Brouwer Andrew F, Jeon Jihyoun, Hirschtick Jana L, Jimenez-Mendoza Evelyn, Mistry Ritesh, Bondarenko Irina V, Land Stephanie R, Holford Theodore R, Levy David T, Taylor Jeremy M G, Fleischer Nancy L, Meza Rafael
Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
Epidemiology, University of Michigan, Ann Arbor, Michigan, USA.
Tob Control. 2020 Nov 16. doi: 10.1136/tobaccocontrol-2020-055967.
Even prior to 2018, electronic nicotine delivery systems (ENDS) began to dramatically change the landscape of tobacco products and product use patterns in the USA.
Using a Markov multistate transition model accounting for complex survey design, transition rates between never, non-current, cigarette, ENDS and dual use states were estimated for 23 253 adult participants in waves 1-4 (approximately 2013-2017) of the Population Assessment of Tobacco and Health study. We made short-term transition projections and estimated HRs for age, sex, race/ethnicity, education and income.
Cigarette use was persistent among adults, with 89.7% (95% CI 89.1% to 90.3%) of exclusive cigarette users and 86.1% (95% CI 84.4% to 87.9%) of dual users remaining cigarette users (either exclusive or dual) after one wave. In contrast, ENDS use was less persistent, with 72.1% (95% CI 69.6% to 74.6%) of exclusive ENDS users and 50.5% (95% CI 47.8% to 53.3%) of dual users remaining ENDS users (with or without cigarettes) after one wave. Exclusive ENDS users were more likely to start cigarette use after one wave than either never users (HR 25.2; 95% CI 20.9 to 30.5) or non-current users (HR 5.0; 95% CI 4.3 to 5.8). Dual users of ENDS and cigarettes were more likely to stop using cigarettes than exclusive cigarette users (HR 1.9; 95% CI 1.6 to 2.3). Transition rates varied among sociodemographic groups.
Multistate transition models are an effective tool for uncovering and characterising longitudinal patterns and determinants of tobacco use from complex survey data. ENDS use among US adults was less persistent than cigarette use prior to 2018.
甚至在2018年之前，电子尼古丁传送系统（ENDS）就已开始极大地改变美国烟草产品的格局和产品使用模式。
利用一个考虑复杂调查设计的马尔可夫多状态转换模型，对烟草与健康人口评估研究第1 - 4轮（约2013 - 2017年）的23253名成年参与者从不吸烟、非当前吸烟、吸卷烟、使用ENDS和双重使用状态之间的转换率进行了估计。我们进行了短期转换预测，并估计了年龄、性别、种族/族裔、教育程度和收入的风险比。
成年人中卷烟使用情况持续存在，在一轮调查后，89.7%（95%置信区间89.1%至90.3%）的单纯卷烟使用者和86.1%（95%置信区间84.4%至87.9%）的双重使用者仍为卷烟使用者（单纯或双重）。相比之下，ENDS使用的持续性较差，在一轮调查后，72.1%（95%置信区间69.6%至74.6%）的单纯ENDS使用者和50.5%（95%置信区间47.8%至53.3%）的双重使用者仍为ENDS使用者（无论是否吸卷烟）。单纯ENDS使用者在一轮调查后开始吸卷烟的可能性高于从不吸烟者（风险比25.2；95%置信区间20.9至30.5）或非当前吸烟者（风险比5.0；95%置信区间4.3至5.8）。ENDS和卷烟双重使用者停止吸卷烟的可能性高于单纯卷烟使用者（风险比1.9；95%置信区间1.6至2.3）。转换率在社会人口学群体中有所不同。
多状态转换模型是从复杂调查数据中揭示和描述烟草使用纵向模式及决定因素的有效工具。2018年之前，美国成年人中ENDS的使用持续性低于卷烟使用。
