Socioeconomic and Racial/Ethnic Differences in E-Cigarette Uptake among Cigarette Smokers: Longitudinal Analysis of the Population Assessment of Tobacco and Health (PATH) Study

Abstract

Introduction: Sociodemographic differences in electronic cigarette use among cigarette smokers have not been previously characterized in the US adult population. Methods: We analyzed longitudinal data from Waves 1 and 2 of the nationally representative Population Assessment of Tobacco and Health (PATH) study. Differences by income (based on federal poverty level (FPL)) and race/ethnicity in e-cigarette uptake at Wave 2 among cigarette smokers who were e-cigarette nonusers at Wave 1 were assessed using binomial and multinomial logistic regression. We differentiated e-cigarette users who quit cigarettes (exclusive users) from those who did not quit cigarettes (dual users). E-cigarette-related attitudes/beliefs were evaluated to understand potential contributions to sociodemographic differences in e-cigarette uptake and use patterns. Results: Among 6592 smokers who were e-cigarette nonusers at Wave 1, 13.5% began using e-cigarettes at Wave 2, of whom 91.3% were dual users. Compared with non-Hispanic Whites, non-Hispanic Black, and Hispanics were less likely to become exclusive e-cigarette users (OR [Blacks] = 0.27, 95% CI = 0.09 to 0.77; OR [Hispanics] = 0.26, 95% CI = 0.09 to 0.70). Low-income smokers were less likely than higher-income smokers to become exclusive e-cigarette users (OR [<100% FPL vs. ≥200% FPL] = 0.48, 95% CI = 0.27 to 0.89). Black, Hispanic, and low-income smokers were more likely to believe e-cigarettes are more harmful than cigarettes and to have positive tobacco-related social norms. Conclusions: Black, Hispanic, and low-income smokers were less likely than White and higher-income smokers to begin using e-cigarettes in the context of quitting cigarettes. Differences in e-cigarette uptake may be partly explained by perceived harm or social norms of e-cigarettes. Implications: Results of this study show that the exclusive use of e-cigarettes is more prevalent in higher-income and White smokers. Our data suggest that higher-income and White smokers may be more likely to use e-cigarettes as a means to quit combustible cigarettes compared with low-income and racial/ethnic minority smokers. These findings suggest that sociodemographic differences in e-cigarette uptake and use patterns may contribute to widening disparities in cigarette smoking.