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E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015

Kaitlyn M Berry, Lindsay M Reynolds, Jason M Collins, et al.

Tob Control 2019;1:42–9.



Tobacco use is the leading preventable cause of death in the US, responsible for more than 400,000 deaths annually. Fewer than one in ten smokers successfully quit over the prior year, despite general awareness of the health benefits associated with smoking cessation. Prior studies looking at the role of e-cigarette use in cigarette cessation/reduction have largely relied on the analysis of non-representative samples that are impossible to generalise to the population at large. This study aims to look at the role of e-cigarettes in smoking cessation and changes in smoking intensity in adults in the US.

The PATH Study was a large, nationally representative, cohort study designed to collect data on use patterns, risk perceptions, attitudes and health outcomes associated with tobacco products. Data from the PATH study collected in two Waves were used in this study. A sample of 5124 adults were aged 25+ years who were not current e-cigarette users at Wave 1. The study modelled 30-day cigarette cessation and substantial reduction in cigarette consumption as a function of e-cigarette initiation between surveys. Participants were 55% male and predominantly non-Hispanic white (69.8%); 75% of the sample was aged <55 years. Most cigarette smokers were everyday smokers (82.4%) but consumed less than one pack per day (63.7%).

Between Waves 1 and 2, 6.9% of cigarette smokers who were not current e-cigarette users transitioned to former smokers. Cigarette smokers who initiated e-cigarette use between waves and reported they used e-cigarettes at Wave 2 had 7.88-times the odds of 30-day cigarette cessation compared with non-users of e-cigarettes at Wave 2. Cigarette smokers who began using e-cigarettes every day and did not achieve cessation had 5.70-times the odds of reducing their average daily cigarette use by at least 50% between Waves 1 and 2 compared with e-cigarette non-users.

Strengths of the study included: (1) evidence was provided on the association between e-cigarette initiation specifically and cigarette cessation/reduction; (2) the data came from a large, nationally representative survey of the adult population; (3) the analysis was robust to all sensitivity checks conducted. Limitations included: (1) analysis was dependent on self-reported data; (2) the study could not conclude that e-cigarette initiation preceded cigarette cessation or reduction; (3) the conclusions were limited by a relatively short follow-up time.

The study concluded that daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. Less frequent e-cigarette use was not associated with cigarette cessation/reduction. The results suggest incorporating frequency of e-cigarette use for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.

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