Trajectories Between Cigarette Smoking and Electronic Nicotine Delivery System Use Among Adults in the U.S.

Smoking causes six million deaths annually worldwide. There are controversies regarding the use of electronic nicotine delivery systems (ENDS) to help smokers quit. The purpose of this study was to examine trajectories from prior ENDS use to current cigarette use among adults in the United States. We used National Cancer Institute public data from 2018 to build two statistical models. For model 1, we examined the association between prior ENDS use (vs. never ENDS use) and current cigarette use. For model 2, we examined the association between ENDS use (current and former vs. never) and continuing to smoke among ever smokers. For both models, sociodemographic covariates included age, race and ethnicity, sex, and income and incorporated survey weights. The Health Information National Trends Survey (HINTS) data set included 3,437 participants representing all 245,360,828 people 18 and over in the United States. Compared with those who were not prior ENDS users, prior ENDS users had about 10 times the odds of being current cigarette smokers (AOR=9.74, 95% CI=5.82, 16.31). Additionally, among ever smokers, compared with those who were never ENDS users, current ENDS users were significantly more likely to be current smokers (AOR=5.69, 95% CI=2.46, 13.16). Thus, ENDS use was strongly associated with later cigarette smoking, and smokers who use ENDS were more likely to continue smoking than those who did not use ENDS. These results underscore concerns regarding ENDS and question whether ENDS represent a valuable tool to help smokers quit.