Purpose:We examined quitting behaviors among a cohort of dual users (cigarettes and electronic cigarettes [e-cigarettes]) and exclusive cigarette smokers for: (1) cigarette smoking reduction, (2) quit attempts, (3) abstinence from cigarettes, and (4) abstinence from all tobacco products. Methods: Participants enrolled in the Tobacco User Adult Cohort and categorized as "daily" user of cigarettes and "daily" or "some days per week" use of e-cigarettes (ie, dual users; n = 88) or "daily" user of cigarettes only (ie, cigarette smokers; n = 617) served as the analytic sample. Participants were interviewed face to face every 6 months, through 18 months. Data on self-reported current product(s) used, cessation interest, quit attempts and abstinence from cigarettes, and all tobacco products were collected. Results: No difference in reduction of cigarette consumption over time was noted between groups. Rates of reporting an attempt to quit all tobacco products (≥ 24 hours of not using any tobacco in an attempt to quit) also did not differ by group. Compared to cigarette smokers, dual users were more likely to report abstinence from cigarettes at 6 months (OR = 2.54, p = .045) but not at 12 or 18 months. There was no significant difference in abstinence from all tobacco products by group at 6, 12, or 18 months. Conclusions: Although dual use of e-cigarettes has been cited as a potential cessation tool for cigarette smokers, our findings indicated that this association was only observed in the short term. We also found no evidence of any association between dual use and eventual abstinence from all tobacco products. Implications: Our study observed that, in the natural environment, dual users of cigarettes and e-cigarettes were more likely than cigarette smokers to quit cigarettes in the short term but no more likely to quit using cigarettes and all tobacco products over time.
In pre-post studies when all outcomes are completely observed, previous studies have shown that analysis of covariance (ANCOVA) is more powerful than a change-score analysis in testing the treatment effect. However, there have been few studies comparing power under missing post-test values. This paper was motivated by the Behavior and Exercise for Physical Health Intervention (BePHIT) Study, a pre-post study designed to compare two interventions on postmenopausal women's walk time. The goal of this study was to compare the power of two methods which adhere to the intent-to-treat (ITT) principle when post-test data are missing: ANCOVA after multiple imputation (MI) and the mixed model applied to all-available data (AA). We also compared the two ITT analysis strategies to two methods which do not adhere to ITT principles: complete-case (CC) ANCOVA and the CC mixed model. Comparisons were made through analyses of the BePHIT data and simulation studies conducted under various sample sizes, missingness rates, and missingness scenarios. In the analysis of the BePHIT data, ANCOVA after MI had the smallest p-value for the test of the treatment effect of the four methods. Simulation results demonstrated that the AA mixed model was usually more powerful than ANCOVA after MI. The power of ANCOVA after MI dropped the fastest as the missingness rate increased; in most simulated scenarios, ANCOVA after MI had the smallest power when 50% of the post-test outcomes were missing.
Overall, these findings signal the magnitude of tobacco marketing exposures and their pernicious impact on youth. Findings underscore the importance of federal, state, and local-level tobacco regulatory policies to protect youth from the marketing that puts them at risk for a lifetime of nicotine addiction and tobacco-related diseases.
This cohort's enumeration allowed us to compare factors associated with tobacco product preferences and the use of novel products. The inclusion of rural Appalachia-a region with high tobacco use and disease burden-may provide additional insights into the implementation of tobacco control interventions.
Regulatory action that imposes restrictions on the availability or use of price promotions could alter the purchasing behavior of rural Americans in such a way that makes it easier to reduce tobacco use or quit. Such action would also restrict flexibility in the price of tobacco products, which is known as a powerful tobacco control lever.
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