{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T12:48:01Z","timestamp":1769345281508,"version":"3.49.0"},"reference-count":28,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,27]],"date-time":"2024-03-27T00:00:00Z","timestamp":1711497600000},"content-version":"unspecified","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,11]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The majority of tobacco users have had their first contact with nicotine at a young age. The aim of this study was to explore the association between the first tobacco or nicotine product tried and the transition to regular product use in 28 European countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A secondary analysis of participants aged 15\u201340 years (n=8884) from 28 countries was conducted (Eurobarometer wave 93.2; August\u2013September 2020). Participants who reported having ever tried tobacco or nicotine products were asked which product they tried first. Self-reported history of tobacco use determined whether they were established users (\u22651\u2009time weekly) of a range of products at any point in their life. Multilevel logistic regression was used to measure the association between first product tried and becoming a regular user of tobacco or nicotine products.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was large variation between countries in the proportion of participants aged \u226440 years that ever tried tobacco or nicotine; Estonia had the highest proportion of ever users (85.8%) and Poland had the lowest (38.9%). Among those who had ever tried tobacco or nicotine, boxed cigarettes were the most common first product (72.3%) and pipe was the least common (0.4%). Compared with those who first tried e-cigarettes, the odds of ever becoming a regular user of any tobacco or nicotine product were higher among those who first had hand-rolled cigarettes (adjusted OR, aOR 2.23; 95%\u2009CI 1.43 to 3.48) or boxed cigarettes (aOR 2.08; 95%\u2009CI1.43 to 3.02) and lower among those who first tried waterpipe (aOR 0.22; 95%\u2009CI 0.14 to 0.34).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although this study cannot infer causality, the findings show that odds of becoming a regular tobacco user differs widely depending on the first product used. Better understanding of the associations between first product use and regular tobacco use could be informative to tobacco control policy-makers and help tailor prevention programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-080818","type":"journal-article","created":{"date-parts":[[2024,3,28]],"date-time":"2024-03-28T14:01:02Z","timestamp":1711634462000},"page":"e080818","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["First experience with nicotine products and transition to regular tobacco use: a secondary data analysis in 28 European countries"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6016-6705","authenticated-orcid":false,"given":"Nikita B","family":"Rajani","sequence":"first","affiliation":[{"name":"Department of Primary care and Public Health, Imperial College London School of Public Health, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jyoti","family":"Goyal","sequence":"additional","affiliation":[{"name":"Department of Primary care and Public Health, Imperial College London School of Public Health, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2101-2559","authenticated-orcid":false,"given":"Filippos T","family":"Filippidis","sequence":"additional","affiliation":[{"name":"Department of Primary care and Public Health, Imperial College London School of Public Health, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,3,28]]},"reference":[{"key":"2025121411041742000_14.3.e080818.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01169-7"},{"key":"2025121411041742000_14.3.e080818.2","unstructured":"World Health Organization . 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A systematic review and meta-analysis of studies of adolescent E-cigarette use and future smoking initiation","volume":"116","author":"Chan","year":"2021","journal-title":"Addiction"},{"key":"2025121411041742000_14.3.e080818.12","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2019-055283"},{"key":"2025121411041742000_14.3.e080818.13","doi-asserted-by":"crossref","unstructured":"Parnham JC , Vrinten C , Rad\u00f3 MK , et al . Multistate transition Modelling of E-cigarette use and cigarette smoking among youth in the UK. Tob Control 2023:tc-2022-057777. doi:10.1136\/tc-2022-057777","DOI":"10.1136\/tc-2022-057777"},{"key":"2025121411041742000_14.3.e080818.14","doi-asserted-by":"crossref","unstructured":"Al Oweini D , Jawad M , Akl EA . The Association of Waterpipe tobacco smoking with later initiation of cigarette smoking: a systematic review and meta-analysis exploring the Gateway theory. 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