The Effect of E-Cigarette Use on Smoking-Related Disparities in the US

• In Event: Substance Use, Maternal Behavior, and Racial Inequities in Perinatal Health

Abstract

The benefits of policies aiming to improve public health by reducing tobacco use requires knowledge of how demand for tobacco products is interrelated and whether use of e-cigarettes helps people quit smoking. This study examines the impact of e-cigarette use on smoking-related disparities among disadvantaged groups in the U.S.

Smoking and related harms in the U.S. are concentrated among disadvantaged groups, such as minority populations and those with lower incomes, who tend to have higher smoking prevalence than the general population. The extent to which e-cigarette use influences existing smoking-related disparities is not well understood. If e-cigarettes were more widely adopted among disadvantaged groups, helped smokers quit, and had similar cessation effects as in the general population, then increased e-cigarette use could potentially reduce disparities in smoking prevalence. Conversely, if adoption of e-cigarettes is likely to be concentrated among higher SES groups (as we find to be the case), differential use of e-cigarettes may result in those groups bearing the largest health burden of smoking falling farther behind. This study will investigate which outcome predominates for various disadvantaged groups, such as those with low-incomes and racial and ethnic minorities.

Survey data from the CPS-Tobacco Use Supplement will be used to model cessation from smoking as a function of e-cigarette use, demographics, socioeconomic factors, and relevant economic variables. Regression models are estimated with and without correction for unobserved confounding factors. In the latter case, we model the selection-process directly with various estimators from the treatment effects literature developed for the bivariate binary outcome model. Biprobit, copula-based, and control function models are used to account for selection effects in e-cigarette use, with a focus on the role of these products in reducing smoking-related disparities.

The results indicate that the average marginal effect on the probability of past-year smoking cessation from using e-cigarettes is an increase of 8-9 percentage points for Hispanic, Black, and White individuals. The effect sizes for Asian and Native American individuals is even larger. Other findings are that every-day e-cigarette use leads to a much larger likelihood of quitting smoking, compared to less-than-daily vaping or not using e-cigarettes at all. Similarly, quitting smoking is more likely with sweet and other flavored e-cigarettes than with menthol-flavored e-cigarettes, which are, in turn, more effective than unflavored e-cigarettes. While the results suggest e-cigarettes have the potential to reduce smoking-related disparities, we find that Black and Hispanic smokers are less likely to use e-cigarettes compared to White smokers. This implies that the adoption of e-cigarettes to date may have widened the gap in smoking prevalence between disadvantaged groups and the general population, potentially exacerbating existing health inequities. If these findings are corroborated with further research, they would have important implications for tobacco control policies aimed at reducing smoking-related health and economic burdens. Targeted cessation programs that encourage smokers who have not been able to quit by other means to use appealing e-cigarettes as a cessation aid, as is down in some other countries, may help move toward equitable public health outcomes in the US.

Author

• James E Prieger, Pepperdine University
  Presenting Author