Poster #108 - E-Cigarettes and Smoking Cessation: Implications for Racial and Ethnic Health Disparities in the U.S.

• In Event: Saturday Poster Luncheon

Abstract

Smoking-related morbidity and mortality in the United States remain disproportionately concentrated among historically disadvantaged populations, raising persistent concerns about health equity. The benefits of policies to reduce tobacco use require understanding how demand for tobacco products is interrelated and whether e-cigarettes help people quit smoking. This study examines the impact of e-cigarette use on smoking-related disparities among disadvantaged ethnic and racial groups in the U.S. 

We examine repeated cross-sectional data from the Tobacco Use Supplement to the Current Population Survey (CPS-TUS) for 2014–2015, 2018–2019, and 2022–2023. The sample consists of adults who smoked cigarettes a year ago. The primary outcome is recent smoking cessation, defined as no longer smoking at the time of the survey. The key explanatory variable is any e-cigarette use during the prior year. To address confounding, we estimate regression models that include demographics, socioeconomic characteristics, state-level policy and economic controls, and fixed effects. To account for potential endogeneity in e-cigarette use, we employ instrumental variables (IV), bivariate probit, and copula-based endogenous treatment effect models, using instruments such as workplace vaping policies and state e-cigarette taxes and regulations. 

Across specifications, e-cigarette use is positively associated with smoking cessation. Conventional regression estimates indicate an increase in cessation probability of approximately 7.4 percentage points. Models that account for endogeneity by IV and copulas produce substantially larger effects, with a preferred estimate of the average treatment effect on the treated (ATET) of 15.7 percentage points. Linear IV estimates are similar to the endogeneity-corrected nonlinear copula models, reinforcing the conclusion that failure to address selection bias leads to attenuation of the estimated effect. The cessation effect varies markedly with patterns of use: daily e-cigarette use is strongly associated with quitting, while occasional use shows little to no effect. Use of flavored e-cigarettes, particularly non-tobacco flavors, is also associated with higher cessation rates. 

We find that the benefits of e-cigarette use for cessation are broadly shared by individuals in all racial and ethnic groups; there are no significant differences in treatment effects across groups after adjusting for confounders and selection. However, disparities in usage patterns—such as lower rates of e-cigarette uptake, less frequent use, and different product choices among some disadvantaged populations—moderate the extent to which disadvantaged groups realize cessation benefits. Native American, multiracial, Hispanic, and Black individuals are less likely to use e-cigarettes daily when they use them, compared to White individuals. Furthermore, Black individuals who smoke are less likely to use e-cigarettes, and when they do, the impacts on cessation (while still positive) are smaller than the treatment effects for Whites. These findings suggest that while e-cigarettes have the potential to reduce smoking-related disparities, unequal adoption and usage patterns may limit their equity-enhancing effects. 

Overall, the results indicate that e-cigarettes can play a meaningful role in promoting smoking cessation at the population level. Policy discussions should therefore consider not only the average public health impact of e-cigarettes, but also how regulations and public messaging influence access, usage patterns, and cessation outcomes across different populations.

Author

• James E Prieger, Pepperdine University
  Presenting Author