Quach Natalie E, Pierce John P, Chen Jiayu, Dang Brian, Stone Matthew D, Strong David R, Trinidad Dennis R, McMenamin Sara B, Messer Karen
Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.
Moores Cancer Center, University of California, San Diego, La Jolla.
JAMA Netw Open. 2025 Mar 3;8(3):e250089. doi: 10.1001/jamanetworkopen.2025.0089.
An important public health goal is to increase tobacco cessation, but there is limited research on associations of vaping with tobacco cessation.
To estimate the association of vaping with long-term tobacco cessation among US cigarette smokers who used electronic nicotine delivery systems (ENDS; ie, e-cigarettes) in 2017.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used a nationally representative sample of US cigarette smokers from the Population Assessment of Tobacco and Health cohort at wave 4 (2017) with follow-up at wave 6 (2021). Data were analyzed from June 2023 to June 2024.
Wave 4 ENDS use: daily, nondaily, or no use.
The primary outcomes were 12 or more months' abstinence from cigarette smoking and 12 or more months' abstinence from both cigarette and ENDS use, ascertained at wave 6. Propensity score matching was used to control confounding on 14 potential confounders, including interest in quitting, income, age, education, nondaily smoking, and presence of a smoke-free home.
A total of 6013 smokers were included in the sample (3634 aged ≥35 years [weighted percentage, 65.2%]; 3182 female [weighted percentage, 46.5%]). Among smokers who vaped daily (228 individuals), an estimated 20.9% (95% CI, 15.0% to 26.8%) were abstinent from cigarette smoking at follow-up, compared with 14.3% abstinence (95% CI, 13.0% to 15.5%) among smokers who did not vape (5070 individuals) and 12.6% abstinence (95% CI, 9.8% to 15.4%) among smokers who vaped nondaily (715 individuals). Compared with similar propensity score-matched smokers who did not vape, smoking cessation was 4.1 percentage points lower among those who vaped daily (95% CI, -11.9 to 3.6 percentage points; P = .30), a nonsignificant difference. Smoking cessation was 5.3 percentage points lower among those who vaped nondaily (95% CI, -9.1 to -1.5 percentage points; P = .01) compared with similar propensity score-matched controls. Considering abstinence from both smoking and vaping, compared with matched controls, smokers who vaped daily had lower abstinence at follow-up by 14.7 percentage points (95% CI, -20.2 to -9.2 percentage points; P < .001), and those who vaped nondaily had lower abstinence by 7.2 percentage points (95% CI, -10.7 to -3.8 percentage points; P < .001).
In this representative cohort study of US smokers who used ENDS, neither daily nor nondaily vaping was associated with increased smoking cessation, and each was associated with reduced tobacco abstinence, suggesting that careful adjustment of confounding is critical in studies of ENDS and smoking cessation.
一个重要的公共卫生目标是增加戒烟人数，但关于电子烟使用与戒烟之间关联的研究有限。
评估2017年使用电子尼古丁传送系统（ENDS；即电子烟）的美国吸烟者中，电子烟使用与长期戒烟之间的关联。
设计、背景和参与者：这项队列研究使用了来自烟草与健康人口评估队列第4波（2017年）的具有全国代表性的美国吸烟者样本，并在第6波（2021年）进行随访。数据于2023年6月至2024年6月进行分析。
第4波时ENDS的使用情况：每日使用、非每日使用或不使用。
主要结局是在第6波时确定的戒烟12个月或更长时间以及戒烟和停止使用ENDS 12个月或更长时间。倾向得分匹配用于控制14个潜在混杂因素的混杂作用，这些因素包括戒烟意愿、收入、年龄、教育程度、非每日吸烟以及无烟家庭的存在情况。
样本中共有6013名吸烟者（3634名年龄≥35岁[加权百分比，65.2%]；3182名女性[加权百分比，46.5%]）。在每日使用电子烟的吸烟者（228人）中，随访时估计有20.9%（95%CI，15.0%至26.8%）戒烟，而未使用电子烟的吸烟者（5070人）中戒烟率为14.3%（95%CI，13.0%至15.5%），非每日使用电子烟的吸烟者（715人）中戒烟率为12.6%（95%CI，9.8%至15.4%）。与倾向得分匹配的未使用电子烟的类似吸烟者相比，每日使用电子烟者的戒烟率低4.1个百分点（95%CI，-11.9至3.6个百分点；P = 0.30），差异无统计学意义。与倾向得分匹配的对照组相比，非每日使用电子烟者的戒烟率低5.3个百分点（95%CI，-9.1至-1.5个百分点；P = 0.01）。考虑到戒烟且停止使用电子烟，与匹配的对照组相比，每日使用电子烟的吸烟者随访时的戒烟率低14.7个百分点（95%CI，-20.2至-9.2个百分点；P < 0.001），非每日使用电子烟的吸烟者戒烟率低7.2个百分点（95%CI，-10.7至-3.8个百分点；P < 0.001）。
在这项对使用ENDS的美国吸烟者进行的代表性队列研究中，每日和非每日使用电子烟均与戒烟增加无关，且均与烟草戒断减少有关，这表明在ENDS与戒烟的研究中，仔细调整混杂因素至关重要。
