Changes in Nicotine Product Use among Dual Users of Tobacco and Electronic Cigarettes: Findings from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2015

Background: Dual use of tobacco cigarettes and e-cigarettes (dual use) is the most common poly-tobacco use pattern among U.S. adults. Whether dual use facilitates or inhibits smoking cessation is of concern, yet limited information exists regarding continuation of dual use over time. Purpose: This study examined variation in nicotine product use over a one-year period, and evaluated predictors of smoking abstinence among dual users. Methods: Data from 1,082 dual users of tobacco cigarettes and e-cigarettes were analyzed using Wave 1 (2013-2014) and Wave 2 (2014-2015) of the Population Assessment of Tobacco and Health Study. Descriptive analyses assessed variation in nicotine product use at Wave 2. Weighted logistic regression was used to identify correlates of smoking abstinence. Results: The majority of Wave 1 dual users (88.5%) continued using combustible tobacco at Wave 2: 59.2% were exclusive cigarette smokers, 25.5% remained dual users, and 3.8% reported some other combustible tobacco use pattern. The odds of being smoke-free at Wave 2 were higher among dual users who reported everyday (versus someday) e-cigarette use (aOR: 1.85; 95% CI: 1.18-2.89). Everyday use of tobacco cigarettes was inversely associated with smoking abstinence (aOR 0.33; 95% CI: 0.21-0.51). Conclusions: Over a one year period, most dual users still smoked tobacco cigarettes. Frequency of cigarette and e-cigarette use at Wave 1 were each associated with odds of smoking abstinence. Findings suggest that daily e-cigarette use may increase dual users' chances of becoming smoke free.