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Open AccessArticle

Exploring the Bi-Directional Association between Tobacco and E-Cigarette Use among Youth in Canada

1
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
2
Department of Addictions, King’s College London, London SE5 8BB, UK
3
Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(21), 4256; https://doi.org/10.3390/ijerph16214256
Received: 16 September 2019 / Revised: 22 October 2019 / Accepted: 30 October 2019 / Published: 1 November 2019
(This article belongs to the Special Issue Electronic Cigarettes: Good and Bad Impacts)
Research has demonstrated associations between e-cigarette use and tobacco use among youth. However, few studies have examined whether reciprocal relationships exist between e-cigarette and tobacco use. The objective of this study was to examine whether bi-directional associations exist between e-cigarette and tobacco use in a large longitudinal sample of Canadian youth. A longitudinal sample of secondary students (n = 6729) attending 87 schools in Ontario and Alberta, Canada, who completed the COMPASS student questionnaire across three waves (from 2014–2015 to 2016–2017) was identified. Using cross-lagged models, we explored bi-directional associations between current tobacco and e-cigarette use, adjusting for relevant covariates. Our findings showed that current e-cigarette use predicted subsequent tobacco use between Wave 1 (W1) and Wave 2 (W2) of the study (W1–2: OR = 1.54, 95% CI = 1.37–1.74). Similarly, current tobacco use predicted e-cigarette use during earlier waves of the study (W1–2: OR = 1.43, 95% CI = 1.30–1.58). However, these relationships dissipated in later waves, when tobacco use no longer predicted e-cigarette use (W2–3: OR = 1.07, 95% CI = 0.99–1.16). This study extends prior work that focused mainly on the association between e-cigarette and subsequent tobacco use. Specifically, our findings portray a more complex relationship, where e-cigarette use may influence and be influenced by tobacco use. View Full-Text
Keywords: bi-directional; e-cigarette; tobacco; electronic cigarettes; youth bi-directional; e-cigarette; tobacco; electronic cigarettes; youth
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Aleyan, S.; Gohari, M.R.; Cole, A.G.; Leatherdale, S.T. Exploring the Bi-Directional Association between Tobacco and E-Cigarette Use among Youth in Canada. Int. J. Environ. Res. Public Health 2019, 16, 4256.

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