E-Cigarette Use and Regular Cigarette Smoking Among Youth: Population Assessment of Tobacco and Health Study (2013–2016)

Following their introduction a decade ago, electronic cigarettes (e-cigarettes) have grown in popularity. Given their novelty, knowledge of the health consequences of e-cigarette use remains limited. Epidemiologic studies have not comprehensively explored associations between e-cigarette use and hypertension, a highly prevalent health condition and major contributor to cardiovascular disease burden. In this study, cross-sectional associations of cigarette smoking and e-cigarette use (vaping) with self-reported diagnosed hypertension were evaluated among 19,147 18–55 year old respondents in Wave 3 (2015–2016) of the Population Assessment of Tobacco and Health Study. Multivariable analyses first modeled smoking and vaping as separate 2-category variables, then as a 6-category composite variable accounting for former smoking. After adjusting for potential confounders, current vaping (aOR = 1.31; 95%CI: 1.05–1.63) and current smoking (aOR = 1.27; 95%CI: 1.10–1.47) were both associated with higher odds of hypertension. In analyses modeling smoking and vaping compositely, respondents who were concurrently smoking and vaping had the highest odds of hypertension (aOR = 1.77; 95%CI: 1.32–2.39 [referent: never smokers]). These results differ somewhat from prior epidemiologic studies of vaping and respiratory outcomes, which consistently report smaller point estimates for current vaping than for current smoking. Our findings reinforce the uncertainty surrounding long-term health consequences of vaping, as well as highlight important distinctions between respiratory and cardiovascular outcomes when considering the harm reduction potential of e-cigarettes.

Download Full-text

Investigating gateway effects using the PATH study

F1000Research ◽

10.12688/f1000research.18354.1 ◽

2019 ◽

Vol 8 ◽

pp. 264 ◽

Cited By ~ 2

Author(s):

Peter Lee ◽

John Fry

Keyword(s):

Cigarette Smoking ◽

Odds Ratio ◽

Meta Analysis ◽

Smoking Initiation ◽

Continuous Variable ◽

Sensitivity Analyses ◽

Health Study ◽

Cigarette Use ◽

Tobacco Products ◽

Residual Confounding

Background: A recent meta-analysis of nine cohort studies in youths reported that baseline ever e-cigarette use strongly predicted cigarette smoking initiation in the next 6-18 months, with an adjusted odds ratio of 3.62 (95% confidence interval 2.42-5.41). A recent review of e-cigarettes agreed there was substantial evidence for this “gateway effect”. However, the number of confounders considered in the studies was limited, so we investigated whether the effect might have resulted from inadequate adjustment, using Waves 1 and 2 of the Population Assessment of Tobacco and Health study. Methods: Our main analyses considered Wave 1 never cigarette smokers who, at Wave 2, had information available on smoking initiation. We constructed a propensity score for ever e-cigarette use from Wave 1 variables, using this to predict ever cigarette smoking. Sensitivity analyses accounted for use of other tobacco products, linked current e-cigarette use to subsequent current smoking, or used propensity scores for ever smoking or ever tobacco product use as predictors. We also considered predictors using data from both waves to attempt to control for residual confounding from misclassified responses. Results: Adjustment for propensity dramatically reduced the unadjusted odds ratio (OR) of 5.70 (4.33-7.50) to 2.48 (1.85-3.31), 2.47 (1.79-3.42) or 1.85 (1.35-2.53), whether adjustment was made as quintiles, as a continuous variable or for the individual variables. Additional adjustment for other tobacco products reduced this last OR to 1.59 (1.14-2.20). Sensitivity analyses confirmed adjustment removed most of the gateway effect. Control for residual confounding also reduced the association. Conclusions: We found that confounding is a major factor, explaining most of the observed gateway effect. However, our analyses are limited by small numbers of new smokers considered and the possibility of over-adjustment if taking up e-cigarettes affects some predictor variables. Further analyses are intended using Wave 3 data which should avoid these problems.

Download Full-text

Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA

Tobacco Control ◽

10.1136/tobaccocontrol-2020-055999 ◽

2021 ◽

pp. tobaccocontrol-2020-055999

Author(s):

Alyssa F Harlow ◽

Jessica L Fetterman ◽

Craig S Ross ◽

Rose Marie Robertson ◽

Aruni Bhatnagar ◽

...

Keyword(s):

Cigarette Smoking ◽

Multinomial Logistic Regression ◽

Sociodemographic Factors ◽

Tobacco Product ◽

Electronic Cigarette ◽

Health Study ◽

Cigarette Use ◽

Use Patterns ◽

The Usa ◽

Former Smokers

BackgroundFew studies assess whether electronic cigarette (e-cigarette) device characteristics or flavours impact longitudinal patterns of cigarette and e-cigarette use.DesignWe examined data from waves 2–4 of the Population Assessment of Tobacco and Health Study (2014–2018). Among adult (≥18 years) current e-cigarette users at wave 2 who were current smokers (dual users; n=1759) and former smokers (exclusive e-cigarette users; n=470), we classified participants into four use patterns at wave 3 (~12 months later) and wave 4 (~24 months later): (1) dual use of e-cigarettes and cigarettes; (2) exclusive cigarette smoking; (3) exclusive e-cigarette use; (4) non-use of both products. We used multinomial logistic regression to assess correlates of changing use patterns at 24 months, relative to no change, adjusting for sociodemographic factors.ResultsAt 24 months, 26.5% of baseline exclusive e-cigarette users, and 9% of baseline dual users, abstained from both vaping and smoking. Participants who vaped non-tobacco flavours (vs tobacco flavours), and used refillable tank or modifiable devices (vs disposable, cartridges and other devices) were less likely to transition to non-use of both products and to exclusive cigarette smoking. Baseline daily vaping (vs non-daily) was positively associated with exclusive e-cigarette use at 24 months for baseline daily cigarette smokers, but negatively associated with exclusive e-cigarette use and non-use of both products at 24 months for baseline non-daily smokers.ConclusionsNon-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.

Download Full-text

Electronic cigarette use among heart failure patients: Findings from the Population Assessment of Tobacco and Health study (Wave 1: 2013–2014)

Heart & Lung ◽

10.1016/j.hrtlng.2019.11.006 ◽

2020 ◽

Vol 49 (3) ◽

pp. 229-232

Author(s):

Emily C. Gathright ◽

Wen-Chih Wu ◽

Lori A.J. Scott-Sheldon

Keyword(s):

Heart Failure ◽

Electronic Cigarette ◽

Health Study ◽

Cigarette Use ◽

Population Assessment ◽

Heart Failure Patients

Download Full-text

Patterns of E-cigarette Use and Subsequent Cigarette Smoking Cessation Over 2 Years (2013/2014–2015/2016) in the Population Assessment of Tobacco and Health Study

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa182 ◽

2020 ◽

Cited By ~ 3

Author(s):

Allison M Glasser ◽

Mahathi Vojjala ◽

Jennifer Cantrell ◽

David T Levy ◽

Daniel P Giovenco ◽

...

Keyword(s):

Smoking Cessation ◽

Cigarette Smoking ◽

The United States ◽

Adjusted Relative Risk ◽

Cigarette Use ◽

Short Term ◽

Population Assessment ◽

Quit Attempt ◽

Quit Smoking

Abstract Introduction Understanding the population impact of e-cigarettes requires determining their effect on cigarette smoking cessation. Methods Using the US Population Assessment of Tobacco and Health cohort, we examined smoking cessation among adult current cigarette smokers at Wave 1 with follow-up data at Waves 2 and 3 (n = 9724). Results By Wave 3 (2015/2016), 17.3% of smokers had quit smoking. Smokers using e-cigarettes daily or who increased to daily use over the three waves were two to four times more likely to have quit in the short term (<1 year) and long term (1+ years) compared with never e-cigarette users (p < .001). E-cigarette use in the last quit attempt was associated with a higher likelihood of short-term (<1 year) quitting at Wave 3 (adjusted relative risk ratio: 1.33; 95% confidence interval: 1.04, 1.71) compared with smokers who did not use an e-cigarette in their last quit attempt. Noncurrent (no use in any wave) e-cigarette users and users who were unstable in use frequency were 33% and 47% less likely to quit in the short-term, respectively (p < .001). Flavored (vs nonflavored) and using a rechargeable (vs disposable) e-cigarette device was associated with an increased likelihood of both short- and long-term quitting. Conclusion Smoking cessation was more likely among frequent e-cigarette users, users of e-cigarettes in last quit attempt, and users of flavored and rechargeable devices. Less frequent, unstable, past, or never e-cigarette users were less likely to quit smoking. Monitoring the relationship between patterns of e-cigarette and cigarette use is complex but critical for gauging the potential of e-cigarettes as a harm reduction tool. Implications This study suggests that consistent and frequent e-cigarette use over time is associated with cigarette smoking cessation among adults in the United States. In addition, findings suggest that flavored e-cigarette use and use of rechargeable e-cigarette devices can facilitate smoking cessation. These results underscore the importance of carefully defining and characterizing e-cigarette exposure patterns, potential confounders, and use of e-cigarettes to quit smoking, as well as variations in length of the smoking cessation.

Download Full-text

The Relationship between Menthol Cigarette Use, Smoking Cessation and Relapse: Findings from Waves 1 to 4 of the Population Assessment of Tobacco and Health Study

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa212 ◽

2020 ◽

Author(s):

Sarah D Mills ◽

Yajing Hao ◽

Kurt M Ribisl ◽

Christopher A Wiesen ◽

Kristen Hassmiller Lich

Keyword(s):

Estimating Equation ◽

The United States ◽

Health Study ◽

Cigarette Use ◽

Cigarette Smokers ◽

Population Assessment ◽

Lower Odds ◽

Menthol Cigarette ◽

Representative Study ◽

The Relationship

Abstract Introduction Some, but not all, studies suggest that menthol cigarette smokers have more difficulty quitting than non-menthol cigarette smokers. Inconsistent findings may be a result of differences in smoker characteristics (e.g. daily vs. non-daily smokers) across studies. This study examines the relationship between menthol cigarette use, cessation and relapse in a longitudinal, nationally representative study of tobacco use in the United States. Methods Data come from four waves of the Population Assessment of Tobacco and Health Study. Waves 1-4 were conducted approximately annually from September 2013 to January 2018. Generalized estimating equation models were used to prospectively examine the relationship between menthol cigarette use, cessation, and relapse in non-daily and daily adult (18+) smokers. Cessation was defined as smokers who had not used cigarettes within the past 30 days at their subsequent assessment. Relapse was defined as cessation followed by past 30-day smoking in the next assessment. Results Among daily smokers (n=13,710), 4.0% and 5.3% of menthol and non-menthol smokers quit after one year, respectively. In an adjusted model, menthol smokers were less likely to quit compared to non-menthol smokers (OR=0.76 [0.63, 0.91]). When the sample was stratified by race/ethnicity, African-American (OR=0.58 [0.34, 0.99]) and White (OR=0.58 [0.34, 0.99]) daily menthol users were less likely to have quit. Among non-daily smokers (n=3,608), there were no significant differences in quit rates. Among daily and non-daily former smokers, there were also no differences in relapse rates between menthol and non-menthol smokers. Conclusions Menthol cigarette use is associated with lower odds of cessation. Implications Findings from this study suggest that menthol cigarette use is associated with lower odds of cessation, but not relapse. Removing menthol cigarettes from the market may improve cessation rates.

Download Full-text

Association of smoking and electronic cigarette use with wheezing and related respiratory symptoms in adults: cross-sectional results from the Population Assessment of Tobacco and Health (PATH) study, wave 2

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054694 ◽

2019 ◽

pp. tobaccocontrol-2018-054694 ◽

Cited By ~ 17

Author(s):

Dongmei Li ◽

Isaac K Sundar ◽

Scott McIntosh ◽

Deborah J Ossip ◽

Maciej Lukasz Goniewicz ◽

...

Keyword(s):

Lower Risk ◽

Respiratory Symptoms ◽

Electronic Cigarettes ◽

Electronic Cigarette ◽

Health Study ◽

Cigarette Use ◽

Cross Sectional ◽

Population Assessment ◽

Increased Risk ◽

The Cross

BackgroundWheezing is a symptom of potential respiratory disease and known to be associated with smoking. Electronic cigarette use (‘vaping’) has increased exponentially in recent years. This study examined the cross-sectional association of vaping with wheezing and related respiratory symptoms and compare this association with smokers and dual users.MethodsThe Population Assessment of Tobacco and Health study wave 2 data collected from October 2014 to October 2015 with 28 171 adults were used. The cross-sectional association of vaping with self-reported wheezing and related respiratory symptoms relative to smokers and dual users of tobacco and electronic cigarettes were studied using multivariable logistic and cumulative logistic regression models with consideration of complex sampling design.ResultsAmong the 28 171 adult participants, 641 (1.2%) were current vapers who used e-cigarettes exclusively, 8525 (16.6%) were current exclusive smokers, 1106 (2.0%) were dual users and 17 899 (80.2%) were non-users. Compared with non-users, risks of wheezing and related respiratory symptoms were significantly increased in current vapers (adjusted OR (aOR)=1.67, 95% CI: 1.23 to 2.15). Current vapers had significantly lower risk in wheezing and related respiratory symptoms compared with current smokers (aOR=0.68, 95% CI: 0.53 to 0.87). No significant differences were found between dual users and current smokers in risk of wheezing and related respiratory symptoms (aOR=1.06, 95% CI: 0.91 to 1.24).ConclusionsVaping was associated with increased risk of wheezing and related respiratory symptoms. Current vapers had lower risk in wheezing and related respiratory symptoms than current smokers or dual users but higher than non-users. Both dual use and smoking significantly increased the risk of wheezing and related respiratory symptoms.

Download Full-text

Longitudinal e-Cigarette and Cigarette Use Among US Youth in the PATH Study (2013–2015)

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz006 ◽

2019 ◽

Vol 111 (10) ◽

pp. 1088-1096 ◽

Cited By ~ 14

Author(s):

Cassandra A Stanton ◽

Maansi Bansal-Travers ◽

Amanda L Johnson ◽

Eva Sharma ◽

Lauren Katz ◽

...

Keyword(s):

Cigarette Smoking ◽

Linear Models ◽

Statistical Tests ◽

Health Study ◽

Tobacco Prevention ◽

Cigarette Use ◽

Cross Sectional ◽

Prevalence Estimates ◽

One Year ◽

Weighted Prevalence

Abstract Background Evidence is accumulating that youth who try Electronic Nicotine Delivery Systems (ENDS, e-cigarettes) may go on to try cigarettes. This analysis examines the bidirectional patterns of ENDS and cigarette use among US youth over one year and uses propensity score matching (PSM) to examine frequency of ENDS use on changes in cigarette smoking. Methods Our analysis included 11 996 participants who had two waves of available data (Wave 1 [W1] 2013–2014; Wave 2 [W2] 2014–2015) drawn from the longitudinal Population Assessment of Tobacco and Health Study. Cross-sectional weighted prevalence estimates are reported for cigarettes and ENDS. We used PSM to estimate the likelihood of ENDS use at W1 and to draw matched analytic samples, then used regression (logistic or linear) models to examine the effect of W1 ENDS use on W2 cigarette smoking. All statistical tests were two-sided. Results In weighted analyses, 69.3% of W1 past-30-day cigarette smokers exhibited past-30-day smoking at W2; 42.2% of W1 past-30-day ENDS users were using ENDS at W2. W1 ever use of either product was similarly associated with W2 new use of the other product. Unweighted PSM models indicated W1 cigarette-naïve ENDS use was associated with W2 ever-cigarette smoking (n = 676; adjusted odds ratio = 3.21, 95% confidence interval [CI] = 1.95 to 5.45, P < .001); W1 ever-ENDS use did not affect change in cigarette frequency at W2 (n = 1020, beta = 0.31, 95% CI = −0.76 to 1.39, P = .57); 1–5 days ENDS use compared with ever, no past-30-day ENDS use was associated with a statistically significant decrease of W2 smoking days (n = 256, beta = −2.64, 95% CI = −4.96 to −0.32; P = .03); and W1 6+ day ENDS users did not show a decrease in frequency of cigarette smoking. Conclusions Ever-ENDS use predicts future cigarette smoking, and frequency of ENDS use has a differential impact on subsequent cigarette smoking uptake or reduction. These results suggest that both cigarettes and ENDS should be targeted in early tobacco prevention efforts with youth.

Download Full-text

Associations Between Nicotine Metabolite Ratio and Gender With Transitions in Cigarette Smoking Status and E-Cigarette Use: Findings Across Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa022 ◽

2020 ◽

Vol 22 (8) ◽

pp. 1316-1321 ◽

Cited By ~ 1

Author(s):

Terril L Verplaetse ◽

MacKenzie R Peltier ◽

Walter Roberts ◽

Kelly E Moore ◽

Brian P Pittman ◽

...

Keyword(s):

Cigarette Smoking ◽

Smoking Status ◽

Smoking Behavior ◽

Cigarette Use ◽

Nicotine Metabolism ◽

Population Assessment ◽

Study Results ◽

Metabolite Ratio ◽

And Gender ◽

Nicotine Metabolite Ratio

Abstract Introduction Nicotine metabolite ratio (NMR), the ratio of trans 3′-hydroxycotinine to cotinine, is a biomarker of nicotine metabolism. Discrepant findings among clinical trials and population-based studies warrant replication on whether higher NMR, or faster nicotine metabolism, is associated with quitting cigarette smoking. Associations of NMR and e-cigarette use are largely unknown, as well as the relationship between NMR and gender on quitting cigarette smoking or e-cigarette use. Methods The Population Assessment of Tobacco and Health (PATH) Study is a nationally representative, longitudinal cohort study assessing tobacco use in the US population. In the current study, the PATH (waves 1 and 2; adult interviews) was used to evaluate longitudinal predictions in relationships among NMR and gender and their association with transitions (quit vs. current stable) in cigarette smoking status and e-cigarette use status across waves 1 and 2 of the PATH study. Results NMR and gender were not significantly associated with quit behavior for combustible cigarettes. Regarding e-cigarettes, a significant two-way interaction demonstrated that women with higher NMR were less likely to quit e-cigarette use compared to women with lower NMR (odds ratio [OR] = 0.10, 95% confidence interval [CI] = 0.02–0.57; p = .01). Conclusions Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism across waves 1 and 2 of the PATH study. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. Implications Findings identify that women with faster nicotine metabolism were 10 times less likely to quit e-cigarettes compared to women with slower nicotine metabolism. Results suggest that NMR may be used as a biomarker for transitions in e-cigarette quit behavior for women. Establishing parameters for NMR collection and for the use of NMR as a biomarker for cigarette smoking behavior and e-cigarette use is an important next step, and may have implications for early intervention and treatment for cessation.

Download Full-text