Associations of Demographics, Dependence, and Biomarkers with Transitions in Tobacco Product Use in
Friday, March 17, 2023
Posted by: Natalia Gromov
Shafie-Khorassani
F, Piper ME, Jorenby DE, Baker TB, Benowitz NL, Hayes-Birchler T, Meza R,
Brouwer AF.
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.
Nicotine Tob Res. 2023 Feb 9;25(3):462-469. doi: 10.1093/ntr/ntac207. PMID:
36037523; PMCID: PMC9910158.
Introduction. 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.
Aims and methods. We
followed 380 adult daily cigarette users and dual users every 2 months for up
to 2 years. We estimated transition rates between noncurrent, 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 or partner behaviors, and
other measures.
Results. 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 1 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 or toxicity reduction or because of restrictions on where or 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, and emotional enjoyment of e-cigarettes (secondary dependence
motives) were facilitators of smoking cessation among dual users.
Conclusions. Tobacco
control policy and interventions may be informed by the barriers and
facilitators of product transitions.
Implications. Although
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.
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