Relating Onset of Health Conditions to Changes in Tobacco/Nicotine Use — Analyses based on the U.S. PATH Study *
and | Mar 13, 2023
About this article
Published Online: Mar 13, 2023
Page range: 1 - 10
Received: Oct 06, 2022
Accepted: Jan 10, 2023
DOI: https://doi.org/10.2478/cttr-2023-0001
© 2023 Peter N. Lee et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Changes in tobacco/nicotine product use between Waves 1 and 4 in relation to onset of health condition in Waves 2 or 3a. Note that initiation and quitting of cigarettes is regardless of e-cigarette use, and that initiation of e-cigarettes is regardless of smoking habits.
| Change in product use in relation to onset of health condition | OR for main analysis |
OR excluding other tobacco/nicotine product users |
OR controlling for three more variables |
|---|---|---|---|
| Any major respiratory condition | 1.11 (0.85–1.44) | 0.91 (0.65–1.27) | 1.01 (0.78–1.32) |
| Asthma | 1.14 (0.84–1.56) | 0.95 (0.63–1.43) | 1.08 (0.79–1.48) |
| Any respiratory condition | 1.05 (0.86–1.28) | 0.82 (0.63–1.07) | 0.98 (0.80–1.19) |
| Any cardiovascular condition | 1.65 (1.31–2.08) | 1.96 (1.49–2.59) | 1.61 (1.27–2.04) |
| High blood pressure | 1.34 (1.13–1.58) | 1.23 (0.99–1.52) | 1.28 (1.08–1.52) |
| High cholesterol | 1.05 (0.89–1.23) | 0.88 (0.71–1.08) | 1.03 (0.87–1.22) |
| Diabetes | 1.15 (0.95–1.38) | 1.17 (0.93–1.47) | 1.11 (0.92–1.33) |
| Cancer | 1.41 (0.96–2.05) | 1.55 (0.98–2.46) | 1.34 (0.92–1.97) |
| Any major smoking-related condition | 1.35 (1.12–1.62) | 1.51 (1.20–1.89) | 1.28 (1.06–1.54) |
| Any major respiratory condition | 0.97 (0.75–1.24) | 1.86 (1.22–2.83) | 1.07 (0.83–1.39) |
| Asthma | 0.90 (0.64–1.27) | 0.96 (0.50–1.82) | 0.96 (0.68–1.36) |
| Any respiratory condition | 1.06 (0.86–1.32) | 1.47 (1.00–2.17) | 1.16 (0.93–1.44) |
| Any cardiovascular condition | 1.16 (0.87–1.54) | 0.98 (0.56–1.74) | 1.27 (0.95–1.69) |
| High blood pressure | 1.09 (0.87–1.37) | 1.84 (1.20–2.83) | 1.16 (0.92–1.45) |
| High cholesterol | 1.29 (1.02–1.62) | 1.75 (1.17–2.62) | 1.34 (1.06–1.70) |
| Diabetes | 1.08 (0.82–1.42) | 1.37 (0.86–2.18) | 1.17 (0.89–1.54) |
| Cancer | 0.77 (0.47–1.25) | 1.38 (0.59–3.23) | 0.81 (0.50–1.33) |
| Any major smoking-related condition | 1.05 (0.84–1.30) | 1.73 (1.18–2.56) | 1.16 (0.93–1.44) |
| Any major respiratory condition | 2.86 (2.10–3.90) | 3.36 (1.76–6.42) | 2.02 (1.47–2.79) |
| Asthma | 1.57 (1.05–2.35) | 1.78 (0.75–4.22) | 1.29 (0.85–1.95) |
| Any respiratory condition | 2.08 (1.61–2.68) | 1.41 (0.71–2.83) | 1.67 (1.28–2.18) |
| Any cardiovascular condition | 1.67 (1.16–2.42) | 2.21 (1.08–4.55) | 1.42 (0.98–2.08) |
| High blood pressure | 1.55 (1.19–2.01) | 1.38 (0.74–2.57) | 1.28 (0.98–1.67) |
| High cholesterol | 1.33 (1.01–1.75) | 1.38 (0.76–2.49) | 1.33 (1.00–1.77) |
| Diabetes | 1.74 (1.31–2.32) | 2.32 (1.37–3.92) | 1.61 (1.20–2.16) |
| Cancer | 2.51 (1.52–4.14) | 3.67 (1.48–9.13) | 2.14 (1.27–3.60) |
| Any major smoking-related condition | 1.94 (1.48–2.55) | 2.61 (1.50–4.51) | 1.55 (1.17–2.06) |
Other changes in tobacco/nicotine habits between Waves 1 and 4 in relation to onset of health conditions in Waves 2 or 3 (main analyses)a.
| Health condition | ORs for change in tobacco/nicotine habits | |||||
|---|---|---|---|---|---|---|
| Re-initiating cigarettes | Initiating cigarettes in never e-cig users | Quitting cigarettes in never e-cig users | Re-initiating cigarettes in never e-cig users | Initiating e-cigarettes in never smokers | Smokers becoming dual users | |
| Any major respiratory condition | 1.22 (0.57–2.61) | 1.08 (0.83–1.41) | 0.97 (0.74–1.27) | 1.14 (0.48–2.70) | 3.36 (1.57–7.16) | 1.49 (0.98–2.27) |
| Asthma | 0.95 (0.41–2.30) | 1.15 (0.84–1.57) | 0.77 (0.52–1.14) | 0.93 (0.36–2.38) | 1.96 (0.79–4.83) | 0.65 (0.32–1.33) |
| Any respiratory condition | 0.98 (0.54–1.76) | 1.03 (0.85–1.26) | 1.06 (0.84–1.34) | 0.89 (0.45–1.76) | 1.99 (1.02–3.88) | 1.53 (1.06–2.21) |
| Any cardiovascular condition | 0.73 (0.35–1.51) | 1.64 (1.30–2.07) | 1.12 (0.82–1.52) | 0.60 (0.25–1.41) | 1.82 (0.77–4.32) | 1.42 (0.83–2.42) |
| High blood pressure | 1.17 (0.73–1.88) | 1.32 (1.11–1.57) | 0.97 (0.75–1.25) | 0.99 (0.57–1.73) | 1.33 (0.76–2.33) | 0.91 (0.58–1.42) |
| High cholesterol | 1.18 (0.76–1.84) | 1.04 (0.88–1.23) | 1.24 (0.96–1.59) | 1.29 (0.80–2.09) | 1.21 (0.65–2.25) | 1.45 (0.94–2.23) |
| Diabetes | 1.80 (1.09–2.98) | 1.14 (0.95–1.38) | 1.05 (0.78–1.41) | 2.02 (1.18–3.46) | 4.23 (2.45–7.29) | 1.02 (0.60–1.75) |
| Cancer | 0.81 (0.25–2.64) | 1.39 (0.94–2.05) | 0.66 (0.38–1.15) | 0.86 (0.24–3.12) | 2.36 (0.63–8.78) | 0.57 (0.19–1.74) |
| Any major smoking-related condition | 0.95 (0.52–1.74) | 1.33 (1.11–1.61) | 1.03 (0.81–1.31) | 0.94 (0.48–1.84) | 2.20 (1.17–4.14) | 0.95 (0.62–1.46) |
Change in amount smoked (cigs/day) between Waves 1 and 4 in relation to onset of health conditions in Waves 2 or 3.
| Health condition | Change (95% CI) |
||
|---|---|---|---|
| Additional analysis E in continuing smokers at Waves 1 and 4 | Additional analysis F in smokers at Wave 1 (allowing for quitting only) |
Additional analysis G in the whole Wave 1 population (allowing for quitting and relapse) |
|
| Any major respiratory condition | −0.29 (−1.18 to +0.60) | −0.77 (−1.69 to +0.14) | −0.36 (−0.71 to −0.02) * |
| Asthma | −0.13 (−1.38 to +1.11) | +0.08 (−1.19 to +1.34) | −0.05 (−0.51 to +0.41) |
| Any respiratory condition | +0.06 (−0.71 to +0.84) | −0.43 (−1.21 to +0.36) | −0.23 (−0.51 to +0.04) |
| Any cardiovascular condition | −2.24 (−3.31 to −1.16) *** | −2.32 (−3.40 to −1.23) *** | −0.39 (−0.73 to −0.05) * |
| High blood pressure | −1.08 (−1.94 to −0.22) * | −1.03 (−1.88 to −0.17) * | −0.13 (−0.39 to +0.14) |
| High cholesterol | −0.48 (−1.35 to +0.39) | −0.64 (−1.52 to +0.24) | −0.11 (−0.37 to +0.15) |
| Diabetes | −0.43 (−1.43 to +0.56) | −0.21 (−1.22 to +0.79) | −0.07 (−0.37 to +0.23) |
| Cancer | +0.12 (−1.63 to +1.88) | +0.37 (−1.43 to +2.18) | +0.00 (−0.61 to +0.61) |
| Any major smoking-related condition | −0.36 (−1.16 to +0.44) | −1.18 (−1.99 to −0.36) ** | −0.21 (−0.47 to +0.06) |
Comparison of original results (adjusted for sex and age group) with those avoiding reverse causation (see footnote). Results not shown for analysis or combined analysis where number of changes following onset of the condition is less than 2.
| Health condition | Tobacco/nicotine habit change | Original results | Additional analysis C | Additional analysis D | Additional analyses C + D | |
|---|---|---|---|---|---|---|
| Any major respiratory condition | Initiating smoking | OR | 1.11 (0.85–1.44) | 1.22 (0.78–1.89) | – | – |
| n | 286 | 113 | 80 | 193 | ||
| Quitting smoking | OR | 0.97 (0.75–1.24) | 0.75 (0.47–1.20) | 1.78 (1.12–2.83) | 1.16 (0.84–1.61) | |
| n | 459 | 218 | 181 | 399 | ||
| Initiating e-cigarettes | OR | 2.86 (2.10–3.90) | 3.92 (2.39–6.45) | 1.74 (0.48–6.32) | 3.53 (2.22–5.61) | |
| n | 656 | 321 | 255 | 576 | ||
| Any respiratory condition | Initiating smoking | OR | 1.05 (0.86–1.28) | 1.15 (0.82–1.60) | 1.01 (0.32–3.20) | 1.14 (0.83–1.57) |
| n | 553 | 237 | 163 | 400 | ||
| Quitting smoking | OR | 1.06 (0.86–1.32) | 0.83 (0.57–1.23) | 1.56 (1.01–2.42) | 1.09 (0.82–1.46) | |
| n | 639 | 310 | 234 | 544 | ||
| Initiating e-cigarettes | OR | 2.08 (1.61–2.68) | 2.64 (1.73–4.05) | 2.18 (0.96–4.99) | 2.54 (1.74–3.70) | |
| n | 1092 | 543 | 437 | 980 | ||
| Any cardio-vascular condition | Initiating smoking | OR | 1.65 (1.31–2.08) | 2.29 (1.63–3.22) | 0.93 (0.16–5.57) | 2.22 (1.59–3.10) |
| n | 279 | 117 | 66 | 183 | ||
| Quitting smoking | OR | 1.16 (0.87–1.54) | 0.97 (0.57–1.64) | 1.22 (0.63–2.35) | 1.06 (0.70–1.60) | |
| n | 331 | 150 | 123 | 273 | ||
| Initiating e-cigarettes | OR | 1.67 (1.16–2.42) | 1.83 (0.95–3.53) | 1.26 (0.28–5.75) | 1.72 (0.94–3.15) | |
| n | 587 | 287 | 248 | 535 | ||
| Any major smoking-related condition | Initiating smoking | OR | 1.35 (1.12–1.62) | 2.03 (1.55–2.65) | 0.95 (0.24–3.87) | 1.98 (1.52–2.57) |
| n | 521 | 219 | 139 | 358 | ||
| Quitting smoking | OR | 1.05 (0.84–1.30) | 0.79 (0.53–1.19) | 1.61 (1.05–2.49) | 1.10 (0.82–1.48) | |
| n | 606 | 286 | 227 | 513 | ||
| Initiating e-cigarettes | OR | 1.94 (1.48–2.55) | 2.22 (1.39–3.55) | 0.93 (0.26–3.42) | 2.01 (1.29–3.12) | |
| n | 1048 | 526 | 412 | 938 |
Selection of health conditions for analysis and rules used for excluding individuals for analysis.
| Health condition considered initially | Reason for excluding conditions from analyses presented | Individuals excluded on the basis of health conditions present at Wave 1 | |
|---|---|---|---|
| 1 | COPD | Not clearly distinct from 2 or 3 | – |
| 2 | Chronic bronchitis | Not clearly distinct from 1 or 3 | – |
| 3 | Emphysema | Not clearly distinct from 1 or 2 | – |
| 4 | Any major respiratory disease (i.e., conditions 1, 2 or 3) | Included | Any of 1, 2 or 3 |
| 5 | Asthma | Included | 5 only |
| 6 | Other lung/respiratory condition | Not clearly defined | – |
| 7 | Any respiratory condition (i.e. conditions 1, 2, 3, 5 or 6) | Included | Any of 1, 2, 3, 5 or 6 |
| 8 | Congestive heart failure | Few changes | – |
| 9 | Stroke | Few changes | – |
| 10 | Heart attack | Few changes | – |
| 11 | Some other heart condition | Not clearly defined | – |
| 12 | Any cardiovascular condition (i.e. conditions 8, 9, 10 or 11) | Included | Any of 8, 9, 10 or 11 |
| 13 | High blood pressure | Included | 13 only |
| 14 | High cholesterol | Included | 14 only |
| 15 | Diabetes (sugar or borderline) | Included | 15 only |
| 16 | Cancer | Included | 16 only |
| 17 | Tobacco-related cancer | Few changes | – |
| 18 | Any major smoking-related condition (i.e., conditions 4, 7 or 12) | Included | Any of 4, 7 or 12 |