Transitions in electronic cigarette use among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1 and 2 (2013–2015)

TLDR

The study examined how adult e‑cigarette users’ use of e‑cigarettes and cigarettes changed from Wave 1 to Wave 2 of the PATH Study, and highlighted the need for further waves to understand long‑term patterns. The authors analyzed 2,835 adult e‑cigarette users, calculating adjusted prevalence ratios with a predicted marginal probability approach to identify correlates of e‑cigarette discontinuation and smoking abstinence at Wave 2. Nearly half of adult e‑cigarette users stopped using e‑cigarettes after one year, with dual users showing varied transitions—44 % maintained dual use, 44 % stopped e‑cigarettes but kept smoking, and 12 % stopped smoking—while daily e‑cigarette use was associated with a 40 % higher likelihood of smoking abstinence, and overall e‑cigarette use patterns were highly variable.

Abstract

<h3>Introduction</h3> This study assessed patterns of e-cigarette and cigarette use from Wave 1 to Wave 2 among adult e-cigarette users at Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. <h3>Methods</h3> We examined changes in e-cigarette use frequency at Wave 2 among adult e-cigarette users at Wave 1 (unweighted n=2835). Adjusted prevalence ratios (aPR) were calculated using a predicted marginal probability approach to assess correlates of e-cigarette discontinuance and smoking abstinence at Wave 2. <h3>Results</h3> Half (48.8%) of adult e-cigarette users at Wave 1 discontinued their use of e-cigarettes at Wave 2. Among dual users of e-cigarettes and cigarettes at Wave 1, 44.3% maintained dual use, 43.5% discontinued e-cigarette use and maintained cigarette smoking and 12.1% discontinued cigarette use at Wave 2, either by abstaining from cigarette smoking only (5.1%) or discontinuing both products (7.0%). Among dual users at Wave 1, daily e-cigarette users were more likely than non-daily users to report smoking abstinence at Wave 2 (aPR=1.40, 95% CI 1.02 to 1.91). Using a customisable device (rather than a non-customisable one) was not significantly related to smoking abstinence at Wave 2 (aPR=1.14, 95% CI 0.81 to 1.60). <h3>Conclusions</h3> This study suggests that e-cigarette use patterns are highly variable over a 1-year period. This analysis provides the first nationally representative estimates of transitions among US adult e-cigarette users. Future research, including additional waves of the PATH Study, can provide further insight into long-term patterns of e-cigarette use critical to understanding the net population health impact of e-cigarettes in USA.