The association between e-cigarette use characteristics and combustible cigarette consumption and dependence symptoms: Results from a national longitudinal study

Background: Existing longitudinal surveys focused on the association between ever use of e-cigarettes and combustible cigarette consumption, making it difficult to infer what characteristics of e-cigarette use could potentially change combustible cigarette use behavior, which may have long-term health consequences. Although e-cigarettes' efficacy of alleviating dependence symptoms was supported by studies conducted in laboratory settings, whether the results can be translated into symptom reduction in the real world and over time is an open question. Methods: This study conducted secondary analysis on the Waves 1-2 data of the Population Assessment of Tobacco and Health (PATH) Study to examine the association between e-cigarette use characteristics (frequency, flavoring, and voltage adjustment) and combustible cigarette use outcomes (frequency, quantity, and symptoms), using the Heckman 2-step selection procedure with the selection bias controlled. The inclusion criteria ensured that we followed an adult cohort of exclusive combustible cigarette users at Wave 1. Results: The result shows that higher frequency of e-cigarette use was associated with lower combustible cigarette consumption and dependence symptoms, controlling for the corresponding baseline cigarette use variable and other confounders. Given the frequency of e-cigarette use, the feature of voltage adjustment was not significantly associated with any of the cigarette use outcomes. Flavoring, on the other hand, was associated with lower quantity of cigarette use. Conclusions: Exclusive smokers who start using e-cigarettes do indeed change the frequency and quantity with which they smoke cigarettes. E-cigarette use may also help reduce dependence symptoms.