Is E-cigarette Use Associated With Persistence or Discontinuation of Combustible Cigarettes? A 24-Month Longitudinal Investigation in Young Adult Binge Drinkers

Abstract

Introduction It remains unclear whether electronic cigarette (e-cigarette) use promotes persistent combustible tobacco use or smoking discontinuation over time. Alcohol use is associated with greater risk of adverse health effects of tobacco, and higher likelihood of e-cigarette use, making drinkers a high priority subpopulation. This study examined longitudinal patterns of combustible tobacco and e-cigarette use over 24-months in young adult binge drinkers. Method A pooled dataset of 1,002 (58.5% female; M age = 22.14) binge drinkers from the United States (60%) and Canada (40%) was used. The primary outcomes were past month combustible tobacco and e-cigarette use. Nicotine dependence was measured using the Fagerström Test of Cigarette Dependence. Alcohol severity was measured using the Young Adult Alcohol Consequences Questionnaire. Latent transition analysis (LTA) was used to identify patterns of cigarette smoking and e-cigarette use over 24 months. Results The LTA yielded a four-class solution: 1) e-cigarettes-only users (prevalence over time: 7.75-10.10%), 2) dual-product users (2.61-9.89%), 3) combustible-only smokers (8.12-20.70%) and 4) non-users (61.66-80.06%). Dual-product users predominantly transitioned to complete abstinence or exclusively e-cigarette use. In combustible-only smokers, the most common transition was to abstinence, followed by persistence of combustible-only status. At 24-months, 63% of e-cigarettes-only users transitioned to abstinence, with 37% continuing e-cigarettes-only use and 0% transitioning to dual or combustible cigarette use. Conclusions Dual-product use in young adult binge drinkers was associated with discontinuation of combustible tobacco over time, and e-cigarette-only use was not associated with subsequent combustible tobacco use. Implications These findings suggest that concurrent or exclusive e-cigarette use is not a risk factor for persistence or development of combustible tobacco use in this subpopulation, with dual-product use reflecting a transitional pattern away from combustible use, toward discontinuation.

Use of electronic nicotine delivery systems and cigarette smoking—Add-on vs. displacement dual use

“…A US study ( 21 ) using data from the Tobacco Use Supplement to Current Population Surveys and the National Health Interview Survey found that from 2014/2015 to 2018/2019, exclusive ENDS use increased while exclusive cigarette and dual use of ENDS and cigarettes decreased [in the US, dual use primarily fits our definition of add-on use ( 22 , 23 )]. In agreement with studies ( 12 , 13 ) cited above, a 24-month study on the consumption of tobacco and e-cigarettes among young adult binge drinkers showed that dual use is often a transitional phase between cigarette smoking and cessation ( 24 ). The latent transition analysis revealed four distinct user patterns among young adults from the US and Canada: (1) exclusive e-cigarette use, (2) dual use, (3) exclusively combustible cigarette smoking, and (4) non-use.…”

“…For smokers who used only combustible cigarettes, the most common transition was abstinence, followed by those who remained in the group of combustible cigarette smoking. After 24 months, 63% of exclusive e-cigarette users transitioned to abstinence, 37% continued to use e-cigarettes, and none transitioned to dual or combustible cigarette use ( 24 ).…”

Randomized trial assessing the effect of the JUUL system on switching away from cigarettes and smoking reduction among U.S. adults who smoke cigarettes.

“…However, data from studies that have evaluated biomarkers of exposure show that cigarette smoking is the primary driver of toxicant exposure among dual users (Holt et al, 2023; Majeed et al, 2020; Smith et al, 2021), and that if dual use is accompanied by substantial reductions in cigarette consumption it results in reduced exposure to toxicants known to be associated with smoking-induced disease (Anic et al, 2022; Cohen et al, 2021; D’Ruiz et al, 2016; Holt et al, 2023; Pulvers et al, 2020). Additionally, data from observational longitudinal studies suggest that dual use is often a transitional state on a pathway to complete switching (Martinez-Loredo et al, 2022; Selya et al, 2021). Given that reductions in cigarette consumption meaningfully decrease risk of mortality (Inoue-Choi et al, 2019), these changes in daily cigarette smoking suggest that dual users who decrease their cigarette consumption may reduce their health risk.…”

Flavor science in the context of research on electronic cigarettes

“…Elsewhere, data from young adult binge drinkers suggest that when comparing baseline to a 24-month follow-up, most exclusive eCig users transitioned to abstinence or remained as exclusive eCig users; notably, none transitioned to exclusive combustible tobacco use or dual use. Further, among those who were dual users at baseline, most transitioned to non-use (41%), or exclusive eCig use (24%), or remained dual users (17%), leading the authors to conclude that concurrent or exclusive eCig use was not a risk factor for development or persistence of combustible tobacco use ( Martinez-Loredo et al, 2022 ). Conversely, among never smokers, eCig use may represent a novel on-ramp leading to development of nicotine dependence, especially for adolescents and young adults who find the diverse flavors of eCigs highly appealing.…”