Abstract
Background: The evidence on harms and benefits of e-cigarettes partly concerns whether their use encourages smokers to quit. We addressed this using data from the nationally representative PATH study, with detailed accounting for potential confounding variables. Methods: We considered adults aged 25+. Our original analyses, reported in version 1 of this paper, used data for Waves 1 to 3, separate analyses considering Waves 1 to 2, 2 to 3 and 1 to 3. These related baseline ever e-cigarette use (or e-product use at Wave 2) to quitting at follow-up, adjusting for confounders derived from 55 candidates. Sensitivity analyses omitted ever other product users, linked quitting to current e-cigarette use, and used values of some predictors modified using follow-up data. Additional analyses used data for Waves 1 to 4, separately considering sustained, delayed and temporary quitting during Waves 1 to 3, 2 to 4 and 1 to 4. Sensitivity analyses considered 30-day quitting, restricted attention to smokers attempting to quit, and considered ever smokeless tobacco or snus use. Results: In the original analyses, unadjusted odds ratios (ORs) of quitting smoking forever 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 reduced after adjustment, to 1.23 (0.94-1.61), 1.51 (1.24-1.85) and 1.39 (1.11-1.74). Quitting rates remained elevated in users in all sensitivity analyses. The additional analyses found associations of e-cigarette use with sustained, delayed and temporary quitting, associations little affected by considering 30-day quitting, and only slightly reduced restricting attention to quit attempters. Ever use of smokeless tobacco or snus also predicted increased quitting. Conclusions: As does most evidence from clinical trials, other analyses of PATH, and other epidemiological studies, our results suggest using e-cigarettes helps adult smokers to quit.
Highlights
It is believed that e-cigarettes cause far less harm to their users than do cigarettes (Nutt et al, 2014), the introduction of e-cigarettes may theoretically have various adverse and beneficial effects (Lee et al, 2019)
All smokers at baseline Not followed at subsequent wavesb Smokers at baseline Quit by follow-up Demographics (A) Age range Gender Hispanic origin Race Census region Total household income Poverty status Total number in the household Highest grade level of school completed Currently enrolled in a degree program Current employment status Aspects of smoking – general (B) Age range started smoking cigarettes fairly regularly Current someday cigarette smokers Cigarettes per day Ever used other tobacco products Frequently crave tobacco product(s)
Discussion of results based on Waves 1, 2 and 3 The first set of analyses described in this report summarise evidence from Waves 1, 2 and 3 of the US Population Assessment of Tobacco and Health (PATH) study relating to the possibility that e-cigarette use may increase the likelihood of smokers quitting cigarettes
Summary
It is believed that e-cigarettes cause far less harm to their users than do cigarettes (Nutt et al, 2014), the introduction of e-cigarettes may theoretically have various adverse and beneficial effects (Lee et al, 2019). The evidence on harms and benefits of e-cigarettes partly concerns whether their use encourages smokers to quit We addressed this using data from the nationally representative PATH study, with detailed accounting for potential confounding variables. Our original analyses, reported in version 1 of this paper, used data for Waves 1 to 3, separate analyses considering Waves 1 to 2, 2 to 3 and 1 to 3 These related baseline ever e-cigarette use (or e-product use at Wave 2) to quitting at follow-up, adjusting for confounders derived from 55 candidates. Results: In the original analyses, unadjusted odds ratios (ORs) of quitting smoking forever 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 reduced after adjustment, to 1.23 (0.94-1.61), 1.51 (1.24-1.85) and 1.39 (1.11-1.74). Conclusions: As does most evidence from clinical trials, other analyses of PATH, and other epidemiological studies, our results suggest using e-cigarettes helps adult smokers to quit
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