背景:自2019年以来,随着豆荚和一次性用品的兴起,香烟和电子尼古丁输送系统(ENDS)的使用可能发生了变化,肺损伤爆发,口味禁令,烟草21和COVID-19大流行。
方法:使用烟草与健康研究的人群评估,我们将多状态过渡模型应用于第4-5波(2017-2019)的28061名成年人和第5-6波(2019-2021)的24584名成年人,估计启动的过渡率,每个时期和年龄组的停止和转换产品。
结果:从2017-2019年到2019-2021年,从未使用过这两种产品的成年人的香烟开始减少,但ENDS开始没有显着变化。仅使用ENDS的持久性仍然很高(1年后为75%-80%)。仅使用香烟的过渡保持相似(剩下88%,7%用于非当前使用,5%用于双重或仅ENDS使用)。相比之下,双重使用到仅ENDS的过渡从每年的9.5%(95%CI7.3%到11.7%)增加到20.0%(95%CI17.4%到22.6%),减少双重用途的持久性。双重使用到仅使用香烟的过渡保持在约25%。这些变化在成人年龄组中在质量上相似,尽管18-24岁的成年人显示出从仅使用香烟转变为双重用途以及从双重用途转变为仅使用ENDS的可能性最高。
结论:2019-2021年,成年人使用ENDS的持久性仍然很高,但与2017-2019年相比,更大比例的双重用户过渡到仅使用ENDS。由于仅使用香烟的用户切换到双重用途的比例仍然很低,尤其是老年人,这一变化对公众健康的影响很小。
BACKGROUND: The use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the lung injuries outbreak, flavour bans, Tobacco 21 and the COVID-19 pandemic.
METHODS: Using the Population Assessment of Tobacco and Health Study, we applied a multistate transition model to 28 061 adults in waves 4-5 (2017-2019) and 24 584 adults in waves 5-6 (2019-2021), estimating transition rates for initiation, cessation and switching products for each period overall and by age group.
RESULTS: Cigarette initiation among adults who never used either product decreased from 2017-2019 to 2019-2021, but ENDS initiation did not significantly change. The persistence of ENDS-only use remained high (75%-80% after 1 year). Cigarette-only use transitions remained similar (88% remaining, 7% to non-current use and 5% to dual or ENDS-only use). In contrast, dual use to ENDS-only transitions increased from 9.5% (95% CI 7.3% to 11.7%) to 20.0% (95% CI 17.4% to 22.6%) per year, decreasing the persistence of dual use. The dual to cigarette-only use transition remained at about 25%. These changes were qualitatively similar across adult age groups, though adults ages 18-24 years exhibited the highest probability of switching from cigarette-only use to dual use and from dual use to ENDS-only use.
CONCLUSIONS: The persistence of ENDS use among adults remained high in 2019-2021, but a larger fraction of dual users transitioned to ENDS-only use compared with 2017-2019. Because the fraction of cigarette-only users switching to dual use remained low, especially among older adults, the public health implications of this change are minimal.