Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design
Transitions between cigarette, ENDS and dual use in adults in the PATH study (waves 1-4): multistate transition modelling accounting for complex survey design
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DOI：
10.1136/tobaccocontrol-2020-055967
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发表时间：
2022-05-01
期刊：
影响因子：
5.2
通讯作者：
Meza, Rafael
中科院分区：
文献类型：
--
作者：
Brouwer, Andrew F.;Jeon, Jihyoun;Meza, Rafael
甚至在2018年之前，电子尼古丁传递系统（ENDS）就开始极大地改变美国烟草产品的格局和产品使用模式。方法采用复杂调查设计的马尔可夫多状态过渡模型，估计了烟草与健康人口评估研究第1-4波（约2013-2017年）的23253名成年参与者从不、不吸烟、吸烟、ENDS和双重使用状态之间的过渡率。我们做了短期过渡预测，并估计了年龄、性别、种族/民族、教育程度和收入的人力资源。结果吸烟在成年人中持续存在，89.7% （95% CI 89.1%至90.3%）的独家吸烟者和86.1% （95% CI 84.4%至87.9%）的双重吸烟者在一次浪潮后仍然是香烟使用者（无论是独家还是双重）。相比之下，使用ENDS的持久性较差，在一波后，72.1% （95% CI 69.6%至74.6%）的纯ENDS使用者和50.5% （95% CI 47.8%至53.3%）的双重使用者仍然使用ENDS（有或不吸烟）。独家ENDS使用者比从不吸烟者（HR 25.2; 95% CI 20.9至30.5）或非吸烟者（HR 5.0; 95% CI 4.3至5.8）更有可能在一波后开始吸烟。ENDS和香烟双重使用者比纯香烟使用者更有可能停止吸烟（HR 1.9; 95% CI 1.6 - 2.3）。不同社会人口群体的转换率各不相同。结论：多状态过渡模型是从复杂的调查数据中发现和描述烟草使用的纵向模式和决定因素的有效工具。2018年之前，美国成年人使用终端的持续时间不如香烟。
Introduction Even prior to 2018, electronic nicotine delivery systems (ENDS) began to dramatically change the landscape of tobacco products and product use patterns in the USA. Methods Using a Markov multistate transition model accounting for complex survey design, transition rates between never, non-current, cigarette, ENDS and dual use states were estimated for 23 253 adult participants in waves 1-4 (approximately 2013-2017) of the Population Assessment of Tobacco and Health study. We made short-term transition projections and estimated HRs for age, sex, race/ethnicity, education and income. Results Cigarette use was persistent among adults, with 89.7% (95% CI 89.1% to 90.3%) of exclusive cigarette users and 86.1% (95% CI 84.4% to 87.9%) of dual users remaining cigarette users (either exclusive or dual) after one wave. In contrast, ENDS use was less persistent, with 72.1% (95% CI 69.6% to 74.6%) of exclusive ENDS users and 50.5% (95% CI 47.8% to 53.3%) of dual users remaining ENDS users (with or without cigarettes) after one wave. Exclusive ENDS users were more likely to start cigarette use after one wave than either never users (HR 25.2; 95% CI 20.9 to 30.5) or non-current users (HR 5.0; 95% CI 4.3 to 5.8). Dual users of ENDS and cigarettes were more likely to stop using cigarettes than exclusive cigarette users (HR 1.9; 95% CI 1.6 to 2.3). Transition rates varied among sociodemographic groups. Conclusions Multistate transition models are an effective tool for uncovering and characterising longitudinal patterns and determinants of tobacco use from complex survey data. ENDS use among US adults was less persistent than cigarette use prior to 2018.