scholarly journals E-Cigarette Flavors and Frequency of E-Cigarette Use among Adult Dual Users Who Attempt to Quit Cigarette Smoking in the United States: Longitudinal Findings from the PATH Study 2015/16–2016/17

Author(s):  
Karin A. Kasza ◽  
Maciej L. Goniewicz ◽  
Kathryn C. Edwards ◽  
Michael D. Sawdey ◽  
Marushka L. Silveira ◽  
...  

Potential mechanisms by which e-cigarette use may relate to combustible cigarette smoking cessation are not well-understood. We used U.S. nationally representative data to prospectively evaluate the relationship between e-cigarette flavor use and frequency of e-cigarette use among adult cigarette/e-cigarette dual users who attempted to quit smoking cigarettes. Analyses used Population Assessment of Tobacco and Health (PATH) Study data from adult dual users (2015/16) who attempted to quit smoking between 2015/16 and 2016/17 (Wave 3-Wave 4, n = 685, including those who did/did not quit by 2016/17). E-cigarette flavor use (usual/last flavor, past 30-day flavor; assessed in 2015/16) was categorized into Only tobacco; Only menthol/mint; Only non-tobacco, non-menthol/mint; and Any combination of tobacco, menthol/mint, other flavor(s). The key outcome, evaluated at follow-up in 2016/17, was frequent e-cigarette use, which was defined as use on 20+ of past 30 days. Logistic regression was used to evaluate associations between e-cigarette flavor use in 2015/16 and frequent e-cigarette use at follow-up in 2016/17. Dual users who attempted to quit smoking had greater odds of frequent e-cigarette use at follow-up when they used only non-tobacco, non-menthol/mint flavor than when they used only tobacco flavor as their regular/last e-cigarette flavor (OR = 1.9, 95% CI: 1.1–3.4); findings were no longer significant when adjusted for factors including e-cigarette device type (AOR = 1.4, 95% CI: 0.7–2.8). Past 30-day e-cigarette flavor use results were generally similar, although frequent e-cigarette use at follow-up was highest among those who used any combination of tobacco, menthol/mint, or other flavors. Findings indicate that e-cigarette flavor use among dual users who attempt to quit smoking may be related to e-cigarette use frequency overall, which may indicate a mechanism underlying findings for e-cigarette use and smoking cessation. Further longitudinal research may help to disentangle how e-cigarette characteristics uniquely impact e-cigarette use frequency and smoking cessation/sustained use.


Author(s):  
Allison M Glasser ◽  
Mahathi Vojjala ◽  
Jennifer Cantrell ◽  
David T Levy ◽  
Daniel P Giovenco ◽  
...  

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.



Author(s):  
Jennifer L Pearson ◽  
Yitong Zhou ◽  
Sabrina L Smiley ◽  
Leslie F Rubin ◽  
Emily Harvey ◽  
...  

Abstract Introduction This study examined the association between the introduction of an e-cigarette and subsequent change in cigarette smoking among smokers who were not immediately interested in quitting. Aims and Methods The Moment Study was a 21-day intensive longitudinal study with an online follow-up survey at 30 days. After observing baseline cigarette smoking for 1 week, participants received 10 cigalike e-cigarettes on study days 6 and 13. Participants reported cigarettes per day, e-cigarette puffs per day, and e-cigarette satisfaction using text-message-based surveys. Results The sample of 96 daily smokers was majority female (53.1%), African American (67.7%), and non-Hispanic (95.8%). When e-cigarettes were provided (day 6), average cigarettes per day dropped by 1.82 cigarettes (p < .0001). The within-person e-cigarette puff effect on daily cigarette smoking was significantly negative (β = −0.023; p = .005); a participant who consumed 100 more e-cigarette puffs in a day than usual for that person was expected to smoke 2.3 fewer cigarettes that day, but this was only true for non-menthol smokers (p = .006). Smokers older than 45 and those who started smoking at a younger age rated e-cigarettes as less satisfying (ps < .05). Participants with greater than the median reported satisfaction were 6.5 times more likely to use an e-cigarette at follow-up. Conclusions Giving e-cigarettes to smokers who did not intend to quit reduced their cigarette smoking on days when they used e-cigarette more frequently, but this relationship did not hold for menthol smokers. Satisfaction with e-cigarette use was predictive of continued use 30 days later. Implications A greater amount of cigalike e-cigarette use resulted in less smoking among adult daily smokers without immediate plans to quit, but a lack of nicotine delivery and satisfaction for these devices may have limited their utility as a replacement for cigarette smoking, especially among menthol smokers. The global concept of “satisfaction” may be an important driver of e-cigarette use among adult smokers.



Author(s):  
Lin Li ◽  
Ron Borland ◽  
K Michael Cummings ◽  
Geoffrey T Fong ◽  
Shannon Gravely ◽  
...  

Abstract Introduction There is limited research on the role of flavors in nicotine vaping products (NVPs) in relation to smoking. We examined patterns of flavor use in NVPs in relation to progression towards quitting. Methods Data come from 886 concurrent users of NVPs (at least weekly) and cigarettes who were first surveyed in 2016 and then successfully recontacted in 2018 as part of the ITC 4CV Surveys conducted in Australia, Canada, England and the United States. Participants were asked about their main vaping flavor categorized as: 1) tobacco or unflavored, 2) menthol/mint flavored, and 3) “sweet” flavors (e.g., fruit/candy). We examined whether flavor was associated with progression towards quitting smoking between survey years. Results Overall, 11.1% of baseline concurrent users quit smoking by 2018. Compared to users of tobacco flavors, those vaping “sweet” flavors were more likely to quit smoking between surveys (13.8% vs. 9.6%; adjusted OR=1.61, 95% CI 1.01-2.58, p<0.05), but those using menthol flavors were no more likely to quit smoking (8.3% vs. 9.6%, aOR=0.87, 95% CI 0.43-1.47, p=0.69). Among those who had quit smoking in 2018, 52.0% were still vaping, which was lower than the 65.8% among continuing smokers (aOR=0.60, 95% CI 0.39-0.92, p=0.02). Sweet flavor users were no more likely to continue vaping compared to tobacco flavor users, either for those continuing smoking or those having quit smoking by 2018. There was a net shift away from tobacco flavor among those who continued to vape at follow-up. Conclusions Use of fruit and other sweet flavored e-liquids is positively related to smokers’ transition away from cigarettes. Implications With multiple jurisdictions considering limiting or banning the sale of flavored NVPs, it is important to consider how such policies may impact smokers using NVPs to transition away from cigarette smoking. Our results indicate that vapers who used sweet flavors were more likely to transition away from cigarette smoking and quit cigarette use, at least in the short term, compared to those who used tobacco or unflavored NVPs. Randomized clinical trials are needed to establish if the observed association between use of flavored e-liquids and smoking cessation is due to self-selection or is truly causal.



Author(s):  
Zongshuan Duan ◽  
Yu Wang ◽  
Jidong Huang

E-cigarettes are the most-used tobacco products among U.S. adolescents. Emerging evidence suggests that adolescents using e-cigarettes are at elevated risk for initiating cigarette smoking. However, whether this risk may differ by sex remains unknown. This study analyzed data from Wave 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal survey. Generalized estimation equations (GEE) were performed to estimate the associations between baseline e-cigarette use and subsequent cigarette smoking, controlling for sociodemographic characteristics, mental health conditions, and other tobacco use. Effect modifications by sex were examined. Multivariate analyses showed that, among baseline never cigarette smokers, past-30-day e-cigarette use at baseline waves was significantly associated with past-30-day cigarette smoking at follow-up waves (aOR = 3.90, 95% CI: 2.51–6.08). This association was significantly stronger for boys (aOR = 6.17, 95% CI: 2.43–15.68) than for girls (aOR = 1.10, 95% CI: 0.14–8.33). Additionally, using other tobacco products, older age, and having severe externalizing mental health problems at baseline were significantly associated with an increased likelihood of cigarette smoking at follow-up. The prospective association between e-cigarette use and cigarette smoking differs by sex among U.S. adolescents. Sex-specific tobacco control interventions may be warranted to curb the youth tobacco use epidemic.



Author(s):  
Adam M Leventhal ◽  
Hongying Dai

Abstract Background Evidence of US adult flavored e-cigarette use prevalence stratified by age, smoking status, and purpose for vaping (ie, quitting smoking, to use when or where smoking is not allowed) can inform policies that reduce the tobacco-related cancer burden. Methods Current flavored e-cigarette use (use 1 or more nontobacco flavors) prevalence estimates were compared across subpopulation groups using 2-sided statistical significance tests in the July 2018 Current Population Survey Tobacco Use Supplement, a nationally representative cross-sectional adult survey (n = 46 759). Results Current flavored e-cigarette use was reported by 1.6% (95% confidence interval [CI] = 1.47% to 1.69%) of all respondents. Among current vapers, the percentage of those who used flavored e-cigarettes was higher for adults aged 18-24 years (89.6%), 25-34 years (86.7%), and 35-44 years (76.0%) than for adults aged 45 years and older (60.4%, Ps < .001); was higher in never smokers (89.8%) than current (72.9%), long-term former (73.9%), and recent former (80.4%) smokers (Ps ≤ .009); was higher in smokers who reportedly did (78.9%) vs did not (71.1%) use e-cigarettes to vape where or when smoking is not allowed (P = .005); and did not differ between smokers who reportedly did (75.0%) vs did not (73.9%) vape to quit smoking (P = .71). Individuals who vaped to quit smoking and currently used flavored e-cigarettes constituted 0.9% (95% CI = 0.82% to 0.99%) of all adults (weighted N = 2 251 000, 95% CI = 2 046 000 to 2 476 000) and 57.2% of current flavored e-cigarette users. Conclusions Flavored e-cigarette use prevalence was low among US adults overall but common for current vapers. Flavored e-cigarette use was disproportionately prevalent among never smokers and other subpopulations that might experience harm from vaping.



2017 ◽  
Vol 13 (2) ◽  
pp. 59-62 ◽  
Author(s):  
Amer Siddiq Amer Nordin ◽  
Simon Justin Adamson ◽  
John Douglas Sellman

Introduction: Weight gain during smoking cessation is a major concern. The relationship between smoking and weight is complex and not well understood. There is interest in substitution of nicotine with food.Aims: This study investigates whether the development of food addiction explains weight gain following a quit smoking attempt.Methods: This study was a subset of a larger study investigating smoking cessation in New Zealand. Participants were assessed on five visits over a 1-year period. Using validated instruments, measurements for smoking, weight, food intake, craving and food addiction were taken.Results: Among the 256 participants, 54.7% attended at least one follow-up. Food addiction prevalence at baseline was 0.8%. 14.5% were quit at early follow-up and 14.8% at late follow-up. Weight gain was found in abstainers compared to those still smoking. No increase in food addiction was detected.Conclusion: The development of food addiction does not play a prominent role in post quit weight gain. Further research is needed to elucidate the underlying weight gain mechanisms.



2017 ◽  
Vol 32 (5) ◽  
pp. 1234-1238 ◽  
Author(s):  
Emily Frith ◽  
Paul D. Loprinzi

Introduction: We evaluated the specific association between exercise and smoking cessation via smoking-mediated intentions to quit smoking among a national sample of young daily smokers in the United States. Design: Prospective cohort study over a 2-year period, with daily smokers assessed across all 50 states in the United States. Setting: Data from the 2003 to 2005 National Youth Smoking Cessation Survey were used. Participants: A total of 1175 young adult smokers aged between 18 and 24 years. Measures: Baseline exercise and intent to quit smoking were assessed via validated survey measures. Smoking status at the 2-year follow-up period was assessed via survey assessment. Results: After adjustments, meeting exercise guidelines at baseline was associated with an increased baseline intent to quit smoking among this national sample of daily smokers (OR = 1.49; 95% confidence interval [CI]: 1.07-2.07; P = .01). After adjustments, those with a baseline intent to quit smoking had a 71% increased odds ratio (OR) of being a nonsmoker at the 2-year follow-up (OR = 1.71; 95% CI: 1.20-2.44; P = .003). Baseline exercise was not associated with 2-year follow-up smoking status (OR = 0.87; 95% CI: 0.60-1.28; P = .50). Conclusion: In this nationally representative sample of young daily smokers, there was a positive association between exercise participation and intention to quit smoking. Baseline intent to quit smoking was independently associated with nonsmoking status at a 2-year follow-up. Thus, this indirect link between exercise and smoking status may be partially explained by the influence of exercise engagement on smoking-specific intentions.



2020 ◽  
Vol 47 (2) ◽  
pp. 284-292 ◽  
Author(s):  
Allison M. Glasser ◽  
Alexis Barton ◽  
Jessica Rath ◽  
Bethany Simard ◽  
Shyanika W. Rose ◽  
...  

Despite declines in overall cigarette smoking in the United States, menthol cigarette smoking prevalence has increased among young adults (18-25 years) and remains constant among older adults (26 years and older). Disparities in menthol cigarette use exist, with higher prevalence among younger adult smokers and among racial/ethnic minority populations. Menthol in cigarettes has been shown to play a role in increasing smoking initiation and making it more difficult to quit smoking. Little research focuses on perceptions of the addictive potential and health consequences of menthol cigarette use. This analysis uses data from a national panel of U.S. adults ( n = 1,303) surveyed in 2016. Participants were asked to what extent they agreed with various statements regarding menthol use among demographic and tobacco use subgroups. These data reveal disparities in perceptions of the impact of menthol use, with Black, non-Hispanic, and Hispanic adults and adults with lower income and less education misperceiving the health effects and addiction potential of menthol in cigarettes. Determining how and to what extent population subgroups understand the effect of menthol cigarette use can inform public education strategies and, in turn, policy efforts to ban or restrict menthol cigarette availability.



2021 ◽  
Vol 8 ◽  
pp. 205435812199724
Author(s):  
Ann Bugeja ◽  
Ieta Shams ◽  
Sophie Harris ◽  
Edward G. Clark ◽  
Kevin D. Burns ◽  
...  

Background: It is unclear whether kidney donation leads to lifestyle changes in terms of cannabis and cigarette use. Objective: To describe cigarette and cannabis use before and after kidney donation and to determine their associations with lifestyle and clinical factors. Design: Retrospective cohort study. Setting: The Living Kidney Donor program in the Champlain Local Health Integration Network at The Ottawa Hospital in Ottawa, Canada. Patients: The study included 178 living kidney donors who donated between January 2009 and December 2018. Measurements: Donors were screened for cannabis and cigarette use by telephone interview. Their clinical characteristics and changes in kidney function before and after donation were recorded. Methods: Cannabis and cigarette use before and after kidney donation were compared using chi-square test. Risk factors associated with their use was examined by univariate and multivariate logistic regression. Wilcoxon rank sum test was used to examine the association of cannabis and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI) estimated glomerular filtration rate (eGFR) at donation and at last follow-up. T-test was used to examine the association of cigarette smoking and CKD-EPI eGFR at donation and at last follow-up. Results: Among 305 donors, 262 met inclusion criteria and 178 participated (mean of 4.7 ± 2.9 years from kidney donation). Cannabis and cigarette use were reported by 5% (9 of 178) and 13% (23 of 178) at donation. After donation, 8% (14 of 178) and 5% (9 of 178) started cannabis and cigarettes, respectively; 74% (17 of 23) of smokers remained smokers after donation and 88% (53 of 60) who quit smoking before donation did not restart after donation. In multivariate analysis, non-married/common-in-law status was associated with cannabis use (odds ratio, 2.73; 95% confidence interval, 1.05-7.11; P = .04). There was no difference in eGFR pre- or post-donation among cannabis or cigarette users. Limitations: The single-center study design limits generalizability. Social desirability bias may have affected survey responses and cigarette smoking was not quantified. Conclusions: Cannabis and cigarette use was uncommon in the studied population and was not associated with remaining kidney function. Cannabis use increased post-donation. Most smokers remained smokers after donation and most donors who quit smoking before donation did not restart after donation. This warrants education and support for potential donors who smoke, to quit smoking prior to donation to reduce risks of cardiovascular and end-stage kidney disease. Trial Registration: Not applicable as this is not a clinical trial.



F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1099 ◽  
Author(s):  
Peter N. Lee ◽  
John S. Fry

Background: Part of the evidence on harms and benefits of e-cigarettes concerns whether using e-cigarettes encourages smokers to quit.  With limited results from controlled trials, and weaknesses in much epidemiological data, we addressed this using nationally representative prospective study data, with detailed accounting for factors associated with quitting. Methods: Analyses used data for adults aged 25+ years from Waves 1 to 3 of the US PATH study. Separate analyses concerned follow-up from Waves 1 to 2, 2 to 3 and 1 to 3.  The main analyses related baseline ever e-cigarette use (or e-product use at Wave 2) to having quit at follow-up, adjusting for predictors of quitting derived from 55 candidates.  Sensitivity analyses omitted adults who had never used other products, linked quitting to current rather than ever e-cigarette use, used modified values of some predictors using later recorded data, or (in Wave 1 to 3 analysis only) also adjusted for quitting by Wave 2. Results: In the main analyses, unadjusted odds ratios (ORs) of quitting for ever e-cigarette use were 1.29 (95% CI 1.01-1.66), 1.52 (1.26-1.83) and 1.47 (1.19-1.82) for the Wave 1 to 2, 2 to 3, and 1 to 3 analyses.  These estimates reduced after adjustment, to 1.23 (0.94-1.61), 1.51 (1.24-1.85) and 1.39 (1.11-1.74).  The final models, including between six and nine predictors, always included household income, everyday/someday smoking, wanting to smoke after waking and having tried quitting, with other variables included in specific analyses.  Quitting rates remained elevated in e-cigarette users in all sensitivity analyses. ORs were increased where other product users were omitted.  Adjusted ORs of quitting for current e-cigarette use were 1.41 (1.06-1.89), 1.30 (1.01-1.67) and 1.56 (1.21-2.00). Conclusions: The results suggest e-cigarettes may assist adult smokers to quit, particularly in individuals not using other nicotine products, and who are current e-cigarette users.



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