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<p>Understanding the population impact of electronic nicotine delivery systems (ENDS) requires, in part, examining whether ENDS use could promote smoking relapse among formerly-smoking adults (FSAs) or initiation among never-smoking adults (NSAs). The second year (Y2) of follow-up among FSAs (<i>N</i>=3,855) and NSAs (<i>N</i>=3,186) who purchased JUUL e-cigarettes was analyzed. Inverse propensity-weighted analyses examined whether smoking across Y2 follow-ups (i.e., persistent vs. intermittent vs. not at all) is predicted by Y1 behavior (<i>any</i> smoking and/or <i>persistent</i> ENDS use (JUUL or other brand]). Overall, 6.3% of FSAs and 4.0% of NSAs persistently smoked over Y2. Having engaged in <i>any</i> Y1 smoking predicted persistent smoking in Y2 (FSAs: ORs=6.54–28.12 across strata of Y1 ENDS use; NSAs: ORs= 6.51–67.67; all <i>p</i>&lt;.001). Persistent Y1 ENDS use predicted directionally <i>lower</i> likelihood of Y2 smoking among FSAs; this was statistically significant in those smoking “some days/every day” in Y1 (OR=0.63 for persistent Y2 smoking) and those not smoking at <i>all</i> Y1 follow-ups (OR=0.68 for intermittent Y2 smoking). Among NSAs, persistent Y1 ENDS use was not associated with Y2 smoking. Overall, persistent smoking was uncommon among non-smoking adults two years after purchasing JUUL, and prior Y1 smoking was the strongest predictor of future smoking. These findings suggest low bounds on rates of smoking reinitiation (among FSAs) and establishment of regular smoking (among NSAs) following ENDS uptake and thus do not substantially undermine ENDS’ population-level benefits. Persistent ENDS use was inversely associated with smoking relapse among some groups of FSAs.</p>

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Cigarette Smoking Over Two Years Among US Adults Who Formerly or Never Smoked and Recently Purchased Electronic Nicotine Delivery Systems

  • 期刊论文

  • 发表日期：

    2026年7月6日

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  • Arielle Selya,
  • Sooyong Kim,
  • Michael Hannon,
  • Nicholas Goldenson,
  • Saul Shiffman

摘要

Understanding the population impact of electronic nicotine delivery systems (ENDS) requires, in part, examining whether ENDS use could promote smoking relapse among formerly-smoking adults (FSAs) or initiation among never-smoking adults (NSAs). The second year (Y2) of follow-up among FSAs (N=3,855) and NSAs (N=3,186) who purchased JUUL e-cigarettes was analyzed. Inverse propensity-weighted analyses examined whether smoking across Y2 follow-ups (i.e., persistent vs. intermittent vs. not at all) is predicted by Y1 behavior (any smoking and/or persistent ENDS use (JUUL or other brand]). Overall, 6.3% of FSAs and 4.0% of NSAs persistently smoked over Y2. Having engaged in any Y1 smoking predicted persistent smoking in Y2 (FSAs: ORs=6.54–28.12 across strata of Y1 ENDS use; NSAs: ORs= 6.51–67.67; all p<.001). Persistent Y1 ENDS use predicted directionally lower likelihood of Y2 smoking among FSAs; this was statistically significant in those smoking “some days/every day” in Y1 (OR=0.63 for persistent Y2 smoking) and those not smoking at all Y1 follow-ups (OR=0.68 for intermittent Y2 smoking). Among NSAs, persistent Y1 ENDS use was not associated with Y2 smoking. Overall, persistent smoking was uncommon among non-smoking adults two years after purchasing JUUL, and prior Y1 smoking was the strongest predictor of future smoking. These findings suggest low bounds on rates of smoking reinitiation (among FSAs) and establishment of regular smoking (among NSAs) following ENDS uptake and thus do not substantially undermine ENDS’ population-level benefits. Persistent ENDS use was inversely associated with smoking relapse among some groups of FSAs.