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Trajectories of ENDS and cigarette use among dual users: analysis of waves 1 to 5 of the PATH Study
  1. Nandita Krishnan1,
  2. Carla J Berg1,
  3. Angelo F Elmi2,
  4. Elias M Klemperer3,4,
  5. Scott E Sherman5,
  6. Lorien C Abroms1
  1. 1 Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
  2. 2 Department of Biostatistics and Bioinformatics, The George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
  3. 3 Department of Psychiatry, University of Vermont, Burlington, Vermont, USA
  4. 4 Vermont Center on Behavior and Health, Burlington, Vermont, USA
  5. 5 Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
  1. Correspondence to Dr Nandita Krishnan, Department of Prevention and Community Health, The George Washington University Milken Institute School of Public Health, Washington, DC 20052, USA; nkrishnan{at}gwu.edu

Abstract

Introduction Concurrent electronic nicotine delivery system (ENDS) and cigarette (dual) use is harmful. Identifying longitudinal trajectories of ENDS and cigarette use among dual users can help to determine the public health impact of ENDS and inform tobacco control policies and interventions.

Objectives (1) To identify independent and joint trajectories of ENDS and cigarette use among wave (W) 1 adult dual users across W1 to W5 of the Population Assessment of Tobacco and Health (PATH) Study; and (2) identify W1 predictors of ENDS and cigarette joint trajectory group membership.

Methods We used group-based trajectory modelling to estimate independent and joint trajectories of ENDS and cigarette use from wave 1 (W1; 2013–2014) to wave 5 (W5; 2018–2019) among W1 adult established dual users of ENDS and cigarettes (n=545) from the PATH Study. We used multinomial logistic regression to identify W1 predictors of joint trajectories.

Results Two ENDS (early quitters=66.0%, stable users=34.0%) and three cigarette (stable users=55.2%, gradual quitters=27.3%, early quitters=17.5%) trajectories of W1 were identified. In joint trajectory analysis, 41.6% of participants were early ENDS quitters and stable cigarette users; 14.8% early ENDS quitters and gradual cigarette quitters; 14.6% stable ENDS users and stable cigarette users; 11.2% stable ENDS users and gradual cigarette quitters; 10.3% early ENDS quitters and early cigarette quitters; and 7.4% stable ENDS users and early cigarette quitters. Cigarette and ENDS use frequency, nicotine dependence, cannabis use and other non-combusted tobacco product use predicted trajectory group membership (p values <0.05).

Conclusions Most dual users maintained long-term cigarette smoking or dual use, highlighting the need to address cessation of both products. Continued monitoring of trajectories and their predictors is needed, given ongoing changes to the ENDS marketplace.

  • Electronic nicotine delivery devices
  • Co-substance use
  • Cessation

Data availability statement

Data are available in a public, open access repository. This analysis used data from PATH Public Use Files (PUFs), which are available for download from https://doi.org/10.3886/ICPSR36498.v16.

https://doi.org/10.1136/tc-2022-057405

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    Data availability statement

    Data are available in a public, open access repository. This analysis used data from PATH Public Use Files (PUFs), which are available for download from https://doi.org/10.3886/ICPSR36498.v16.

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    Footnotes

    • Twitter @eliask87, @lorien_a

    • Contributors NK conceptualised the study, analysed the data, wrote the original draft and reviewed and revised the manuscript. LA and CB provided input to the conceptualisation of the study and data analysis, and reviewed and revised the manuscript. AFE provided input into the data analysis and reviewed the manuscript. EMK and SS critically reviewed the manuscript. NK is responsible for the overall content and is the guarantor of this paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.