1. Alcohol, Other Drugs, and Health: Current Evidence March–April 2018
Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
March–April 2018

2. Watkins SL, et al. JAMA Pediatr. 2018;172(2):181–187.
Featured Article
Association of Noncigarette Tobacco Product Use With Future Cigarette Smoking Among Youth in the Population Assessment of Tobacco and Health (PATH) Study,
Watkins SL, et al. JAMA Pediatr. 2018;172(2):181–187.

3. Study Objective
To determine whether use of smokeless tobacco products by non-smoking youth predicted cigarette initiation.

4. Study Design
Prospective cohort study of 10,384 youths (aged 12-17) who reported never smoking a cigarette at baseline and who completed one-year follow-up questionnaire about cigarette use.
Outcome at one year was whether the participant ever smoked a cigarette, and at least one day of cigarette use in last 30 days.

5. Assessing Validity of an Article about Prognosis
Are the results valid?
What are the results?
How can I apply the results to patient care?
Based on the Users’ Guides to the Medical Literature; for more information, see the following:

6. Are the Results Valid? Was the sample representative?
Were the subjects sufficiently homogeneous with respect to prognostic risk?
Was follow-up sufficiently complete?
Were objective and unbiased outcome criteria used?

7. Was the sample representative?
Yes. Participants were from a nationally representative longitudinal cohort.

8. Were the subjects sufficiently homogeneous with respect to prognostic risk?
Yes. And the authors adjusted for sex, age, race/ethnicity, parental educational level, and urban residence.

9. Was follow-up sufficiently complete?
Yes. Retention at one-year follow-up was 87.9%.

10. Were objective and unbiased outcome criteria used?
Yes.

11. What Are the Results? How likely are the outcomes over time?
How precise are the estimates of likelihood?

12. How likely are the outcomes over time?
At follow-up, 4.6% of non-smokers initiated cigarette smoking in the one-year observation period, and 2.1% reported past 30-day cigarette smoking.

13. How precise are the estimates of likelihood?
Among youths who had never smoked a cigarette at baseline, adjusted odds of any cigarette use initiation were approximately double for ever users of:
e-cigarettes (odds ratio [OR], 2.53; 95% CI, )
hookah (OR, 1.79; 95% CI, )
noncigarette combustible tobacco (OR, 1.64; 95% CI, )
smokeless tobacco (OR, 1.66; 95% CI, ) compared with never users (Table 2).
Odds of past 30-day cigarette use at follow-up were also approximately double for ever users of e-cigarettes (OR, 1.87; 95% CI, ), hookah (OR, 1.92; 95% CI, ), noncigarette combustible tobacco (OR, 1.78; 95% CI, ), and smokeless tobacco (OR, 2.07; 95% CI, ) compared with never users.

14. How Can I Apply the Results to Patient Care?
Were the study patients and their management similar to those in my practice?
Was follow-up sufficiently long?
Can I use the results in the management of patients in my practice?

15. Were the study patients similar to those in my practice?
The study population was large, 49% female, 53% white, 14% African American, 22% Latino, and 80% urban-dwelling.

16. Was follow-up sufficiently long?
Yes.

17. Can I use the results in the management of patients in my practice?
Yes. This study demonstrates that use of any nicotine-based product by adolescents is associated with cigarette smoking initiation; this risk should be considered among the public health harms of these products.
Efforts to regulate these products using strategies known to reduce youth cigarette use should be applied broadly to nicotine-containing non-cigarette products.