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Tob Control. 2019 Jan;28(1):42-49. doi: 10.1136/tobaccocontrol-2017-054108. Epub 2018 Mar 24.

E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013-2015.

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Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA.
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.



The role of electronic cigarettes (e-cigarettes) in product transitions has been debated.


We used nationally representative data from the Population Assessment of Tobacco and Health Study waves 1 (2013-2014) and 2 (2014-2015) to investigate the associations between e-cigarette initiation and cigarette cessation/reduction in the USA. We limited the sample to current cigarette smokers aged 25+ years who were not current e-cigarette users at wave 1. We modelled 30-day cigarette cessation and substantial reduction in cigarette consumption as a function of e-cigarette initiation between surveys using multivariable logistic regression.


Between waves 1 and 2, 6.9% of cigarette smokers who were not current e-cigarette users transitioned to former smokers. After adjusting for covariates, cigarette smokers who initiated e-cigarette use between waves and reported they used e-cigarettes daily at wave 2 had 7.88 (95% CI 4.45 to 13.95) times the odds of 30-day cigarette cessation compared with non-users of e-cigarettes at wave 2. Cigarette smokers who began using e-cigarettes every day and did not achieve cessation had 5.70 (95% CI 3.47 to 9.35) times the odds of reducing their average daily cigarette use by at least 50% between waves 1 and 2 compared with e-cigarette non-users.


Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.


ENDS; PATH; cigarette reduction; e-cigarette; e-cigarette initiation; electronic cigarette; population assessment of tobacco and health; product transitions; smoking cessation; vape; vaping

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