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- Title
Associations of demographics, dependence, and biomarkers with transitions in tobacco product use in a cohort of cigarette users and dual users of cigarettes and e-cigarettes.
- Authors
Shafie-Khorassani, Fatema; Piper, Megan E; Jorenby, Douglas E; Baker, Timothy B; Benowitz, Neal L; Hayes-Birchler, Todd; Meza, Rafael; Brouwer, Andrew F
- Abstract
<bold>Introduction: </bold>It is uncertain whether e-cigarettes facilitate smoking cessation in the real world. We aimed to understand whether and how transitions among cigarette, e-cigarette, and dual use are associated with sociodemographics, dependence measures, and biomarkers.<bold>Methods: </bold>We followed 380 adult daily cigarette users and dual users every 2 months for up to 2 years. We estimated transition rates between non-current, cigarette-only, e-cigarette-only, and dual use states using a multistate transition model. We estimated univariable hazard ratios (HR) for demographics, dependence measures for cigarettes and e-cigarettes, biomarkers, spousal/partner behaviors, and other measures.<bold>Results: </bold>We estimated that participants transitioned from cigarette-only to e-cigarette-only through a period of dual use. Dual users ceased smoking (transitioning to e-cigarette-only use) at a greater rate than cigarette-only users did (HR 2.44, 95% CI: 1.49, 4.02). However, of the 60% of dual users estimated to transition to single product use in one year, 83% would transition to cigarette-only use and only 17% to e-cigarette-only use. E-cigarette dependence measures were generally associated with reduced e-cigarette cessation rather than enhanced cigarette cessation. E-cigarette users motivated by harm/toxicity reduction or because of restrictions on where/when they could smoke had reduced rates of smoking relapse. Cigarette dependence and spousal smoking were barriers to cigarette cessation for dual users, while using e-cigarettes first in the morning, motivation to quit smoking, and sensory/social/emotional enjoyment of e-cigarettes (secondary dependence motives) were facilitators smoking cessation among dual users.<bold>Conclusions: </bold>Tobacco control policy and interventions may be informed by the barriers and facilitators of product transitions.<bold>Implications: </bold>While e-cigarettes have the potential to promote smoking cessation, their real-world impact is uncertain. In this cohort, dual users were more likely to quit smoking than cigarette-only users, but the overall impact was small because most dual users returned to cigarette-only use. Moreover, e-cigarette dependence promoted continued dual use rather than smoking cessation. Yet, high motivation to quit smoking and the sensory, social, and emotional enjoyment of e-cigarettes facilitated smoking cessation in dual users. Better understanding the barriers and facilitators of transitions can help to develop regulations and interventions that lead to more effective use of e-cigarettes for smoking cessation.
- Subjects
TOBACCO products; ELECTRONIC cigarettes; TOBACCO use; CIGARETTES; HARM reduction; SMOKING cessation
- Publication
Nicotine & Tobacco Research, 2023, Vol 25, Issue 3, p462
- ISSN
1462-2203
- Publication type
journal article
- DOI
10.1093/ntr/ntac207