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Association of device type, flavours and vaping behaviour with tobacco product transitions among adult electronic cigarette users in the USA
  1. Alyssa F Harlow1,
  2. Jessica L Fetterman2,
  3. Craig S Ross1,
  4. Rose Marie Robertson3,
  5. Aruni Bhatnagar4,
  6. Emelia J Benjamin1,2,
  7. Andrew C Stokes5
  1. 1Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3Tobacco Regulation and Addiction Center, American Heart Association, Dallas, Texas, USA
  4. 4Department of Medicine, University of Louisville, Louisville, Kentucky, USA
  5. 5Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Ms Alyssa F Harlow, Department of Epidemiology, Boston University School of Public Health, Boston 02118, MA, USA; afharlow{at}


Background Few studies assess whether electronic cigarette (e-cigarette) device characteristics or flavours impact longitudinal patterns of cigarette and e-cigarette use.

Design We examined data from waves 2–4 of the Population Assessment of Tobacco and Health Study (2014–2018). Among adult (≥18 years) current e-cigarette users at wave 2 who were current smokers (dual users; n=1759) and former smokers (exclusive e-cigarette users; n=470), we classified participants into four use patterns at wave 3 (~12 months later) and wave 4 (~24 months later): (1) dual use of e-cigarettes and cigarettes; (2) exclusive cigarette smoking; (3) exclusive e-cigarette use; (4) non-use of both products. We used multinomial logistic regression to assess correlates of changing use patterns at 24 months, relative to no change, adjusting for sociodemographic factors.

Results At 24 months, 26.5% of baseline exclusive e-cigarette users, and 9% of baseline dual users, abstained from both vaping and smoking. Participants who vaped non-tobacco flavours (vs tobacco flavours), and used refillable tank or modifiable devices (vs disposable, cartridges and other devices) were less likely to transition to non-use of both products and to exclusive cigarette smoking. Baseline daily vaping (vs non-daily) was positively associated with exclusive e-cigarette use at 24 months for baseline daily cigarette smokers, but negatively associated with exclusive e-cigarette use and non-use of both products at 24 months for baseline non-daily smokers.

Conclusions Non-tobacco flavours, daily vaping and modifiable e-cigarette devices may help some smokers abstain from cigarette smoking via transitioning to exclusive e-cigarette use, but are also associated with ongoing exclusive e-cigarette use.

  • electronic nicotine delivery devices
  • cessation
  • non-cigarette tobacco products

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  • Contributors AFH conducted all analyses and wrote the first draft of the manuscript. AS and JLF provided supervision to analyses. All authors helped with interpretation of results, provided edits to the manuscript and approved the final version of the manuscript.

  • Funding This work was supported by the National Heart, Lung and Blood Institute and FDA Center for Tobacco Products (CTP) through U54HL120163 and K01HL154130-01.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, the Food and Drug Administration or the American Heart Association.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This research was deemed exempt by the Boston University Medical Center Institutional Review Board.

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

  • Data availability statement Data are available in a public, open access repository. This manuscript makes use of fully de-identified secondary data from the Population Assessment of Tobacco and Health (PATH) Study. Public use data files are available for download from the National Addiction and HIV Data Archive Program (NAHDAP):".