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E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013–2015
  1. Kaitlyn M Berry1,
  2. Lindsay M Reynolds2,
  3. Jason M Collins1,
  4. Michael B Siegel3,
  5. Jessica L Fetterman4,
  6. Naomi M Hamburg4,
  7. Aruni Bhatnagar5,
  8. Emelia J Benjamin4,6,
  9. Andrew Stokes1
  1. 1 Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  3. 3 Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
  4. 4 Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  5. 5 Department of Medicine, University of Louisville, Louisville, Kentucky, USA
  6. 6 Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr. Andrew Stokes; acstokes{at}


Background The role of electronic cigarettes (e-cigarettes) in product transitions has been debated.

Methods We used nationally representative data from the Population Assessment of Tobacco and Health Study waves 1 (2013–2014) and 2 (2014–2015) to investigate the associations between e-cigarette initiation and cigarette cessation/reduction in the USA. We limited the sample to current cigarette smokers aged 25+ years who were not current e-cigarette users at wave 1. We modelled 30-day cigarette cessation and substantial reduction in cigarette consumption as a function of e-cigarette initiation between surveys using multivariable logistic regression.

Results Between waves 1 and 2, 6.9% of cigarette smokers who were not current e-cigarette users transitioned to former smokers. After adjusting for covariates, cigarette smokers who initiated e-cigarette use between waves and reported they used e-cigarettes daily at wave 2 had 7.88 (95% CI 4.45 to 13.95) times the odds of 30-day cigarette cessation compared with non-users of e-cigarettes at wave 2. Cigarette smokers who began using e-cigarettes every day and did not achieve cessation had 5.70 (95% CI 3.47 to 9.35) times the odds of reducing their average daily cigarette use by at least 50% between waves 1 and 2 compared with e-cigarette non-users.

Conclusions Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation.

  • electronic cigarette
  • e-cigarette
  • vaping
  • vape
  • ENDS
  • smoking cessation
  • e-cigarette initiation
  • cigarette reduction
  • product transitions
  • population assessment of tobacco and health
  • PATH

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  • Contributors AS designed the study. KMB analysed the data and wrote the first draft of the manuscript. All authors contributed to interpreting the findings and revising the manuscript.

  • Funding Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health and the Center for Tobacco Products under Award Number P50HL120163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Institutional review board approval was not required as we based the study on secondary analyses of publicly available, de-identified data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Public-use data files for the Population Assessment of Tobacco and Health (PATH) study can be accessed from the National Addiction & HIV Data Archive Program.

  • Correction notice This article has been corrected since it was published Online First. The supplementary file had minor errors within it and has now been replaced with a corrected file.