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Open AccessArticle

Electronic Cigarette Use and Smoking Initiation in Taiwan: Evidence from the First Prospective Study in Asia

1
Chung-Hua Institution for Economic Research, Taipei 106, Taiwan
2
College of Public Health, Taipei Medical University, Taipei 110, Taiwan
3
Master’s Program in Global Health and Development, Taipei Medical University, Taipei 110, Taiwan
4
Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei 110, Taiwan
5
Department of Medicine, Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA 94117, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(7), 1145; https://doi.org/10.3390/ijerph16071145
Received: 14 January 2019 / Revised: 21 March 2019 / Accepted: 22 March 2019 / Published: 30 March 2019
(This article belongs to the Special Issue Electronic Cigarettes: Good and Bad Impacts)
A growing literature indicates that electronic cigarette use increases the risk of subsequent initiation of conventional smoking among cigarette-naïve adolescents in several Western countries. This research assesses the same relationship in an Asian country, Taiwan. The Taiwan Adolescent to Adult Longitudinal Study is a school-based survey that was carried out in two waves in 2014 (baseline) and in 2016 (follow-up). It employs probability sampling to create nationally representative samples of students in junior high school (mean age 13, 7th grade at baseline) and in senior high school (mean age 16, 10th grade at baseline). Data from this survey were analyzed via logistic regression to estimate the association between ever use of e-cigarettes at baseline and smoking initiation at follow-up, accounting for susceptibility to smoking, socio-demographic profile, depression status, and peer support. Among the 12,954 cigarette-naïve students surveyed, those with e-cigarette experience at baseline exhibited higher odds of smoking initiation at follow-up (Odds Ratio = 2.14, 95% CI (1.66, 2.75), p < 0.001). For the first time, we confirmed, through a longitudinal survey, a prospective association between ever use of e-cigarettes and smoking initiation in an Asian adolescent population. The restrictive policy on e-cigarettes currently in force in Taiwan is justified to prevent both e-cigarette and cigarette use among adolescents. View Full-Text
Keywords: e-cigarette; smoking initiation; prospective study; Asian youth; Taiwan e-cigarette; smoking initiation; prospective study; Asian youth; Taiwan
MDPI and ACS Style

Chien, Y.-N.; Gao, W.; Sanna, M.; Chen, P.-L.; Chen, Y.-H.; Glantz, S.; Chiou, H.-Y. Electronic Cigarette Use and Smoking Initiation in Taiwan: Evidence from the First Prospective Study in Asia. Int. J. Environ. Res. Public Health 2019, 16, 1145.

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