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Nicotine Tob Res. 2018 Jul 7. doi: 10.1093/ntr/nty141. [Epub ahead of print]

Socio-economic and racial/ethnic differences in e-cigarette uptake among cigarette smokers: Longitudinal analysis of the Population Assessment of Tobacco and Health (PATH) study.

Author information

1
Boston University School of Public Health, Department of Epidemiology. Boston, MA.
2
Boston University School of Public Health, Department of Global Health. Boston, MA.

Abstract

Introduction:

Socio-demographic differences in electronic cigarette use among cigarette smokers have not been previously characterized in the US adult population.

Methods:

We analyzed longitudinal data from Waves 1 and 2 of the nationally representative Population Assessment of Tobacco and Health (PATH) study. Differences by income (based on federal poverty level (FPL)) and race/ethnicity in e-cigarette uptake at Wave 2 among cigarette smokers who were e-cigarette non-users at Wave 1 were assessed using binomial and multinomial logistic regression. We differentiated e-cigarette users who quit cigarettes (exclusive users) from those who did not quit cigarettes (dual users). E-cigarette-related attitudes/beliefs were evaluated to understand potential contributions to socio-demographic differences in e-cigarette uptake and use patterns.

Results:

Among 6,592 smokers who were e-cigarette non-users at Wave 1, 13.5% began using e-cigarettes at Wave 2, of whom 91.3% were dual users. Compared to non-Hispanic Whites, non-Hispanic Black and Hispanics were less likely to become exclusive e-cigarette users (OR [Blacks] =0.27, 95% CI 0.09-0.77; OR [Hispanics] =0.26, 95% CI 0.09-0.70). Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users (OR [<100% FPL vs. ≥200% FPL] =0.48, 95% CI 0.27-0.89). Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.

Conclusions:

Black, Hispanic, and low-income smokers were less likely than White and higher-income smokers to begin using e-cigarettes in the context of quitting cigarettes. Differences in e-cigarette uptake may be partly explained by perceived harm or social norms of e-cigarettes.

Implications:

Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared to low-income and racial/ethnic minority smokers. These findings suggest that socio-demographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.

PMID:
29986109
DOI:
10.1093/ntr/nty141

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