Dataset Information

Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study.

ABSTRACT:

Introduction

Sociodemographic differences in electronic cigarette use among cigarette smokers have not been previously characterized in the US adult population.

Methods

We analyzed longitudinal data from Waves 1 and 2 of the nationally representative Population Assessment of Tobacco and Health (PATH) study. Differences by income (based on federal poverty level (FPL)) and race/ethnicity in e-cigarette uptake at Wave 2 among cigarette smokers who were e-cigarette nonusers at Wave 1 were assessed using binomial and multinomial logistic regression. We differentiated e-cigarette users who quit cigarettes (exclusive users) from those who did not quit cigarettes (dual users). E-cigarette-related attitudes/beliefs were evaluated to understand potential contributions to sociodemographic differences in e-cigarette uptake and use patterns.

Results

Among 6592 smokers who were e-cigarette nonusers at Wave 1, 13.5% began using e-cigarettes at Wave 2, of whom 91.3% were dual users. Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users (OR [Blacks] = 0.27, 95% CI = 0.09 to 0.77; OR [Hispanics] = 0.26, 95% CI = 0.09 to 0.70). Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users (OR [<100% FPL vs. ?200% FPL] = 0.48, 95% CI = 0.27 to 0.89). Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms.

Conclusions

Black, Hispanic, and low-income smokers were less likely than White and higher-income smokers to begin using e-cigarettes in the context of quitting cigarettes. Differences in e-cigarette uptake may be partly explained by perceived harm or social norms of e-cigarettes.

Implications

Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.

SUBMITTER: Harlow AF

PROVIDER: S-EPMC6751515 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study.

Harlow Alyssa F AF Stokes Andrew A Brooks Daniel R DR

Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 20190901 10

<h4>Introduction</h4>Sociodemographic differences in electronic cigarette use among cigarette smokers have not been previously characterized in the US adult population.<h4>Methods</h4>We analyzed longitudinal data from Waves 1 and 2 of the nationally representative Population Assessment of Tobacco and Health (PATH) study. Differences by income (based on federal poverty level (FPL)) and race/ethnicity in e-cigarette uptake at Wave 2 among cigarette smokers who were e-cigarette nonusers at Wave 1 ...[more]

PMID: 29986109

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Project description:IntroductionUnderstanding which non-cigarette tobacco products precede smoking in youth across different racial/ethnic groups can inform policies that consider tobacco-related health disparities.MethodsWe used nationally representative, longitudinal data from the Population Assessment of Tobacco and Health Study waves 1-4. The sample was a dynamic cohort of cigarette-naïve youth aged 12-17 years. Mixed-effects models were used to assess non-cigarette product (e-cigarette, cigar product, or other product) use with cigarette use over 1-year intervals.ResultsOf the 28 788 observations pooled across waves 1-4, respondents were 48.7% non-Hispanic white, 13.9% non-Hispanic black, and 23.1% Hispanic. Odds of cigarette initiation over 1-year follow-up were higher among youth with prior use of e-cigarettes (odds ratio [OR], 2.76; 95% confidence interval [CI], 2.21-3.45), cigars (OR, 2.00; 95% CI, 1.42-2.80), or other products (OR, 1.66; 95% CI, 1.28-2.14) compared to never users. At the population level, 20.6% of cigarette initiation was attributable to e-cigarette use among white youth and 21.6% among Hispanic youth, while only 3.5% of cigarette initiation was attributable to e-cigarette use among black youth. In contrast, 9.1% of cigarette initiation for black youth was attributable to cigar use compared to only 3.9% for both white and Hispanic youth.ConclusionsPrior use of e-cigarettes, cigars, and other non-cigarette products were all associated with subsequent cigarette initiation. However, white and Hispanic youth were more likely to initiate cigarettes through e-cigarette use (vs. cigar or other product use), while black youth were more likely to initiate cigarettes through cigar use (vs. e-cigarette or other product use).ImplicationsOur findings suggest that previous studies on effects of non-cigarette tobacco products may overlook the critical role of cigar products as a pathway into cigarette smoking among US youth, particularly black youth. While our data support the importance of e-cigarette use as a pathway into smoking, regulatory actions aimed at addressing youth e-cigarette use alone may contribute to disparities in black versus white tobacco use and further exacerbate inequities in tobacco-related disease. Thus, contemporary policy development and discourse about the effects of non-cigarette tobacco products on cigarette initiation should consider cigar and other non-cigarette products as well as e-cigarettes.

Project description:ObjectiveTo determine the extent to which socioeconomic and racial/ethnic differences in cancer screening discussion between a patient and his/her primary care physician are due to "within-physician" differences (the fact that patients were treated differently by the same physicians) versus "between-physician" differences (that they were treated by a different group of physicians).Data sourcesWe use data from the baseline patient and physician surveys of two community trials from the Communication in Medical Care (CMC) research series. The two studies combined provide an analysis sample of 5,978 patients ages 50-80 nested within 191 primary care physicians who practiced throughout Southern California.Study designOur main outcomes of interest are whether the physician has ever talked to the patient about fecal occult blood test (FOBT; for colorectal cancer screening), mammogram (for breast cancer screening, female patients only) and the prostate-specific antigen test (PSA, male patients only). We consider five racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, Asian, and other race/ethnicity. We measure socioeconomic status by both income and education. For each type of cancer screening discussion, we first estimate a probit model that includes patient characteristics as the only covariates to assess the overall differences. We then add physician fixed effects to derive estimates of "within-" versus "between-" physician differences.Principal findingsThere was a strong education gradient in the discussion of all three types of cancer screening and most of the education differences arose within physicians. Disparities by income were less consistent across different screening methods, but seemed to have arisen mainly because of "between-physician" differences. Asians were much less likely, compared with whites, to have received discussion about FOBT and PSA and these differences were mainly "within-physician" differences. Black female patients, however, were much more likely, compared with whites treated by the same physicians, to have discussed mammogram with their physicians.ConclusionsDifferences in cancer screening discussion along the different dimensions of patient SES may have arisen because of very different mechanisms and therefore call for a combination of interventions. Physicians need to be aware of the persistent disparities by patient education in clinical communication regarding cancer screening and tailor their efforts to the needs of low-education patients. Quality-improvement efforts targeted at physicians practicing in low-income communities may also be effective in addressing disparities in cancer screening communication by patient income.

Dataset Information

Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study.

Introduction

Methods

Results

Conclusions

Implications

Publications

Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake Among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study.

Similar Datasets

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