Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking
Socioeconomic Disparities in Electronic Cigarette Use and Transitions from Smoking
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DOI：
10.1093/ntr/nty120
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发表时间：
2019-10-01
影响因子：
4.7
通讯作者：
Horn, Samantha J. L.
中科院分区：
文献类型：
--
作者：
Friedman, Abigail S.;Horn, Samantha J. L.
传统卷烟的社会经济差异已经确立，但电子烟的社会经济差异尚未确立。这项研究估计了美国成年人单独使用传统香烟、电子香烟和双重使用(即同时使用两种产品)的社会经济梯度。方法分析考虑了2014年至2016年全国健康访谈调查(N=50306)25至54岁受访者的具有全国代表性的数据。经人口统计学调整的看似无关的回归模型估计了两个社会经济状况指标--受访者的教育程度和家庭收入--与目前完全使用传统香烟、电子烟和双重用途的关系。结果传统香烟的使用表现出负的教育和收入梯度，与现有研究一致：如果受过大学教育，为-12.9个百分点(可信区间：-14.0，-11.8)；如果家庭收入超过联邦贫困水平的400%，则为-9.5个百分点(可信区间：-10.9，-8.1)。对于双重用途，这些梯度比较平坦(-1.4[CI：-1.8，-0.9]和-1.9[CI：-2.5，-1.2])，而对于电子烟的使用，这些梯度在统计学上不显著(-0.03[CI：-0.5，0.4]和-0.3[CI：-0.8，-0.2])。将样本限定为经常吸烟者，受教育程度越高，在访谈中完全使用电子烟的可能性增加0.9个百分点(CI：0.0，1.9)。结论与完全使用传统香烟相比，完全使用电子烟的教育程度和收入梯度很小，在统计学上没有显著差异。此外，受教育程度较高的吸烟者比受教育程度较低的吸烟者更有可能改用电子烟。这种差别转换可能会加剧与吸烟相关的发病率和死亡率方面的社会经济差异，但降低与烟草相关的疾病的负担。Implications Research尚未确定电子烟(电子烟)使用的社会经济差异是否与传统香烟相似。本文使用具有全国代表性的25-54岁美国成年人的数据来估计单独使用传统香烟、电子烟和两用香烟的收入和教育梯度。对于传统香烟的使用，这两个梯度都是陡峭的，并且是负的，但对于电子烟的使用，这两个梯度是平坦的，在统计上并不显著。在吸烟者中重复这一分析表明，受教育程度较高的吸烟者比受教育程度较低的吸烟者更有可能转向专门使用电子烟。这种差别替代可能会加剧与吸烟相关的发病率和死亡率的差异。
Introduction Socioeconomic disparities have been established for conventional cigarette use, but not for electronic cigarettes. This study estimates socioeconomic gradients in exclusive use of conventional cigarettes, electronic cigarettes, and dual use (ie, use of both products) among adults in the United States.Methods Analyses consider nationally representative data on 25- to 54-year-old respondents to the 2014-2016 National Health Interview Surveys (N = 50306). Demographically adjusted seemingly unrelated regression models estimate how two socioeconomic status measures-respondent education and household income-relate to current exclusive use of conventional cigarettes, electronic cigarettes, and dual use.Results Conventional cigarette use exhibits negative education and income gradients, consistent with existing research: -12.9 percentage points (confidence interval [CI]: -14.0, -11.8) if college educated, and -9.5 percentage points (CI: -10.9, -8.1) if household income exceeds 400% of the federal poverty level. These gradients are flatter for dual use (-1.4 [CI: -1.8, -0.9] and -1.9 [CI: -2.5, -1.2]), and statistically insignificant for electronic cigarette use (-0.03 [CI: -0.5, 0.4] and -0.3 [CI: -0.8, -0.2]). Limiting the sample to ever-smokers, higher education is associated with a 0.9 percentage point increase in likelihood of exclusive electronic cigarette use at interview (CI: 0.0, 1.9).Conclusions Education and income gradients in exclusive electronic cigarette use are small and statistically insignificant, contrasting with strong negative gradients in exclusive conventional cigarette use. Furthermore, more educated smokers are more likely to switch to exclusive e-cigarette use than less educated smokers. Such differential switching may exacerbate socioeconomic disparities in smoking-related morbidity and mortality, but lower the burden of tobacco-related disease.Implications Research has not yet established whether socioeconomic disparities in electronic cigarette (e-cigarette) use resemble those observed for conventional cigarettes. This article uses nationally representative data on US adults aged 25-54 to estimate income and education gradients in exclusive use of conventional cigarettes, e-cigarettes, and dual use. Both gradients are steep and negative for conventional cigarette use, but flat and statistically insignificant for e-cigarette use. Repeating the analysis among ever-smokers indicates that more educated smokers are more likely to transition toward exclusive e-cigarette use than less educated smokers. Such differential substitution may exacerbate disparities in smoking-related morbidity and mortality.