Transitions from smoking to exclusive e-cigarette use, dual use, or stopping nicotine use in ALSPAC and their association with modifiable and sociodemographic factors
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Background
E-cigarettes can aid smoking cessation and reduce carcinogen exposure. Understanding differences in characteristics between young adults in the UK who quit smoking, with or without e-cigarettes, or who dual use can help identify and tailor interventions.
Methods
There were 858 participants in the Avon Longitudinal Study of Parents and Children who reported smoking at 21 years. Transitions to the first reported non-exclusive smoking event were measured at 22-30 years and include stopping nicotine use (not currently smoking nor using e-cigarettes), exclusive e-cigarette use, and dual use (smoking and using e-cigarettes). Associations between these transitions and substance use, sociodemographic, and health characteristics were examined through discrete-time survival analysis. Analyses were adjusted for early life confounders, and weighted to mitigate bias. Multiple imputation was used to analyse partially-observed data.
Results
More participants reported stopping nicotine use (52%) than using e-cigarettes (dual use = 27%; exclusive e-cigarette use = 9%). Smoking frequently at age 21 (Subdistribution Hazard Ratio [SHR] = 0.28, CI = 0.22-0.35) and having many friends who smoke at age 21 (SHR = 0.64, CI = 0.50-0.81) decreased the likelihood of stopping nicotine use, and increased the likelihood of dual use (frequent smoking SHR = 3.00, CI = 1.96-4.59; peer smoking SHR = 1.55, CI = 1.07-2.24) and exclusive e-cigarette use (frequent smoking SHR = 2.84, CI = 1.26-6.42). Participants with lower education at age 20 were less likely to stop using nicotine (SHR = 0.68, CI = 0.52-0.90), and more likely to dual use (SHR = 1.72, CI = 1.03-2.90). Cannabis use at age 20 (SHR = 0.67, CI = 0.49-0.92), drug use at age 20 (SHR = 0.77, CI = 0.59-0.99), less exercise at age 18 (SHR = 0.71, CI = 0.53-0.95), and parenthood at age 21 (SHR = 0.46, CI = 0.27-0.79) reduced the likelihood of stopping nicotine use. Higher BMI at age 18 (SHR = 1.58, CI = 1.08-2.31) increased the likelihood of dual use.
Conclusions
Young adults who smoke more frequently, have many peers who smoke, have lower education, exercise less, use cannabis or other drugs likely need greater efforts from stop smoking intervention. Those with greater smoking frequency, more friends who smoke or lower education may need additional support to completely switch to e-cigarettes. Others not engaging with e-cigarettes may benefit from targeted interventions to encourage harm reduction.
