vaping and smoking with greater nicotine concentration. The greater nicotine concentration was also linked to increased number of cigarettes used, and increased frequency and inhalations performed during vaping episodes.

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The study had a high rate of retention, and provided detailed data on products used in a diverse adolescent population. The main limitations of the study included its small sample size, short follow-up, and reliance on self-reported rather than biochemically verified nicotine concentrations.

In-Depth [prospective cohort]:

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This study is a prospective cohort of 10th grade students from 10 high schools in Los Angeles, California. Participants were included in the study if they reported baseline e-cigarette use within the 30 days prior to the initial survey, and participated in the 6-month follow-up survey. Participants were excluded if they did not report nicotine concentration used while vaping. Nicotine concentration was reported as none (0 mg/mL), low (1-5 mg/mL), medium (6-17 mg/mL), or high (≥18 mg/mL).

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Of the 3253 participants of the 10th grade survey, 235 used e-cigarettes at baseline and 181 reported nicotine concentration. At 6-month follow up, for each 1-level of nicotine concentration level adjusted odds ratio of frequent (vs. no) cigarette use was 2.26 (95% CI, 1.28-3.98) while frequent vaping was also more likely (aOR 1.65; 95% CI, 1.09-2.51). Participants who vaped high concentrations of nicotine smoked 14.17 times (95% CI, 13.00-15.33) as many cigarettes as non-nicotine users. Nicotine-users were also found to inhale 2.4-4.9 times as many puffs as non-nicotine users, and engaged in 2.5-3.9 times as many vaping episodes per day.

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