E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveysBMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3262 (Published 26 July 2017) Cite this as: BMJ 2017;358:j3262
- Shu-Hong Zhu, professor1 2,
- Yue-Lin Zhuang, senior statistician2,
- Shiushing Wong, senior statistician2,
- Sharon E Cummins, assistant professor1 2,
- Gary J Tedeschi, clinical director2
- 1Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive MC 0905, La Jolla, CA 92093-0905, USA
- 2Moores Cancer Center, University of California, San Diego, CA, USA
- Correspondence to: S-H Zhu
- Accepted 4 July 2017
Objective To examine whether the increase in use of electronic cigarettes in the USA, which became noticeable around 2010 and increased dramatically by 2014, was associated with a change in overall smoking cessation rate at the population level.
Design Population surveys with nationally representative samples.
Setting Five of the US Current Population Survey-Tobacco Use Supplement (CPS-TUS) in 2001-02, 2003, 2006-07, 2010-11, and 2014-15.
Participants Data on e-cigarette use were obtained from the total sample of the 2014-15 CPS-TUS (n=161 054). Smoking cessation rates were obtained from those who reported smoking cigarettes 12 months before the survey (n=23 270). Rates from 2014-15 CPS-TUS were then compared with those from 2010-11 CPS-TUS (n=27 280) and those from three other previous surveys.
Main outcome measures Rate of attempt to quit cigarette smoking and the rate of successfully quitting smoking, defined as having quit smoking for at least three months.
Results Of 161 054 respondents to the 2014-15 survey, 22 548 were current smokers and 2136 recent quitters. Among them, 38.2% of current smokers and 49.3% of recent quitters had tried e-cigarettes, and 11.5% and 19.0% used them currently (every day or some days). E-cigarette users were more likely than non-users to attempt to quit smoking, 65.1% v 40.1% (change=25.0%, 95% confidence interval 23.2% to 26.9%), and more likely to succeed in quitting, 8.2% v 4.8% (3.5%, 2.5% to 4.5%). The overall population cessation rate for 2014-15 was significantly higher than that for 2010-11, 5.6% v 4.5% (1.1%, 0.6% to 1.5%), and higher than those for all other survey years (range 4.3-4.5%).
Conclusion The substantial increase in e-cigarette use among US adult smokers was associated with a statistically significant increase in the smoking cessation rate at the population level. These findings need to be weighed carefully in regulatory policy making regarding e-cigarettes and in planning tobacco control interventions.
We thank Jessica Sun for her comments on earlier drafts of the paper and for her help in preparing the manuscript.
Contributors: S-HZ and Y-LZ conceived the study. Y-LZ, S-HZ, and SW analyzed the data. S-HZ, Y-LZ, SW, SEC, and GJT interpreted the data. S-HZ, Y-LZ, SEC, GJT, and SW helped draft the manuscript. All authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. S-HZ is guarantor for the study.
Funding: This study was supported by the National Cancer Institute of the National Institutes of Health under the State and Community Tobacco Control (SCTC) Initiative (award No U01CA154280). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funders of this study had no role in the study design; collection, analysis, and interpretation of the data; writing of the manuscript; or decision to submit the manuscript for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: S-HZ has received a grant from the National Institutes of Health for this work. All authors declare no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; and no other relationships or activities exist that could appear to have influenced the submitted work.
Ethical approval: This study is a secondary data analysis of publicly available data, approved by the UCSD Human Research Protection Program (institutional review board No 140821).
Data sharing: The full dataset is publicly available from the US Census Bureau.
Transparency: The lead author (S-HZ) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.
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