Ebrahimi Kalan Mohammad, Brewer Noel T
School of Health Professions, Eastern Virginia Medical School, Norfolk, VA, United States.
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.
Lancet Reg Health Am. 2023 May 16;22:100508. doi: 10.1016/j.lana.2023.100508. eCollection 2023 Jun.
To support tobacco control efforts, this study sought to characterize longitudinal transitions in use of electronic nicotine delivery systems (ENDS) and cigarettes.
Participants were nationally representative samples of 53,729 US adults from Waves 3-5 (2015-2019) of the Population Assessment of Tobacco and Health Study. We examined behavioral transitions (initiation, relapse, progression, and cessation) in ENDS and cigarette use across waves. Weighted generalized estimating equation models adjusted for sociodemographic variables.
Of never ENDS users at baseline, an estimated 1.7% reported initiating ENDS use by follow-up. Of former ENDS users, an estimated 12.1% relapsed into ENDS use. Of periodic ENDS users at baseline, 13% progressed to established ENDS use. Of baseline current ENDS users, 46.3% discontinued ENDS use. The corresponding transitions for cigarette smoking were 1.6% (initiation), 4.8% (relapse), 21.1% (progression), and 14% (discontinuation). Adults aged 18-24 (vs. older age), Hispanics (vs. non-Hispanic white), and past 12-month cannabis users were more likely to initiate ENDS or cigarettes (all < 0.05). Having any internalizing mental health symptoms increased the odds of ENDS initiation, while externalizing symptoms increased the odds of cigarette initiation. Those who perceived nicotine as very harmful (vs. none/low harm) were more likely to discontinue ENDS. Current cigarette users (vs. non-users) at baseline were more likely to initiate, relapse, or discontinue ENDS (all < 0.05) and vice versa.
We observed high changeability in ENDS and cigarette use among US adults over time. In absolute terms, ENDS use grew, while smoking fell. Tobacco control programs should focus on priority populations, including young adults and people with internalizing and externalizing mental health symptoms.
National Institutes of Health, R01-CA246606-01A1, R01-DA048390.
为支持烟草控制工作，本研究旨在描述电子尼古丁传送系统（ENDS）和香烟使用的纵向转变情况。
参与者是来自烟草与健康人口评估研究第3 - 5波（2015 - 2019年）的53729名美国成年人的全国代表性样本。我们研究了各波次中ENDS和香烟使用的行为转变（开始使用、复吸、升级和戒断）。加权广义估计方程模型对社会人口统计学变量进行了调整。
在基线时从不使用ENDS的人群中，估计有1.7%的人在随访时报告开始使用ENDS。在曾经使用ENDS的人群中，估计有12.1%的人复吸使用ENDS。在基线时偶尔使用ENDS的人群中，13%升级为经常使用ENDS。在基线时当前使用ENDS的人群中，46.3%停止使用ENDS。吸烟的相应转变情况为1.6%（开始使用）、4.8%（复吸）、21.1%（升级）和14%（戒断）。18 - 24岁的成年人（与年龄较大者相比）、西班牙裔（与非西班牙裔白人相比）以及过去12个月内使用过大麻的人更有可能开始使用ENDS或香烟（均P < 0.05）。有任何内化心理健康症状会增加开始使用ENDS的几率，而外化症状会增加开始吸烟的几率。那些认为尼古丁危害极大的人（与认为危害极小或无危害的人相比）更有可能停止使用ENDS。基线时当前吸烟的人（与不吸烟者相比）更有可能开始、复吸或停止使用ENDS（均P < 0.05），反之亦然。
我们观察到美国成年人中ENDS和香烟使用随时间变化很大。从绝对数量来看，ENDS的使用增加了，而吸烟减少了。烟草控制项目应关注重点人群，包括年轻人以及有内化和外化心理健康症状的人。
美国国立卫生研究院，R01 - CA246606 - 01A1，R01 - DA048390。
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