Brouwer Andrew F, Jeon Jihyoun, Jimenez-Mendoza Evelyn, Land Stephanie R, Holford Theodore R, Friedman Abigail S, Tam Jamie, Mistry Ritesh, Levy David T, Meza Rafael
Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States.
Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States.
medRxiv. 2023 Oct 21:2023.10.20.23297320. doi: 10.1101/2023.10.20.23297320.
The use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the outbreak of lung injuries related to vaping THC, flavor bans, and the COVID pandemic. We analyzed patterns of initiation, cessation, and transitions between cigarettes, ENDS, and dual use before and after 2019.
Using the Population Assessment of Tobacco and Health (PATH) Study, we applied a multistate transition model to 28,061 adults in Waves 4-5 (2017-19) and 24,751 adults in Waves 5-6 (2019-21), estimating transition rates for initiation, cessation, and switching products for each period overall and by age group.
Cigarette initiation among adults who never used either product decreased from 2017-19 to 2019-21, but ENDS initiation did not significantly change. Persistence of ENDS-only use remained high, with 75-80% still using ENDS only after 1 year. Cigarette-only use transitions remained similar, with about 88% remaining, 7% transitioning to non-current use, and 5% transitioning to dual or ENDS-only use. In contrast, dual use to ENDS-only transitions increased from 9.5% (95%CI: 7.3-11.7%) to 20.1% (95%CI: 17.5-22.7%) per year from 2017-19 to 2019-21, decreasing the persistence of dual use. The dual use to cigarette-only transition remained at about 25%. These changes were qualitatively similar across adult age groups, though adults ages 18-24 years exhibited the highest probability of switching from cigarette-only use to dual use and from dual use to ENDS-only use.
Persistence of ENDS use among adults remained high in 2019-21, but a larger fraction of dual users transitioned to ENDS-only use compared to 2017-19. Because the fraction of cigarette-only users switching to dual use remained low, the public health implications of the increased dual use to ENDS-only transition are minimal.
自2019年以来，随着烟弹和一次性电子烟的兴起、与吸电子烟四氢大麻酚相关的肺部损伤的爆发、口味禁令以及新冠疫情，香烟和电子尼古丁传送系统（ENDS）的使用情况可能发生了变化。我们分析了2019年前后在开始使用、戒烟以及在香烟、ENDS和同时使用这三种情况之间转换的模式。
利用烟草与健康人口评估（PATH）研究，我们对第4 - 5轮（2017 - 2019年）的28,061名成年人以及第5 - 6轮（2019 - 2021年）的24,751名成年人应用了多状态转换模型，估计了每个时期总体以及按年龄组划分的开始使用、戒烟和转换产品的转换率。
在从未使用过这两种产品的成年人中，香烟的开始使用率从2017 - 2019年到2019 - 2021年有所下降，但ENDS的开始使用率没有显著变化。仅使用ENDS的持续率仍然很高，1年后仍有75 - 80%的人仅使用ENDS。仅使用香烟的转换情况保持相似，约88%的人仍继续使用，7%的人转换为不再使用，5%的人转换为同时使用或仅使用ENDS。相比之下，从2017 - 2019年到2019 - 2021年，从同时使用转换为仅使用ENDS的比例从每年9.5%（95%置信区间：7.3 - 11.7%）增加到20.1%（95%置信区间：17.5 - 22.7%），降低了同时使用的持续率。从同时使用转换为仅使用香烟的比例保持在约25%。这些变化在各成年年龄组中性质相似，不过18 - 24岁的成年人从仅使用香烟转换为同时使用以及从同时使用转换为仅使用ENDS的概率最高。
在2019 - 2021年期间，成年人中使用ENDS的持续率仍然很高，但与2017 - 2019年相比，更多的同时使用者转换为仅使用ENDS。由于从仅使用香烟转换为同时使用的比例仍然很低，从同时使用增加转换为仅使用ENDS对公共卫生的影响很小。
